Analysis

Challenges for WHO code on international recruitment

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c1486 (Published 29 March 2010) Cite this as: BMJ 2010;340:c1486
  1. James Buchan, professor
  1. 1Queen Margaret University, Edinburgh
  1. jbuchan{at}qmu.ac.uk

    A global code on international recruitment will have sustained impact only if its signatories support monitoring and also tackle the related issues of workforce planning and retention, says James Buchan

    Earlier this year the executive board of the World Health Organization decided that a draft global code on international recruitment of health workers1 will be on the agenda of the World Health Assembly in May 2010. The code will have implications for any country that recruits doctors and other health workers from abroad. It followed a resolution at the World Health Assembly in 2004 (WHA 57.19) that highlighted concerns about the negative effects of out-migration on the health systems of some developing countries. This article examines how the code has been developed and assesses some of the difficulties of implementation.

    Why have a code?

    In 2006 WHO estimated that there was a shortage of almost 4.3 million doctors, midwives, nurses, and health support workers worldwide.2 The availability of health professionals varies widely, with developing countries in Africa and Asia having low ratios of staff to population (fig 1). Migration of health professionals from developing to developed countries has exacerbated this disparity.

    Fig 1 No of doctors/1000 population in selected countries, 2007 (or most recent year)3

    The debate about the effect of health worker migration on the health systems of developing countries has moved on from an oversimplistic “brain drain” argument, to a recognition of a more nuanced and complex picture.4 5 6 7 However, the argument that we need a more ethical approach to international recruitment that can mitigate any negative effects continues to resonate and has been a driving force in the development of the draft code. Media reports, articles, and online chat rooms continue to spotlight examples of “unethical” recruitment practice.8 9

    Recognition has also been …

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