mobility of health professionals between the india and selected … · 2015-02-25 · session 2:...

Mobility of health professionals

Between the India and Selected EU member

states: A Policy Dialogue

26 July 2013

India Habitat Center, New Delhi

CONTENTS

Keynote Address ........................................................................................................................................... 1

Session 1: International Frameworks on Labour Migration ......................................................................... 5

International Standards (Protection) and the Multilateral Framework on Migration.............................. 5

WHO Code of Practice on the international recruitment of health personnel .......................................... 6

Monitoring of the implementation of the WHO Global Code of Practice on the international

recruitment of health personnel ............................................................................................................... 7

Session 2: Assessment of Services to Professional and Skilled Health Migrants -- India and the Philippines

...................................................................................................................................................................... 9

Assessment of services for skilled migrants from India ............................................................................ 9

Assessment of services for skilled migrants from the Philippines ........................................................... 11

Session 3: The Assessment of Working Conditions of Foreign-trained Health Professionals in Europe .... 14

Investigating the working conditions of Filipino and Indian-born nurses in the United Kingdom .......... 14

International mobility of nurses from Kerala to the EU: prospects and challenges ................................ 16

Session 4: The Effects of the Migration of Health Professionals on the Health Sector of the United

Kingdom ...................................................................................................................................................... 18

Assessment of the impact of migration of health professionals on the labour market and health sector

performance in destination countries ..................................................................................................... 18

Round Table Discussions Policy Implications and Recommendations ....................................................... 23

Closing of the Policy Dialogue ..................................................................................................................... 24

1 | P a g e I L O D e c e n t W o r k A c r o s s B o r d e r s P o l i c y D i a l o g u e

The objective of this expert round-table discussion held in New Delhi on Friday 26th July 2013 was to

validate the policy researches commissioned by the International Labour Organization’s (ILO) Decent

Work Across Borders Project (DWAB). The participants shared their opinions on the relevance in

practical and policy terms and implications of the research findings, in order to inform the final version

of the ILO DWAB’s collaborators.

Each of the main researchers presented details of their researches and the policy implications that could

be extracted from their findings. This was followed by comments and observations by the discussants,

followed by an open discussion. A lively, honest and engaging debate produced numerous issues. The

details of each of the sessions are given below.

Keynote Address

Ms Catherine Vaillancourt-Laflamme, Chief Technical Advisor of ILO DWAB, Manila, welcomed the

delegates and talked about professional mobility being a complex issue. The Right to Mobility, Right to

Health and the Right to Labour were embedded within the Decent Work Agenda. She said this was an

opportunity to share two different models: that of India and the Philippines. She opened the discussion

by saying that there was a need to share opinions and contribute to the debate in order to enrich it.

Ms Tine Staermose, ILO Director for South Asia and Country Office for India, invited Mr TK Manoj

Kumar, Joint Secretary-Diaspora Services, Ministry of Overseas Indian Affairs, and CEO of the India

Centre of Migration to share his perspective.

Mr Kumar found it a privilege and a pleasure to be at this meeting and after welcoming everyone,

especially the titans of research, volunteered to share some remarks on the issue:

• The Government of India’s official stand was that it neither stops nor supports migration.

• However, the Government supports safe and legal migration, and migration with dignity.

• The e-Migrate Project was a comprehensive database initiated to understand which migrants

are going in and out of the country.

• A new immigration Bill on the existing situation was on the anvil.

• The Government promotes skilling through the National Skill Development Agency. A lot of young

people were expected to migrate from the country, and skill development would prepare the

migrant departure. Therefore the mandate of the Ministry of Overseas Affairs was to train five

million people by 2022.

• Circular migration was a very sensitive topic, and he felt it was a good thing. However, migrants

should not be forced to return home after greatly contributing to their destination country.

• Strong rehabilitation measures were recommended when migrants returned home, so they did

not find themselves strangers in their own land.

• The need for strong evidence was very evident; therefore this Project was of enormous value and

importance.


