SUU, Alm.del - 2010-11 (1. samling) - Bilag 197: Orientering om WHO's etiske kodeks for international rekruttering

WHO Global Code of Practice on the InternationalRecruitment of Health PersonnelThe Sixty-third World Health Assembly,Having considered the revised draft global code of practice on the international recruitment ofhealth personnel, annexed to the report by the Secretariat on the international recruitment of healthpersonnel: draft global code of practice,11.ADOPTS, in accordance with Article 23 of the Constitution, the WHO Global Code of Practiceon the International Recruitment of Health Personnel;2.DECIDES that the first review of the relevance and effectiveness of the WHO Global Code ofPractice on the International Recruitment of Health Personnel shall be made by the Sixty-eighth WorldHealth Assembly;3.REQUESTS the Director-General:(1) to give all possible support to Member States, as and when requested, for theimplementation of the WHO Global Code of Practice on the International Recruitment of HealthPersonnel;(2) to cooperate with all stakeholders concerned with the implementation and monitoring ofthe WHO Global Code of Practice on the International Recruitment of Health Personnel;(3) to rapidly develop, in consultation with Member States, guidelines for minimum data sets,information exchange and reporting on the implementation of the WHO Global Code ofPractice on the International Recruitment of Health Personnel;(4) based upon periodic reporting, to make proposals, if necessary, for the revision of the textof the WHO Global Code of Practice on the International Recruitment of Health Personnel inline with the first review, and for measures needed for its effective application.

PreambleThe Member States of the World Health Organization:Recalling resolution WHA57.19 in which the World Health Assembly requested the Director-General to develop a voluntary code of practice on the international recruitment of health personnel inconsultation with all relevant partners;Responding to the calls of the Kampala Declaration adopted at the First Global Forum onHuman Resources for Health (Kampala, 2–7 March 2008) and the G8 communiqués of 2008 and 2009encouraging WHO to accelerate the development and adoption of a code of practice;Conscious of the global shortage of health personnel and recognizing that an adequate andaccessible health workforce is fundamental to an integrated and effective health system and for theprovision of health services;Deeply concerned that the severe shortage of health personnel, including highly educated andtrained health personnel, in many Member States, constitutes a major threat to the performance ofhealth systems and undermines the ability of these countries to achieve the Millennium DevelopmentGoals and other internationally agreed development goals;Stressing that the WHO global code of practice on the international recruitment of healthpersonnel be a core component of bilateral, national, regional and global responses to the challenges ofhealth personnel migration and health systems strengthening;THEREFORE:The Member States hereby agree on the following articles which are recommended as a basisfor action.Article 1 – ObjectivesThe objectives of this Code are:(1) to establish and promote voluntary principles and practices for the ethical internationalrecruitment of health personnel, taking into account the rights, obligations and expectations ofsource countries, destination countries and migrant health personnel;(2) to serve as a reference for Member States in establishing or improving the legal andinstitutional framework required for the international recruitment of health personnel;(3) to provide guidance that may be used where appropriate in the formulation andimplementation of bilateral agreements and other international legal instruments;

