developing the who global code of practice on the ... · developing the who global code of practice...
TRANSCRIPT
Pascal Zurn
1
Developing the WHO Global Code of Practice on the International Recruitment of Health Personnel “The Code” ‐ a history of dialogue to adoption The numbers of migrating health workers have significantly increased in recent decades, with patterns of migration becoming more complicated and involving more countries. While migration of health personnel can bring mutual benefits to both source and destination countries, it can raise various concerns for countries already experiencing various challenges in developing their health workforce as it may further weaken already fragile health systems. In order to provide a global response, in 2004 the World Health Assembly adopted Resolution WHA57.19, which “requests the Director‐General to develop a code of practice on the international recruitment of health personnel, in consultation with Member States and all relevant partners”. Insofar as its legal status, the resolution specifically indicated that such a Code would be a non‐binding instrument. It is critical to note that the discussions on international health worker migration were very polarized, further bearing considerable debate and little agreement on the exact scope of international health worker migration, and whether consensus could ever be achieved on such a proposed WHO Code. In particular, there was strong divergence among countries on how to balance the interests of source and destination countries in the WHO Code. The WHO Secretariat developed a comprehensive programme on the issue of health worker migration, in particular on the development of a WHO code of practice on the international recruitment of health personnel. This programme of work combined both work to improve information on the nature and scope of international health worker migration, and collaboration with various stakeholders to advance and advocate for the development of the WHO Code. To support WHO in developing a code of practice, a multi‐stakeholder process, the Health Worker Migration Policy Initiative, was established. This initiative comprises: (i) a Migration Policy Advisory Council, led by the Global Health Workforce Alliance, and a nongovernmental organization, Realizing Rights: the Ethical Global Initiative, and (ii) a WHO‐led Technical Working Group. Following consideration of the development of the proposed code in several global fora, including the First Global Forum on Human Resources for Health held in Kampala, Uganda in March 2008 and the G8 Summit held in Tokyo, Japan in July 2008, the Secretariat prepared a first draft of a WHO code of practice in August 2008. The first draft was predominantly built upon global agreements and declarations, as well as the collaborative work of the Health Worker Migration Policy Initiative. The draft evolved and pivoted on a review and lessons learned from precedent initiatives to address international health worker recruitment concerns on a country‐by‐country, multilateral, and transnational basis, including a number of international non‐binding instruments aimed at tackling the challenges associated with international health worker recruitment. On 1 September 2008, the Secretariat launched a global, web‐based, five‐weeks public hearing on the first draft of a WHO code of practice. In parallel, informal discussions on health worker migration and on the development of a WHO code of practice were taking place at the WHO Regional Committees of
Pascal Zurn
2
the European Region, South‐East Asia Region and Western Pacific Region. The Secretariat revised the text and prepared a draft code of practice in light of the comments received from the public hearings and regional consultations. In October 2008, a dialogue on health worker migration, jointly organized by the World Health Organization (WHO) and the Organization for Economic Co‐operation and Development (OECD) allowed to provide a detailed picture of the magnitude of international health workers migration. At WHO headquarters, a progress report was prepared and the revised draft code of practice were presented to the 124th Executive Board (EB) session in January 2009. Member States expressed appreciation to the WHO Secretariat for the work done in preparing a draft code of practice and recommended that more consultations and effective participation by Member States was essential to finalize and adopt a code. It was agreed that the Secretariat should prepare a Technical Briefing for the May 2009 World Health Assembly as well as a background paper on the development of a code of practice to support future national, regional and global consultations. Accordingly, a series of national, regional and international meetings were held to discuss issues related to the code in preparation for WHO Regional Committee sessions in the autumn of that year. Meanwhile, G8 countries meeting in L’Aquila, Italy and the Ministerial Declaration of the 2009 meeting of the United Nations Economic and Social Council urged WHO to finalize the code of practice. In