Ms Silvia Costantini, First Counsellor-Political Affairs, Delegation of the European Union to India,

emphasized the importance of this pilot Project to better understand circular migration of health-care

professionals, especially nurses:

• According to her, the biggest challenge for health care in the European Union (EU) was the steady

increase of life expectancy. Therefore, the need for geriatric care has increased.

• Less advanced European states were finding it difficult to retain health-care professionals vis-à-vis

the more developed European states.

• With regard to the issue of brain drain, she emphasised that the EU does not underestimate the

fact that brain drain can be damaging. The migrant source economy was under strain, which could

affect systems. However, brain drain was a consequence of people moving in order to better their

career opportunities.

• There needs to be a “win-win-win” situation for all three stakeholders involved: the receiving

country, the source country through remittances, and the migrants themselves through enhanced

employment opportunities.

• Therefore, there is a need to turn brain drain into brain gain, or putting human capital to better

use.

• Ms Costantini mentioned the EU’s focus on raising the attractiveness of migrants, as part of

Europe’s 20:20 strategy, which aimed to build political momentum in favour of migrants. She

described the blue card as a tool that allows health professionals to enter/leave a country; and

which ensured that the skills and training the health professional acquired was used to the

advantage of both the source and destination country.

• She highlighted the importance of returning workers motivating others to go abroad, which

benefitted the educational system. The Philippines was cited as an example for having potential

for high growth, and therefore brain gain. She reiterated the fact that the remittances sent home

by the high-skilled health professional was an important source of income for the source country.

• Ms Costantini reiterated that ethical recruitment was a core value of EU, and skill upgrading was

very important for migrant health workers.

• She said the EU supports the World Health Organization (WHO) Global Code of Practice on the

International Recruitment of Health Personnel.

• Ms Costantini also spoke about the need to understand the situation in both the host and

destination countries, for which she too underlined the need for strong evidence.

• Since India is a major source of health migrants, she said there was a need for a comprehensive

approach. In Asia, the EU has a long-term strategy with India, with which it had a structured

bilateral dialogue last year that led to the setting up of a common agenda. As a result, the

development of this Project and the knowledge created by it would prove invaluable.

Dr Vishwas Mehta, Joint Secretary, Ministry of Health and Family Welfare:

• There are 540 million people under the age of 25 in India. This demographic dividend can either

be an asset in terms of skilled, trained professionals, or a liability in terms of illiterate people.


• He said migration of health workers from India has been happening for decades, and recently

nurses had joined that phenomenon. Migration of health workers will always happen, it cannot be

stopped. Dr Mehta admitted that people will go abroad for brighter career opportunities.

• However, migration should be less exploitative and as hassle-free as possible. Not only should the

migrants be happy and satisfied, but those receiving them should be, too.

• Dr Mehta mentioned that systems should be developed that are acceptable to both host and

destination countries. For example, these could be in the form of some accreditation or exam.

Presently, there is no working reciprocal arrangement with other countries. No doctor or nurse

going abroad can work there without degrees.

• India has thousands of nursing colleges and schools. There are 1.5 million people registered as

nurses, but he lamented the fact there are no live registers. There are no numbers available on

how many people have gone abroad, and how many have retired. The case is similar with doctors,

of whom 80,000 are registered with the Indian Medical Association.

• Doctor to citizen ration in India is 1:1,700, and he did not know how that gap could be bridged. He

said expansion was needed, but then the quality would be affected. More doctors are required,

but there were not enough faculties in the medical colleges.

• With regard to the allied health system, Dr Mehta said that another 1.6 million health

professionals were required in the country; and there is an urgent need to standardize the nursing

and allied health-care system. However, for a population of 1.2 billion, it is not an easy task.

Ms Staermose:

• Ms Staermose began by thanking everyone for coming to engage on the important issue of

international migration and health workers at the ILO in Delhi.