(4) to facilitate and promote international discussion and advance cooperation on mattersrelated to the ethical international recruitment of health personnel as part of strengthening healthsystems, with a particular focus on the situation of developing countries.Article 2 – Nature and scope2.1 The Code is voluntary. Member States and other stakeholders are strongly encouraged to use theCode.2.2 The Code is global in scope and is intended as a guide for Member States, working togetherwith stakeholders such as health personnel, recruiters, employers, health-professional organizations,relevant subregional, regional and global organizations, whether public or private sector, includingnongovernmental, and all persons concerned with the international recruitment of health personnel.2.3 The Code provides ethical principles applicable to the international recruitment of healthpersonnel in a manner that strengthens the health systems of developing countries, countries witheconomies in transition and small island states.Article 3 – Guiding principles3.1 The health of all people is fundamental to the attainment of peace and security and is dependentupon the fullest cooperation of individuals and states. Governments have a responsibility for the healthof their people, which can be fulfilled only by the provision of adequate health and social measures.Member States should take the Code into account when developing their national health policies andcooperating with each other, as appropriate.3.2 Addressing present and expected shortages in the health workforce is crucial to protectingglobal health. International migration of health personnel can make a sound contribution to thedevelopment and strengthening of health systems, if recruitment is properly managed. However, thesetting of voluntary international principles and the coordination of national policies on internationalhealth personnel recruitment are desirable in order to advance frameworks to equitably strengthenhealth systems worldwide, to mitigate the negative effects of health personnel migration on the healthsystems of developing countries and to safeguard the rights of health personnel.3.3 The specific needs and special circumstances of countries, especially those developing countriesand countries with economies in transition that are particularly vulnerable to health workforceshortages and/or have limited capacity to implement the recommendations of this Code, should beconsidered. Developed countries should, to the extent possible, provide technical and financialassistance to developing countries and countries with economies in transition aimed at strengtheninghealth systems, including health personnel development.3.4 Member States should take into account the right to the highest attainable standard of health ofthe populations of source countries, individual rights of health personnel to leave any country inaccordance with applicable laws, in order to mitigate the negative effects and maximize the positiveeffects of migration on the health systems of the source countries. However, nothing in this Codeshould be interpreted as limiting the freedom of health personnel, in accordance with applicable laws,to migrate to countries that wish to admit and employ them.3.5 International recruitment of health personnel should be conducted in accordance with theprinciples of transparency, fairness and promotion of sustainability of health systems in developing

countries. Member States, in conformity with national legislation and applicable international legalinstruments to which they are a party, should promote and respect fair labour practices for all healthpersonnel. All aspects of the employment and treatment of migrant health personnel should be withoutunlawful distinction of any kind.3.6 Member States should strive, to the extent possible, to create a sustainable health workforce andwork towards establishing effective health workforce planning, education and training, and retentionstrategies that will reduce their need to recruit migrant health personnel. Policies and measures tostrengthen the health workforce should be appropriate for the specific conditions of each country andshould be integrated within national development programmes.3.7 Effective gathering of national and international data, research and sharing of information oninternational recruitment of health personnel are needed to achieve the objectives of this Code.3.8 Member States should facilitate circular migration of health personnel, so that skills andknowledge can be achieved to the benefit of both source and destination countries.Article 4 – Responsibilities, rights and recruitment practices4.1. Health personnel, health professional organizations, professional councils and recruiters shouldseek to cooperate fully with regulators, national and local authorities in the interests of patients, healthsystems, and of society in general.4.2 Recruiters and employers should, to the extent possible, be aware of and consider theoutstanding legal responsibility of health personnel to the health system of their own country such as afair and reasonable contract of service and not seek to recruit them. Health personnel should be openand transparent about any contractual obligations they may have.4.3 Member States and other stakeholders should recognize that ethical international recruitmentpractices provide health personnel with the opportunity to assess the benefits and risks associated withemployment positions and to make timely and informed decisions.4.4 Member States should, to the extent possible, under applicable laws, ensure that recruiters andemployers observe fair and just recruitment and contractual practices in the employment of migranthealth personnel and that migrant health personnel are not subject to illegal or fraudulent conduct.Migrant health personnel should be hired, promoted and remunerated based on objective criteria, suchas levels of qualification, years of experience and degrees of professional responsibility on the basis ofequality of treatment with the domestically trained health workforce. Recruiters and employers shouldprovide migrant health personnel with relevant and accurate information about all health personnelpositions that they are offered.4.5 Member States should ensure that, subject to applicable laws, including relevant internationallegal instruments to which they are a party, migrant health personnel enjoy the same legal rights andresponsibilities as the domestically trained health workforce in all terms of employment andconditions of work.4.6 Member States and other stakeholders should take measures to ensure that migrant healthpersonnel enjoy opportunities and incentives to strengthen their professional education, qualificationsand career progression, on the basis of equal treatment with the domestically trained health workforcesubject to applicable laws. All migrant health personnel should be offered appropriate induction and