January 2010, the draft Code was once again before the WHO Executive Board. While some Member States expressed disagreement with aspects of the draft text, or proposed mechanisms for improvement, it was unanimously agreed that the draft Code was a good basis for negotiation and should be forwarded to the May 2010 World Health Assembly for negotiation and possible adoption. The Sixty‐Third World Health Assembly, on its opening day, May 17, 2010, established a “drafting committee” open to all Member States to negotiate the text of the Code of Practice that had been forwarded by the January 2010 Executive Board. The final text of the WHO Global Code was negotiated in this closed drafting group, who met over three days during the May 2010 World Health Assembly, including a final negotiating session lasting until 4:30 AM on Thursday, May 20, 2010. Triumphantly, the WHO Global Code of Practice on the International Recruitment of Health Personnel was formally adopted by the 193 Member States of the Sixty‐third World Health Assembly on 21 May 2010. This was the second time in the Organization’s history that WHO Member States have used the constitutional authority of the Organization to develop a code; the only other code to be agreed upon was the International Code of Marketing of Breast‐milk Substitutes in 1981. Attachments:
Extracts (Equinet discussion paper 50 ‐ 2007)
Extracts (A guidebook on bilateral agreements to address health worker migration 2010)
Extracts (Selected European and international instruments – European Observatory 2014)
A review of codes and protocols for the
migration of health workers
Catherine Pagett and Ashnie Padarath
Health Systems Trust (South Africa)
The Regional Network for Equity in Health in east and
southern Africa (EQUINET) with the Health Systems Trust
And in co-operation with
the East, Central and Southern African Health Community
(ECSA-HC)
EQUINET DISCUSSION PAPER 50
September 2007
with support from SIDA (Sweden)
25
• access to grievance procedures • freedom from discrimination • regulation of recruitment. Lastly, the ICN states that the credibility, strength and universality of these principles will directly depend on the political will of health sector stakeholders and the regulatory mechanisms introduced for their application and monitoring (ICN, 2002). 3.6.8 World Medical Association Statement on Ethical Guidelines for the International Recruitment of Physicians The World Medical Association (WMA) statement on the Ethical Guidelines for the International Recruitment of Physicians was adopted by the WMA General Assembly in Helsinki, Finland, in May 2003. The statement recognises the physician’s valid reasons for migrating to developed countries but also recognises the impact that movement has on developing source countries. The impact is further exacerbated by active recruitment of health workers in the developing world, which is a direct outcome of poor human resource planning in developed world. The WMA recognises an ethical dimension to the issue of health worker migration exists and as a result has developed a statement to guide national medical associations and policy makers on the recruitment of health professionals (WMA, 2003). The guidelines are framed by three ethical principles: justice, co-operation and autonomy. These ethical guidelines provide the underlying principles of equity of resources, bi-and multilateral co-operation and individual rights, respectively. The WMA recommendations urge countries to do their utmost to ensure proper human resource planning and to not rely on immigration for health professionals. All forms of recruitment should be done within an existing Memorandum of Understanding between the two countries and nothing should interfere with countries entering into this agreement (WMA, 2003). Table 8 summarises all the instruments discussed in Section 3.
Table 8: Summary of instruments discussed in Section 3
Instrument Scope Legal status
Countries covered
GATS – Health Services Modes 1-4
The GATS agreement administered by the World Trade Organisation (WTO) was adopted in 1995. It aims to liberalise trade in services by encouraging the privatisation of health services and an open market for trade. The agreement covers four modes of supply which govern the provision of health services internationally. These are: • Mode 1: Cross-border supply • Mode 2: Consumption Abroad • Mode 3: Commercial Presence • Mode 4: Temporary Movement of
Natural Persons
Legally binding
ESA countries include Burundi, Malawi, Swaziland and Zambia
NHS Code of Practice for the International
The NHS Code of Practice applies to the employees and employers of the NHS, as well as:
Voluntary and legally
United Kingdom and Northern Ireland
26
Instrument Scope Legal status
Countries covered
Recruitment of Health Workers
• agency-recruited temporary and locum healthcare professionals;
• enabling all healthcare organisations to sign-up to the principles; and
• mandating the NHS to deal only with recruitment agencies that comply with the Code of Practice for both domestic and international recruitment.