• International migration is not only a complex issue involving many countries; it also requires close

collaboration between different governmental institutions, including key ministries. She

appreciated the participation of organizations and people without whom this activity would not

have been possible, in particular the Ministry of Labour and Employment, the Ministry of

Overseas Indian Affairs, and the Ministry of Health and Family Welfare. She also thanked the EU

for providing the funding to enable the ILO to mobilize and provide technical assistance to its key

constituents in India, as well as in the other countries that are part of the DWAB Project. The main

points of her address were:

• Across the world, the number of migrants crossing borders in search of employment and human

security is expected to increase rapidly in the coming decades, due to the failure of globalization

to provide jobs and economic opportunities.

• Ms Staermose stated that the ILO sees today’s global challenge as forging the policies and the

resources to better manage labour migration so that it contributes positively to the growth and

development of both home and host societies, as well as to the wellbeing of the migrants

themselves. In 2004, the International Labour Conference of the ILO adopted a Multilateral

Framework on Labour Migration, which is part of a plan of action for migrant workers agreed by

ILO constituents. The Framework is part of an ILO plan of action that aims to better manage


labour migration, so that it contributes positively to the growth and development of both home

and host societies, as well as to the welfare of the migrants themselves. The ILO established the

earliest international standards on migration to ensure a fair deal for migrant workers, and to

maximize gains for both sending and receiving countries and stakeholders.

• She further elaborated that labour migration occurs and persists because it offers substantial

economic benefits to migrant workers and their families, as well as the countries of origin and

destination. In terms of health professionals (nurses and doctors) who migrate to find

employment, some of the known factors that pull this migration flow are that in many destination

countries, the populations are ageing and the demand for elderly care is increasing. Together with

better wages, working conditions and opportunities for professional development constitutes the

key factors.

• In order to design the best policy response to these challenges, Ms Staermose emphasized that it

is critical to collect and analyse data through research, in order to design efficient policy

interventions for the benefit of all. A more detailed analysis of the opportunities and challenges

of circular migration are needed in order to reap its benefits, especially for health professionals,

and equally for the countries involved.

• Circular migration has recently been promoted as a “triple win solution” to migration. This

concept has been widely used and promoted in particular by certain EU Member States and the

EU itself. As stated by some of the more critical segments of the migration stakeholders, “circular

migration could be a way of filling gaps in the labour market without having to fully integrate

those who only come for a limited period of time, or on a seasonal basis”.

• According to Ms Staermose, sending countries such as India will benefit in terms of remittances.

But more importantly, by taking a medium to long-term perspective, India will benefit from

returning health professionals, who have gained international experience and exposure and

received professional training, which will then benefit the medical environment including patients

in India. In turn, this may address some of the quality issues in the health sector, but only if these

health professionals return. Receiving countries such as those in the EU will be able to satisfy their

need for skilled labour in the health professions.

• The ILO brings stakeholders together to design programmes and approaches so that migration can

take place in a safe manner. The ILO strongly believes that migrants are less vulnerable when they

are moving out of choice, and not out of necessity. This is done by engaging governments,

employers’ and workers’ organizations, and professional organizations and recruitment agencies.

• The ILO supports, through technical assistance and upon request, the development of key policies

in the world of work. In many countries, including in South Asia, the ILO has provided technical

assistance to labour migration policies for specific professions. The decent work agenda of the ILO

is at the very heart of their work.

• She further elaborated that the ILO is not only concerned about safe and regular migration, but

through a strong rights-based approach that focus on fundamental rights and principles including

the protection of workers in the process of labour migration. This is critical, if only for the fact the

workers themselves are part and parcel of designing the best models, for the overall policy to be

implementable and serve the purpose it is designed to serve.


• Ms Staermose ended by saying that another key dimension of how the ILO works, both nationally

and globally, is through the promotion of dialogue; not only social dialogue for collective

bargaining of wages and working conditions, but also dialogue to promote the creation of

synergies between different policy frameworks within a country.

