Empirically evaluating the WHO global code of practice on the international recruitment of health personnel’s impact on four high-income countries four years after adoption

Abstract

BackgroundShortages of health workers in low-income countries are exacerbated by the international migration of health workers to more affluent countries. This problem is compounded by the active recruitment of health workers by destination countries, particularly Australia, Canada, UK and USA. The World Health Organization (WHO) adopted a voluntary Code of Practice in May 2010 to mitigate tensions between health workers’ right to migrate and the shortage of health workers in source countries. The first empirical impact evaluation of this Code was conducted 11-months after its adoption and demonstrated a lack of impact on health workforce recruitment policy and practice in the short-term. This second empirical impact evaluation was conducted 4-years post-adoption using the same methodology to determine whether there have been any changes in the perceived utility, applicability, and implementation of the Code in the medium-term.MethodsForty-four respondents representing government, civil society and the private sector from Australia, Canada, UK and USA completed an email-based survey evaluating their awareness of the Code, perceived impact, changes to policy or recruitment practices resulting from the Code, and the effectiveness of non-binding Codes generally. The same survey instrument from the original study was used to facilitate direct comparability of responses. Key lessons were identified through thematic analysis.ResultsThe main findings between the initial impact evaluation and the current one are unchanged. Both sets of key informants reported no significant policy or regulatory changes to health worker recruitment in their countries as a direct result of the Code due to its lack of incentives, institutional mechanisms and interest mobilizers. Participants emphasized the existence of previous bilateral and regional Codes, the WHO Code’s non-binding nature, and the primacy of competing domestic healthcare priorities in explaining this perceived lack of impact.ConclusionsThe Code has probably still not produced the tangible improvements in health worker flows it aspired to achieve. Several actions, including a focus on developing bilateral codes, linking the Code to topical global priorities, and reframing the Code’s purpose to emphasize health system sustainability, are proposed to improve the Code’s uptake and impact.

Doctors on the move: a qualitative study on the driving factors in a group of Egyptian physicians migrating to Germany

“…This migration pattern has been named in the literature the “medical carousel phenomenon”, a term which evokes the impression that all stops are equal, which is actually not the case [11, 12]. The World Health Organisation (WHO) issued a Global Code of Practice in 2010 to mitigate the impact of health profession migration on health care delivery; however this has had little effect on migration practices [13].…”

The Ethical Significance of Migrating Health Professionals’ Legitimate Expectations: Canadian and Australian Pathways to Nowhere?

“…Acta Psychologica,47(2), 143-148. Tam, V., Edge, J., & Hoffman, S. (2016). Empirically evaluating the WHO global code of practice on the international recruitment of health personnel's impact on four high-income countries four years after adoption.…”

“…It is notable that ethical guidelines such as those represented in the Code have in the past been seen by critical reviewers to be abstract, rigid, and ineffective, and to lack grounding and support within a sustainable governance regime Willets & Martineau, 2004). Research studies conducted since the Code's implementation tend to bear out these concerns Tam, Edge, & Hoffman, 2016).…”

“…At subnational institutional levels in both source and destination countries there are many interests represented, both directly and indirectly, in recruitment regimes, and a distinct lack of awareness of the Code has been noted at this level Tam et al, 2016). Health agencies and facilities in destination countries are directly responsible for the planning and execution of international health personnel recruitment practices in an institutional environment in which many different, competing, and often conflicting official and unofficial, formal and informal obligations, commitments and loyalties operate within and between institutions (Ransome & Sampford, 2012, pp.…”

Canada's global health role: supporting equity and global citizenship as a middle power

“…50 The continued supply of foreign-trained clinicians is an assumed factor in Canadian health-care planning initiatives, exacerbating rather than challenging inequities, 51 and there is little evidence of Canada's uptake of the WHO Global Code of Practice on the International Recruitment of Health Personnel that is meant to mitigate harms produced by this long-standing practice of brain drain. 52,53 Globalisation Health equity Transnational risks…”