The NHS Code of Practice manages the recruitment of domestic and international workers into the NHS. The Code sets out principles and best practice benchmarks that manage the rights of recruitment workers and that forbid the active recruitment of health professionals from developing countries without an existing bi-lateral agreement.
non-binding
Commonwealth Code for the International Recruitment of Health Care Workers
The Commonwealth Code was signed by 21 countries in attendance at the pre-World Health Assembly Meeting in May 2003 and, through the principles of co-operation and consensus, the Code is accepted by all Commonwealth countries. However, this does not mean the countries have implemented the Code. The Code seeks to establish a framework that balances the responsibilities of the health workers to their country of origin and the rights of the health workers to seek employment in other countries.
Voluntary and legally non-binding
Common-wealth countries
Melbourne Manifesto
The Melbourne Manifesto was signed by the membership of the Wonca organisation at the Wonca World Rural Health Conference in 2002. The Melbourne Manifesto focuses on the retention and prevention of health workers through various workforce-planning strategies. The Code encourages both source and receiving countries to ensure rational workforce planning and, if international recruitment is necessary, Memoranda of Understanding or exchanges between the two countries should be implemented.
Voluntary and legally non-binding
Adopted by the Wonca membership and implemented by various government-supported recruitment organisations within Australia
Memorandum of Understanding between Namibia and Kenya on Technical
The Ministry of Health and Social Services of the Government of Namibia and the Ministry of Health of the Government of the Republic of Kenya agreed to a Memorandum of Understanding on Technical Cooperation in Health in June
Legally binding
Kenya and Namibia
27
Instrument Scope Legal status
Countries covered
Cooperation in Health
2004. The agreement provides guidelines for the temporary movement of health workers from Kenya to Namibia, outlining the rights and responsibilities of the health workers and government bodies.
SADC Protocol on the Facilitation of Movement of Persons
The overall objective of this protocol is to eliminate the obstacles to the movement of persons with in the Southern African Development Community.
Legally binding
SADC: Angola, Botswana, Democratic Republic of Congo, Lesotho, Madagascar (membership pending), Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Swaziland, Tanzania, Zambia and Zimbabwe
NEPAD Health Strategy
The New Partnership for Africa’s Development (NEPAD) health strategy has been adopted by African Ministers and the AU. It seeks to "establish or strengthen health systems and services so they can provide effective and equitable health care" (NEPAD, 2003). NEPAD identifies six sectors as priorities for achieving the goals of the health strategy, which includes focusing on human resources development aiming to reverse the brain drain as a major priority. The health strategy focuses on retention and migration strategies to mitigate the affects of health worker attrition.
No status African Union
Southern African Ministers 2001 Statement
The Southern African Health Ministers met on 9 June 2001 met in Centurion, Pretoria to renew their concern about the active recruitment of health professionals from their countries by developed countries. The Health Ministers issued a strongly worded statement, noting that recruitment by developed countries is an indication of poor planning for their human resource
No status SADC
28
Instrument Scope Legal status
Countries covered
needs and that recruitment could be seen as ‘looting from these countries and is similar to that experienced during periods of colonisation when all resources, including minerals, were looted to industrialised countries’ (SADC, 2001).
East, Central and Southern African Health Community (ECSA)
Resolutions of ECSA Health Community focus on workforce planning and retention of health workers in the region.
No status ECSA countries
WHO AFRO: Human Resources Development for Health: Accelerating Implementation of the Regional Strategy
The WHO Regional Committee for Africa prepared this paper for discussion at the 52nd Session of the WHO Regional Committee for Africa in 2002. The paper proposed six priority areas in human resource development for countries to take action on in addressing country-specific realities (WHO-AFRO, 2006a). The six priority areas are: • human resource policy; • education, training and skills
development; • human resources management; • managing the migration of skilled
health personnel; • advocacy; and • resource allocation. The paper outlines the roles and responsibilities of the countries and the WHO to ensure the implementation and development of these priorities.