Session 1: International Frameworks on Labour Migration

Facilitator: Ms Neetu Lamba, Programme Officer, ILO Delhi

Mr Nilim Baruah, Regional Migration Specialist for Asia-Pacific, ILO International Standards (Protection) and the Multilateral Framework on Migration • Giving an idea of the scale of labour migration, Mr Baruah said that estimates of migrant workers

by ILO for 2010 are 105.5 million, out of which a little over 30 million (or almost 30 per cent) were

in Asia. However, these numbers do not fully reflect the significance of the migrant workforce in

many countries and economic sectors. Women compose almost about 50 per cent of migrant

stocks though this number differs from country to country.

• Economic growth, demographic changes, labour shortages and wage differentials among

countries of origin and destination continue to drive labour migration in Asia.

• In addition to intra-regional flows, there were skilled labour flows to Organisation for Economic

Co-operation and Development (OECD) countries. Higher wages in OECD countries --combined

with selective migration policies that favour skilled migration of foreign workers -- attracted a

large and growing skilled workforce, especially from India, China and the Philippines.

• The challenges in the countries of origin included information dissemination and skills

development, and regulation of recruitment.

• The challenges in the countries of destination included admission policies (balancing different

interests, regulation of recruitment, reducing irregular inflows, etc) and post admission policies

(decent work for all, equal treatment between nationals and foreign workers, and extension of

labour laws).

• He cited the Korean programme as an example that was good in terms of recruitment rights, but

that there were problems with regard to the return of migrants, as conditions were not better on

their return.

• With regard to the international legal framework, Mr Baruah explained that there were numerous

international instruments that existed to provide standards for human rights. However, these

instruments generally did not affect the state’s sovereign right to control and regulate its borders.

• On Migration-specific conventions, Mr Baruah explained that ILO Conventions (No. 97 and No.

143) were the first international instruments for Migrant Workers (MWs). They put forward equal

treatment between regular status migrants and nationals in employment and working conditions,

and measures to address irregular migration. The international convention on the protection of

the rights of all MWs and family members is the most comprehensive instrument on MWs and has

a section on the rights of irregular MWs. Along with C143, it contains provisions intended to

ensure that MWs enjoy a basic level of protection, whatever their status. Among other ILO


Conventions particularly relevant for MWs includes C118: Equality of Treatment (Social Security);

C157: Maintenance of Social Security Rights; and C181: Private Employment Agencies.

• On the ILO Multilateral Framework on Labour Migration, Mr Baruah stated that this is a global

framework of non-binding principles, guidelines and good practices on a rights-based approach to

labour migration. It is anchored on ILO conventions and standards, and based on tripartite

negotiations and consensus of countries of origin and destination. Adopted in November 2005, it

talks about nine areas consisting of 15 principles and corresponding guidelines. These nine areas

or themes are:

1. Decent work -- access to freely chosen employment; recognition of fundamental rights

at work; income to meet basic needs & responsibilities; adequate level of social

protection;

2. Means for international cooperation in labour migration;

3. Global knowledge base;

4. Effective management of labour migration;

5. Protection of migrant workers;

6. Prevention and protection of abusive practices;

7. Promotion of orderly and equitable process of labour migration;

8. Promotion of social integration and inclusion; and

9. Contribution of labour migration to development.

• Mr Baruah said the guidelines for recruitment and placement included a standardized system of

licensing or certification established in consultation with employers’ and workers’ organizations;

respect of migrant workers’ fundamental principles and rights; and understandable and

enforceable employment contracts. It also promoted sanctions to deter unethical practices, and

fees and other charges for recruitment and placement not to be borne by migrant workers.

• With regard to migration and development, Mr Baruah shared that the guidelines included

adopting policies to encourage circular and return migration and reintegration into the country of

origin, including by promoting temporary labour migration schemes, and facilitating the transfer

of capital, skills and technology by migrant workers, including through providing incentives to

them.

• According to Mr Baruah, the Code needs to have a monitoring, rating and assessment mechanism.

• Mr Baruah ended by saying that promoting international cooperation and partnerships in

managing international labour migration were essential for the protection and welfare of MWs,

and also in curbing irregular migration and expanding legal migration.