orientation programmes that enable them to operate safely and effectively within the health system ofthe destination country.4.7Recruiters and employers should understand that the Code applies equally to those recruited towork on a temporary or permanent basis.Article 5 – Health workforce development and health systems sustainability5.1 In accordance with the guiding principle as stated in Article 3 of this Code, the health systemsof both source and destination countries should derive benefits from the international migration ofhealth personnel. Destination countries are encouraged to collaborate with source countries to sustainand promote health human resource development and training as appropriate. Member States shoulddiscourage active recruitment of health personnel from developing countries facing critical shortagesof health workers.5.2 Member States should use this Code as a guide when entering into bilateral, and/or regionaland/or multilateral arrangements, to promote international cooperation and coordination oninternational recruitment of health personnel. Such arrangements should take into account the needs ofdeveloping countries and countries with economies in transition through the adoption of appropriatemeasures. Such measures may include the provision of effective and appropriate technical assistance,support for health personnel retention, social and professional recognition of health personnel, supportfor training in source countries that is appropriate for the disease profile of such countries, twinning ofhealth facilities, support for capacity building in the development of appropriate regulatoryframeworks, access to specialized training, technology and skills transfers, and the support of returnmigration, whether temporary or permanent.5.3 Member States should recognize the value both to their health systems and to health personnelthemselves of professional exchanges between countries and of opportunities to work and train abroad.Member States in both source and destination countries should encourage and support healthpersonnel to utilize work experience gained abroad for the benefit of their home country.5.4 As the health workforce is central to sustainable health systems, Member States should takeeffective measures to educate, retain and sustain a health workforce that is appropriate for the specificconditions of each country, including areas of greatest need, and is built upon an evidence-basedhealth workforce plan. All Member States should strive to meet their health personnel needs with theirown human resources for health, as far as possible.5.5 Member States should consider strengthening educational institutions to scale up the training ofhealth personnel and developing innovative curricula to address current health needs. Member Statesshould undertake steps to ensure that appropriate training takes place in the public and private sectors.5.6 Member States should consider adopting and implementing effective measures aimed atstrengthening health systems, continuous monitoring of the health labour market, and coordinationamong all stakeholders in order to develop and retain a sustainable health workforce responsive totheir population’s health needs. Member States should adopt a multisectoral approach to addressingthese issues in national health and development policies.5.7 Member States should consider adopting measures to address the geographical maldistributionof health workers and to support their retention in underserved areas, such as through the applicationof education measures, financial incentives, regulatory measures, social and professional support.

Article 6 – Data gathering and research6.1 Member States should recognize that the formulation of effective policies and plans on thehealth workforce requires a sound evidence base.6.2 Taking into account characteristics of national health systems, Member States are encouraged toestablish or strengthen and maintain, as appropriate, health personnel information systems, includinghealth personnel migration, and its impact on health systems. Member States are encouraged tocollect, analyse and translate data into effective health workforce policies and planning.6.3 Member States are encouraged to establish or strengthen research programmes in the field ofhealth personnel migration and coordinate such research programmes through partnerships at thenational, subnational, regional and international levels.6.4 WHO, in collaboration with relevant international organizations and Member States, isencouraged to ensure, as much as possible, that comparable and reliable data are generated andcollected pursuant to paragraphs 6.2 and 6.3 for ongoing monitoring, analysis and policy formulation.Article 7 – Information exchange7.1 Member States are encouraged to, as appropriate and subject to national law, promote theestablishment or strengthening of information exchange on international health personnel migrationand health systems, nationally and internationally, through public agencies, academic and researchinstitutions, health professional organizations, and subregional, regional and internationalorganizations, whether governmental or nongovernmental.7.2 In order to promote and facilitate the exchange of information that is relevant to this Code, eachMember State should, to the extent possible:(a) progressively establish and maintain an updated database of laws and regulations relatedto health personnel recruitment and migration and, as appropriate, information about theirimplementation;(b) progressively establish and maintain updated data from health personnel informationsystems in accordance with Article 6.2; and(c) provide data collected pursuant to subparagraphs (a) and (b) above to the WHOSecretariat every three years, beginning with an initial data report within two years after theadoption of the Code by the Health Assembly.7.3 For purposes of international communication, each Member State should, as appropriate,designate a national authority responsible for the exchange of information regarding health personnelmigration and the implementation of the Code. Member States so designating such an authority,should inform WHO. The designated national authority should be authorized to communicate directlyor, as provided by national law or regulations, with designated national authorities of other MemberStates and with the WHO Secretariat and other regional and international organizations concerned, andto submit reports and other information to the WHO Secretariat pursuant to subparagraph 7.2(c) andArticle 9.1.