No status Sub-Saharan Africa
Migration Dialogue for Southern Africa (MIDSA)
The Migration Dialogue for southern Africa was formed to facilitate open dialogue and cooperation on migration policy issues within the Southern African Development Community (SADC). The strategies set out to ensure the retention of health workers through remuneration and benefit packages; enhancement of training through multi-level and sector organisations; implementation of monitoring and evaluation systems to determine the efficacy of current strategies; further research into the extent and impact of migration (e.g. cost/benefit analysis); and government engagement in research, internal coordination of migration management and private agency partnerships to mitigate the affects of
No status SADC countries
29
Instrument Scope Legal status
Countries covered
migration.
World Health Assembly
The most visible of Human Resources for Health policy initiatives was the intervention of the African Ministers of Health at the 57th World Health Assembly held in Geneva, Switzerland from 17-22 May 2004 (Gilson and Erasmus, 2005). They lobbied for resolutions to mitigate the affects of migration of health workers. As a result, the 57th WHA resolution urged Member States to develop policies to provide incentive for health workers to remain in their countries; to create bilateral agreements between countries; and for receiving countries to aid in strengthening the health systems of developing countries. Among other items, the WHA requested the WHO to help member states set up information systems to monitor the movement of health resources for health, to evaluate the effectiveness of international agreements and to include human resources for health development as a top-priority programme at WHO from 2006 to 2015 (WHA, 2004).
No status WHA
The London Declaration
The British Medical Association (BMA) convened an international global health workforce conference in association with the Commonwealth. The conference recognised the migration of health workers from developing to developed countries has a severe impact on the health care workforce of developing countries and “the lack of healthcare workers in developing countries is an emergency that demands urgent attention” (BMA, 2005).
No status
American Medical Association, American Nurses Association, the Canadian Medical Association, the Common-wealth Medical Association, the Common-wealth Nurses Federation, Health Canada, the Medical Council of Canada, the Royal College of Nursing and the South African Medical Association
International Council of Nurses (ICN)
The International Council of Nurses (ICN) adopted a position statement on ethical nurse recruitment in 2002. This statement
No status ICN
30
Instrument Scope Legal status
Countries covered
Position Statement
was formed as a means to persuade governments and employers to adopt principles on ethical recruitment (ICN, 2002). The ICN recognises the importance of career mobility to the nursing profession and society in general; it allows nurses to broaden their skills and contribute to health care globally. Nevertheless, the movement of nurses out of their country can have drastic affects on the national health care system. The ICN promotes effective resource planning and condemns active recruitment by countries that do not plan for human resources properly.
World Medical Association Statement on Ethical Guidelines for the International Recruitment of Physicians.
The statement recognises the physician’s valid reasons for migrating to developed countries but also recognises the impact that the movement has on source developing countries. The impact is further exacerbated by active recruitment of health workers in the developing world, which is a direct outcome of poor human resource planning in developed world.
No status Adopted by the WMA General Assembly in Helsinki, Finland, in May 2003
4. Analysis In assessing the effectiveness of the various codes and guidelines, there is general consensus that they have played an important role in raising the consciousness and awareness of ethical considerations in the recruitment health workers. Together, the governments and organisations involved have advanced a global agenda and brought this important issue into mainstream debates. However, the various weaknesses and loopholes inherent in the existing instruments render the Codes toothless and represent persuasive moral imperatives rather than obligatory statutory requirements. Commentators and analysts have identified the following key strengths and weaknesses of the instruments under discussion regarding: • their legal status • their content • lack of enforcement. 4.1 Legal status Codes of practice are voluntary, associative and legally non-binding. They provide an overarching set of guidelines and protocols to be followed. Because of the non-legally binding status of the Codes, they create false bravado of security. Exacerbating the effects of the non-binding status of the Codes is the poor use of sanctions and monitoring to ensure
I n n o v a t I o n sC o o p e r a t I o n
in
A Gu ide bo o k o n b i l At e r A l AGre e m e n t s
t o A ddre s s He A lt H Wo rk e r m i Gr At i o n
I b a d a t S . d h I l l o n
M a r g a r e t e . C l a r k
r o b e r t h . k a p p
m Ay 2010
Realizing Rights/glOBal health & DeVelOPMent
at t h e a s pen i n st i t u t e
19
name notes
UK-China Launched March 2006. Only UK agencies who appear on the Code of Practice list are allowed to participate in recruiting under the agreement; UK employers and recruiting agencies should only recruit through the Chinese recruitment agencies listed by the Chinese Ministry of Commerce; under no circumstances should any direct recruitment from China take place and no workers may be recruited from rural areas.