Dr Paul Francis, World Health Organization, New Delhi WHO Code of Practice on the international recruitment of health personnel

• Dr Francis began by saying that the WHO Global Code of Practice on the International

Recruitment of Health Personnel, adopted on May 2010, was developed to address crucial needs

arising from both source and destination countries. The Code also went a little beyond

recruitment and addressed a few systemic issues.


• The Code, according to Dr Paul, was voluntary. But member countries were strongly encouraged

to use the Code as it served as a reference for ethical international recruitment, health workforce

development, health systems sustainability and fair treatment of migrant health personnel.

• The Code provided a dynamic framework for global dialogue and international cooperation to

address challenges associated with the international migration of health personnel.

• The Code also helped in information exchange on issues related to health personnel and health

systems in the context of migration, and reporting on measures taken for its implementation.

Ms Catherine Vaillancourt-Laflamme, ILO DWAB Monitoring of the implementation of the WHO Global Code of Practice on the international recruitment of health personnel • Ms Vaillancourt-Laflamme said this was a collaboration of the Department of Health with the

Department of Labor and Employment, in partnership with the ILO (Philippines), the WHO

(Philippines and Western Pacific Regional Office) and multi-stakeholders.

• According to Ms Vaillancourt-Laflamme the WHO Code of Practice addresses health work-force

migration, given the observed critical shortage in health personnel and weakened health systems

experienced by some 57 source countries identified by the WHO. She said the Code was a

tremendous tool for improving the ethical framework for migrant workers.

• The multi-stakeholder approach that was adopted included representatives from governments,

employers (hospitals), trade unions, recruitment agencies and professional organizations. Ms

Vaillancourt-Laflamme said that a wide audience was brought on board to monitor the

implementation of the code to help make it a “living document”, and to get their perspective on

how the Code helped, if at all.

• She also shared that from the perspective of the Philippines, as a sending country the

stakeholders found the Code restrictive. This has created a demand for more knowledge in the

Philippines.

• Ms Vaillancourt-Laflamme mentioned that after a broad-based and participatory process, the key

recommendations on the monitoring of the implementation of the WHO Global Code included

the:

• Monitoring instrument for sending and receiving countries should be differentiated. The

questions need to be applicable to sending and receiving country respondents; and

• WHO monitoring instrument should include other elements to track implementation of the

bilateral and multilateral agreements such as training, working conditions, grievance mechanism,

skills recognition and responsibilities of recruitment agencies.

Key recommendations: National level

• Local policies related to migration of health professionals needed to be harmonized, based on the

requirements of the Global Code.


• The Code needed to be adapted to policies and programmes to ensure that ethical recruitment is

adhered to by recruiters, which could serve as a basis to institutionalize negotiation mechanisms

with foreign employers.

• Wide dissemination of the Code was required among migrant health workers, trade unions,

employers and recruiters.

• Conduct policy and social dialogues among receiving and sending country stakeholders, including

trade unions, on heath worker migration and the implementation of the WHO code.

• There was a need to create a formal feedback mechanism to obtain information from the health

professionals going through the recruitment process to collect data on good and bad practices, so

as to improve the monitoring of recruiters.

• The Code needed to be turned into something stakeholders could use to build knowledge.

• Ms Vaillancourt-Laflamme ended by saying that the biggest challenge that they faced in this entire

exercise was the time constraint.

Open Discussion

• Shiv Kumar, Co-Founding Director of Catalyst Management Services and Swasti Health Resource

Centre, New Delhi, wanted to know the interplay in terms of the Code ownership, with regard to

the central and state governments. What were the experiences from the Philippines? Dr Francis

responded that with regard to the national vis-a-vis state codes, due to their legal and regulatory

nature, they are addressed at the national level. The state governments were free to adapt it to

suit their own specific needs.

• Dr Binod Khadria, Professor of Economics and Education, and Chairperson of Zakir Husain Centre

for Educational Studies, Jawaharlal Nehru University, made a comment on a provision of the ILO

Multilateral Framework on Labour Migration, according to which fees and other charges for

recruitment and placement should not to be borne by migrant workers. But in reality this was not

the case. He wanted to know whether these costs should be borne by the employee or employer.

