WHO agrees new code on ethical recruitment of international health personnel

The World Health Organization agreed on 21 May to a new voluntary global code of practice on the ethical recruitment of international health personnel which discourages countries from actively recruiting from poor nations facing critical staff shortages.

Severe shortages in 57 poor nations pose a major threat to the performance of already resource strapped health systems and undermines the ability of these nations to achieve key health objectives, says the WHO.

The code, adopted by ministers during the annual World Health Assembly, the WHO’s supreme body, also calls for countries which recruit staff from poorer countries to fund the training of health professionals in those countries.

It also recommends countries should “facilitate circular migration of health personnel [the freedom for medical personnel who have emigrated to go back and forth without restrictions]” so that skills and knowledge achieved can benefit both source and destination countries.

Richard Sezibera, Rwanda’s minister of health, told the BMJ, “[The code is] a very good step in the right direction. It recognises the need for recipient countries, especially in the western world, to contribute to human resource development particularly in low income countries.”

The new code, hammered out after intense negotiations on the sidelines of the assembly, included strong inputs from Norway, the United Kingdom, the European Union, Brazil, the Philippines, Zambia, Kenya, South Africa, and Botswana.

Margaret Chan, WHO director-general, lauded the outcome and told delegates, “You reached agreement on some important items that are a real gift to public health everywhere. Thanks to some all-night efforts, we now have a code of practice on the international recruitment of health personnel.”

Earlier, Dr Chan had warned that the world faces a shortage of four million health personnel and she stressed that luring away health workers from their own countries with better working conditions and pay wastes training.

Manuel M Dayrit, WHO director of human resources for health and a former minister of health of the Philippines, said that all health sector stakeholders, including private and non-governmental agencies, are expected to implement the code.

Although the term financial “compensation” is not included in the code, there is an expectation that donor countries and international institutions will support poor countries for the loss of health personnel both with technical expertise and financially, he said.

The WHO is to track developments and in five years time report on the implementation of the code.

Under other business, the assembly also endorsed moves to step up global efforts in tackling the growing magnitude of non-communicable diseases—mainly cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes, which kill nearly 35 million people per year.

The assembly also adopted a new strategy for reducing the harmful use of alcohol and resolutions to stem the marketing to children of junk food and drinks high in saturated fats, trans-fatty acids, free sugars or salt, to reduce the risk of non-communicable diseases.

“This is a world in which some 43 million pre-school children are obese or overweight. Think what this means in terms of life-long risks to their health,” said Dr Chan.

It also passed a resolution calling for improvement in breastfeeding practices, which WHO estimates could save the lives of about 1 million children every year. Only 35% of children yonger than 6 months are exclusively breastfed, it says.

The assembly also adopted new guidelines on human organ and tissue transplantation that reflect the changes in medical practice by adding two guiding principles to existing guidance.

The first principle improves the level of safety, efficacy and quality of both donation and transplantation procedures, as well as human materials used, and stresses these measures must be maintained and optimised on an ongoing basis. This requires implementation of quality systems including traceability and vigilance, with adverse events and reactions reported, both nationally and for exported human products.

The second principle increases transparency, while ensuring the protection of the anonymity and privacy of donors and recipients are always protected.