LEADERS from the international health sector are drafting a code of practice that will offer morally binding standards for developed nations that recruit health workers from developing countries like Uganda. The effort, which has come as brain drain continues to devastate health systems in poor coun
By Raymond Baguma
and Anne Mugisa
LEADERS from the international health sector are drafting a code of practice that will offer morally binding standards for developed nations that recruit health workers from developing countries like Uganda. The effort, which has come as brain drain continues to devastate health systems in poor countries, is being led by the World Health Organisation (WHO) and Realising Rights, a US-based NGO.
The Global Health Workforce Alliance (GHWA), a coalition of organisations that held an international forum in Kampala last week, is also a partner.
Peggy Clark, the director of Realising Rights, says the code is a statement of principles setting standards.
The code is considered a â€œsoft law,â€ meaning it will not be legally binding.
It seeks to recognise the right to migrate for greener pastures, but balance it with the need for health workers in the countries they leave, Clark says.
Prof. Francis Omaswa, the outgoing director of GHWA, says the code will be discussed and presented for adoption during the World Health Assembly next year.
Sceptics doubt that the code will make any difference given the economic circumstances forcing health workers to leave poor countries.
Even if governments adopt the voluntary code, foreign job recruitment agencies will not follow it and will keep recruiting, they say. They argue that the only solution to brain drain from poor countries is to pay health workers better salaries.
Prof. Brook Baker, a policy analyst with the Health Global Access Project, agreed, saying the proposed code works on the margin of the problem.
â€œPeople used to be taken on ships from Africa to work on farms in America. Now they are being taken on planes.
â€œIt is a forced choice for health workers to go to the UK or the US. To talk of an ethical code is to rule on what kind of ship you go on,â€ he adds.
According to Prof. Baker, the International Monetary Fund policies decimated the health system in Africa in the 1980s.
â€œWe need to improve conditions so that health workers will have a choice. I have talked to health workers in Africa who would prefer to stay to save the lives in communities, maintain family ties rather than go to a cold, dark place in North America.â€
However, Prof. Fitzhugh Mullan of George Washington University explains that it is common sense that highly-trained people from poor countries migrate to where their greatest opportunities exist in developed countries. The code was mentioned during the recent first Global Forum on Human Resources for Health in Kampala.
Proponents did not give details of the code but clues about what it may say can be found in the 2003 Commonwealth Code of Practice for International Recruitment of Health Workers.
The code calls for â€œethical recruitmentâ€ in which both recruiting countries and countries that lose health professionals sign a memorandum of understanding spelling out their obligations for each other.
It adds that there should be transparency, with no targeted recruitment, with each side explaining their intentions and activities for each other.
The code also suggests that recruiting countries should seek self-sufficiency in meeting their health workforce needs and consider helping source countries meet their own manpower needs.
It discourages recruitment of health workers from countries experiencing shortages.
Other provisions might involve respecting the rights of recruits and suggest that source countries should benefit from skills acquired by their health workers who migrate.
Norway is often cited as a model of â€œethical recruitment.â€
In April 2007, it committed itself, to reduce the number of migrant health workers by pursuing a policy of self-sufficiency for itself while providing development assistance to strengthen health systems in poor countries.
Another possible model is a memorandum of understanding between the UK and South Africa.
After it was signed in 2003, registration of South African nurses and midwives in the UK dropped from 24.6% of practitioners from non-EU countries, to 4.4%.
Mary Robinson, a co-author of a February article in The Lancet, a British medical journal, says the most promising policy efforts and bilateral agreements are not those that try to limit recruitment from selected countries.
According to Robinson, policies that promote development assistance and support to strengthen source country health systems and workforces, enable health workers to return to their home countries to train and teach, and forge partnerships between hospitals in source countries and recruiting countries, are more promising.
But that does not satisfy critics. Rotimi Santore, the director of Africa Public Health Right Alliance, says: â€œTo talk of ethics is phoney. It is like shadow boxing, where you throw a lot of punches and hit nothing. You cannot have a code of ethics. Instead, you have to reverse the conditions that cause the problem of migration.â€
A 30-member advisory council chaired by Robinson and Prof. Omaswa, together with a technical working group, will make recommendations to WHO and member states to guide discussions on drafting a framework for the code.
The three participating organisations under an umbrella called the Health Worker Migration Policy Initiative, will consult and gather feedback from policymakers and workers from the six regions of WHO. These are Asia-Pacific, Europe, Africa, Latin America, Middle East and South-East Asia.
An online global dialogue will be launched on March 31, to enable health professionals share knowledge, access experts, and gain support on issues surrounding health worker migration.
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