UK-India Offers individual nurses the opportunity to work in England, excluding health workers from the Indian states of Andhra Pradesh, Madhya Pradesh, Orissa, and West Bengal.
UK-South Africa 2003 and 2008
First signed October 2003 for a 5 year period. The agreement was renewed in 2008 for another 5 years. Facilitates exchange of health care workers and expertise.
UK-Bulgaria In 2000, 33 Bulgarian nurses were recruited to a hospital in England
UK-Spain Agreement provides for recognition of Spanish nurses’ skills in the UK.
UK-Philippines (not renewed)
Agreement for the transfer of “policy thinking” and education; UK allowed to recruit health care professionals.
Philippines-Bahrain Signed April 2007. Seeks to strengthen bilateral cooperation in the field of health services and the exchange of human resources; in addition to facilitating movement of health workforce, provides specific details on mechanisms to support human resources for health development in the Philippines.
Philippines-Canada Agreements with the provinces of Saskatchewan, Manitoba, and British Columbia. Focused mainly on labor movement and social protection, though commitment to support human resources development in Philippines, including describing funding mechanism for such purpose (Saskatchewan).
Philippines-Japan Economic Partnership Agreement
Economic partnership signed in September 2006. Provides for Filipino nurses to go to Japan to obtain qualifications and professional or language training for up to four years. However, they must pass the national Japanese nursing exam.
Philippines-Libya Filipino health workers deployed to Libya through a “government-to- government agreement.”
Philippines-Norway Launched 2003. For recruitment in health care.
Philippines-Palau Signed April 2008. MOU on Medical Tourism/Medical Referral and Higher Education Training in Health.
Philippines-Spain Signed June 2006. Allows entry of up to 100,000 Filipino health workers into Spain where they are afforded the same protections as Spanish workers.
Philippines-UAE Focused on labor mobility and social protection.
South Africa-Cuba Launched October 1996. Provides for transfer of medical professionals through a series of renewable three-year contracts; designed to create a permanent flow of Cuban medical doctors and lecturers into South Africa.
South Africa-Tunisia – Iran
South Africa signed a cooperation agreement with Tunisia in 1999 and with Iran in 2004. Both these agreements provide for the training of South African doctors in each country. They also serve to promote scientific research, health policy and pharmaceutical development amongst other things.
Spain-Colombia Comprehensive bilateral agreement, incorporating concepts of migration and human capacity development.
Bilateral agreements and Health Worker Migration A Partial compilation
Innovations in Cooperation: A Guidebook on bilateral Agreements to Address Health Worker migration
20
Bilateral agreements and Health Worker Migration A Partial compilation
name notes
Spain-France Allowed for Spanish nurses to work in France. The program lasted from 2002 to December 2004.
Spain-Morocco Comprehensive bilateral agreement, incorporating concepts of migration and human capacity development.
Kenya-Namibia June 2004. Provides guidelines for temporary (unidirectional) movement of health workers from Kenya to Namibia upon request of Namibia. Formed as result of Kenya’s inability to fully employ its health workers under terms of an IMF agreement.
Fiji-Nauru Currently in negotiation. Fiji may provide health workers for Nauru to assist in an immediate shortage situation, and Nauru may provide funds to Fiji to produce new health workers to replace those who left under the agreement.
China-Zambia Bilateral agreement that provides full medical scholarships for Zambians to study Chinese and medicine in China.