8.3 Member States are encouraged to consult, as appropriate, with all stakeholders as stipulated inArticle 2.2 in decision-making processes and involve them in other activities related to theinternational recruitment of health personnel.8.4 All stakeholders referred to in Article 2.2 should strive to work individually and collectively toachieve the objectives of this Code. All stakeholders should observe this Code, irrespective of thecapacity of others to observe the Code. Recruiters and employers should cooperate fully in theobservance of the Code and promote the guiding principles expressed by the Code, irrespective of aMember State’s ability to implement the Code.8.5 Member States should, to the extent possible, and according to legal responsibilities, workingwith relevant stakeholders, maintain a record, updated at regular intervals, of all recruiters authorizedby competent authorities to operate within their jurisdiction.8.6 Member States should, to the extent possible, encourage and promote good practices amongrecruitment agencies by only using those agencies that comply with the guiding principles of the Code.8.7 Member States are encouraged to observe and assess the magnitude of active internationalrecruitment of health personnel from countries facing critical shortage of health personnel, and assessthe scope and impact of circular migration.Article 9 – Monitoring and institutional arrangements9.1 Member States should periodically report the measures taken, results achieved, difficultiesencountered and lessons learnt into a single report in conjunction with the provisions of Article 7.2(c).9.2 The Director-General shall keep under review the implementation of this Code, on the basis ofperiodic reports received from designated national authorities pursuant to Articles 7.3 and 9.1 andother competent sources, and periodically report to the World Health Assembly on the effectiveness ofthe Code in achieving its stated objectives and suggestions for its improvement. This report would besubmitted in conjunction with Article 7.2(c).9.3The Director-General shall:(a) support the information exchange system and the network of designated nationalauthorities specified in Article 7;(b) develop guidelines and make recommendations on practices and procedures and suchjoint programmes and measures as specified by the Code; and

(c) maintain liaison with the United Nations, the International Labour Organization, theInternational Organization for Migration, and other competent regional and internationalorganizations as well as concerned nongovernmental organizations to support implementation ofthe Code.9.4 WHO Secretariat may consider reports from stakeholders as stipulated in Article 2.2 onactivities related to the implementation of the Code.9.5 The World Health Assembly should periodically review the relevance and effectiveness of theCode. The Code should be considered a dynamic text that should be brought up to date as required.Article 10 – Partnerships, technical collaboration and financial support10.1 Member States and other stakeholders should collaborate directly or through competentinternational bodies to strengthen their capacity to implement the objectives of the Code.10.2 International organizations, international donor agencies, financial and development institutions,and other relevant organizations are encouraged to provide their technical and financial support toassist the implementation of this Code and support health system strengthening in developingcountries and countries with economies in transition that are experiencing critical health workforceshortages and/or have limited capacity to implement the objectives of this Code. Such organizationsand other entities should be encouraged to cooperate with countries facing critical shortages of healthworkers and undertake to ensure that funds provided for disease-specific interventions are used tostrengthen health systems capacity, including health personnel development.10.3 Member States either on their own or via their engagement with national and regionalorganizations, donor organizations and other relevant bodies should be encouraged to providetechnical assistance and financial support to developing countries or countries with economies intransition, aiming at strengthening health systems capacity, including health personnel development inthose countries.