Sudan-Saudi Arabia Signed in 2009. Facilitates managed labor mobility between Sudan and Saudi Arabia as well as social protection and welfare.
Indonesia-Japan Similar agreement to the one between Japan and the Philippines.
India-Denmark Facilitates managed labor movement of highly skilled workers and ensures their social protection and welfare. Specifically calls on cooperation between training facilities in both countries for mutual benefit.
Poland-Netherlands “project” Allows Polish nurses to work in the Netherlands for a period.
Canada-Switzerland Signed an “agreement protocol” to support mobility of health workers between the two countries. 25
Germany-Croatia – Ukraine – Poland – Slovenia – Czech Republic – Slovak Republic – Bulgaria – Romania
Germany signed bilateral agreements with each of these countries in 2005. The agreements organize the recruitment of foreign nursing aids.
Italy-Romania Some Italian regions have signed bilateral agreements with Romanian provinces.
Italy-Spain “Semi-formal” links with Spain to recruit Spanish nurses.
France-Benin Comprehensively addresses migration flows with a particular focus on health professionals and support for human resources for health development.
France-Senegal Similar to France-Benin, comprehensively addresses migration flows with a particular focus on health professionals and support for human resources for health development.
Australia-New Zealand Trans-Tasman Mutual Recognition Agreement: agreed on mutual recognition of medical qualifications.
ASEAN Mutual Recognition Agreement – Medical Practitioners – Nursing Services – Dental Practitioners
Enables mutual recognition of medical, nursing and dental credentials within the ASEAN economic region. Of note, the agreements require respective terms of services of five, three, and five years in country before credentials are to be recognized.
Health professional mobility in a changing Europe
New dynamics, mobile individuals and diverse
responses
Edited by
James Buchan, Matthias Wismar, Irene A. Glinos, Jeni Bremner
on Health Systems and Policies
European
a partnership hosted by WHO
303Policy responses facilitating mobility or mitigating its negative effects
Table
13
.1 S
elec
ted
Eur
opea
n an
d in
tern
atio
nal i
nstr
umen
ts fo
r et
hica
l rec
ruitm
ent,
pres
ente
d ch
rono
logi
cally
Inst
rum
ent
Aim
Org
aniz
atio
nD
ate
Ad
op
ted
Typ
e
Inte
rnat
iona
l Cou
ncil
of N
urse
s (2
007)
: Pos
ition
Sta
tem
ent:
Ethi
cal N
urse
Rec
ruitm
ent
Cal
l for
a re
gula
ted
recr
uitm
ent p
roce
ss b
ased
on
ethi
cal
prin
cipl
es th
at g
uide
info
rmed
dec
isio
n-m
akin
g an
d re
info
rce
soun
d em
ploy
men
t pol
icie
s on
the
part
of g
over
nmen
ts,
empl
oyer
s an
d nu
rses
, thu
s su
ppor
ting
fair
and
cost
-effe
ctiv
e re
crui
tmen
t and
rete
ntio
n pr
actic
es
The
Inte
rnat
iona
l Cou
ncil
of N
urse
s re
pres
ents
mor
e th
an 1
30 n
atio
nal n
urse
s as
soci
atio
ns
2001
, rev
ised
an
d re
affir
med
in
200
7
Pos
ition
st
atem
ent
Wor
ld O
rgan
isat
ion
for
Fam
ily
Doc
tors
(200
2): A
Cod
e of
P
ract
ice
for
the
Inte
rnat
iona
l R
ecru
itmen
t of H
ealth
Car
e P
rofe
ssio
nals
(Mel
bour
ne
Man
ifest
o)
To p
rom
ote
the
best
pos
sibl
e st
anda
rds
of h
ealth
car
e ar
ound
th
e w
orld
; to
enco
urag
e ra
tiona
l wor
kfor
ce p
lann
ing
by a
ll co
untr
ies
in o
rder
to m
eet t
heir
own
need
s; to
dis
cour
age
activ
ities
whi
ch c
ould
har
m a
ny c
ount
ry’s
hea
lth c
are
syst
em
The
Wor
ld O
rgan
isat
ion
for
Fam
ily D
octo
rs h
as
120
mem
ber
orga
niza
tions
(n
atio
nal c
olle
ges,
ac
adem
ies
or o
rgan
izat
ions
co
ncer
ned
with
the
acad
emic
asp
ects
of
gene
ral f
amily
pra
ctic
e) in
99
coun
trie
s
May
200
2C
ode
Com
mon
wea
lth S
ecre
taria
t (2
003)
: Com
mon
wea
lth C
ode
of P
ract
ice
for
the
Inte
rnat
iona
l R
ecru
itmen
t of H
ealth
Wor
kers
To d
isco
urag
e th
e ta
rget
ed re
crui
tmen
t of h
ealth
wor
kers
fro
m c
ount
ries
that
are
them
selv
es e
xper
ienc
ing
shor
tage
s; to
sa
fegu
ard
the
right
s of
recr
uits
and
the
cond
ition
s re
latin
g to
th
eir
prof
essi
on in
the
recr
uitin
g co
untr
ies
Ado
pted
by
the
Com
mon
wea
lth H
ealth
M
inis
ters
, rep
rese
ntin
g 54
co
untr
ies
May
200
3C
ode
Wor
ld M
edic
al A
ssoc
iatio
n (2
003)
: Sta
tem
ent o
n Et
hica
l G
uide
lines
for
the
Inte
rnat
iona
l R
ecru
itmen
t of P
hysi
cian
s
Cal
ls fo
r ev
ery
coun
try
to d
o its
utm
ost t
o ed
ucat
e an
ade
quat
e nu
mbe
r of
phy
sici
ans
taki
ng in
to a
ccou
nt it
s ne
eds
and
reso
urce
s; a
cou
ntry
sho
uld
not r
ely
on im
mig
ratio
n fro
m o
ther
co
untr
ies
to m
eet i
ts n
eed
for
phys
icia
ns
Wor
ld M
edic
al A
ssoc
iatio
n re
pres
ents
phy
sici
ans;
m
embe
rs in
clud
e 95
nat
iona
l med
ical
as
soci
atio
ns
Sep
tem
ber
2003
Pos
ition
st
atem
ent
Eur
opea
n Fe
dera
tion
of N
urse
s A
ssoc
iatio
ns (2
004)
: Pra
ctic
e G
uida
nce
for
Inte
rnat
iona
l N
urse
Rec
ruitm
ent
Set
s ou
t the
key
con
side
ratio
ns fo
r en
surin
g bo
th e
thic
al
recr
uitm
ent a
nd e
mpl
oym
ent o
f int
erna
tiona
lly re
crui
ted
nurs
es
in E
urop
e (b
ased
on
the
Roy
al C
olle
ge o
f Nur
ses
Goo
d P
ract
ice
Gui
danc
e)
The
Eur
opea
n Fe
dera
tion
of N
urse
s A
ssoc
iatio
ns
repr
esen
ts m
ore
than
1
milli
on E
urop
ean
nurs
es
May
200
4G
uida
nce
Health professional mobility in a changing Europe304
Table
13
.1 c
ontd
Inst
rum
ent
Aim
Org
aniz
atio
nD
ate
Ad
op
ted
Typ
e
Wor
ld F
eder
atio
n of
Pub
lic
Hea
lth A
ssoc
iatio
ns (2
005)
: Et
hica
l Res
tric
tions
on
Inte
rnat
iona
l Rec
ruitm
ent o
f H
ealth
Pro
fess
iona
ls fr
om L
ow-
inco
me
Cou
ntrie
s
Rec
omm
ends
hea
lth e
mpl
oyer
s vo
lunt
arily
ado
pt a
cod
e of
eth
ics
to ju
dici
ousl
y m
anag
e th
e em
ploy
men
t of h
ealth
pr
ofes
sion
als
from
abr
oad,
incl
udin
g no
t rec
ruiti
ng fr
om
deve
lopi
ng c
ount
ries
(bas
ed o
n th
e U
nite
d K
ingd
om’s
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