Mr Baruah clarified that recruitment costs generally did not include training cots; however as in

the example of domestic workers from Cambodia who had to undergo training, the cost was

borne by the workers themselves.

• Mr Parimal Sudhakar, a civil society representative, wanted to know what role civil society

organizations could play in educating nurses, doctors on the Code? Could ethical recruitment be

included in the nursing curriculum? Ms Vaillancourt-Laflamme responded, giving the example in

the Philippines where doctors and nurses were extremely well-educated and went to university.

So if there was a curriculum there named along the lines of “challenges of nurses in a global

world”, it would be very useful.

• Ms Vaillancourt-Laflamme added that health mobility is a complex issue. There is a need to raise

awareness of migrant health-sector workers about what they are likely to encounter in their

destination country. However, health workers themselves also had a responsibility to seek

information -- otherwise a passive category of migrants would be created.


• Ms Vaillancourt-Laflamme mentioned that there was a need to harmonize the multiplication of

Codes for health-sector migrants to alleviate confusion, and there needed to be one standard to

abide by. She also commented that there needed to be a definition for “Ethical Recruitment for

Agencies”, and admitted that there needs to be better work done in this field.

Session 2: Assessment of Services to Professional and Skilled Health

Migrants -- India and the Philippines

Facilitator: Ms Christiane Wiskow, Health Sector Specialist, ILO Geneva

Dr Irudaya Rajan, Centre for Development Studies, Trivandrum Assessment of services for skilled migrants from India The objectives of Dr Rajan’s study were to:

1) Map and assess the existing pre-orientation, pre-departure, and on-site and return

services available to skilled health migrants; and

2) Identify gaps and provide policy recommendations for new services

• Dr Rajan explained that one reason why India’s case was so special was that it ranked No. 1 in

remittance-receiving countries – with inflows reaching $69.8 billion for 2012 (World Bank, 2013).

According to the International Migration Outlook (2013) it is the 4th largest source for immigrants

to OECD countries. He explained that with the outflow of highly skilled health professionals from

India, there is a risk that the country will not meet its health-related Millennium Development

Goals.

According to Dr Rajan, the research methodology included three case studies: the Ministry of

Overseas Indian Affairs, which began in 2004; NORKA ROOTS, Government of Kerala, which

started in 1996; and the Overseas Development and Employment Promotion Consultants

(ODEPC), under the Department of Labour, which began in 1977.

Professor Rajan traced the cycle of migration in the three case studies, which included the pre-

departure stage and on-site services.

On Return services, Indian Nursing Council re-registers the nurses, recognizes their

qualifications. Rehabilitation Programme for Return Migrants was also offered by NORKA.

Findings from the field

• Pre-departure services: Recognition by the stakeholders that they were not providing many

services for the skilled migrants.

• According to Dr Rajan, skilled migrants also felt that they could handle their migration and should

be left on their own.

• Dr Rajan also suggested that pre-departure orientation or training should be offered for potential

migrants.


• With regard to on-site services, he suggested that any dispute should fall within the jurisdiction of

Indian courts.

• However, return services were not properly recognized and not organised according to the needs

of the returnees.

The Gaps include: On-site services; Lack of inter-ministerial collaborations; No mechanism in tracking migrants overseas; Poor redressal system; Return services; Absence of social security agreements with all destination countries; and Absence of services for returnee skilled migrants.

The Gap analysis resulted to the following:

• Fragmented national policy frameworks and programmes; • Absence of a strategic plan and services for skilled professionals; • Lack of data on migrants; • Pre-departure services; • Lack of dissemination of information on services at grassroots level; • Absence of stringent regulatory measures and benchmarks in recruitment processes; • Limited operations and networks by government recruitment agency; and • Lack of assessment of national and international job markets.

Recommendations

Administrative recommendations

According to Dr Rajan, decentralized state level agencies should bridge the gap between

policy and programmes. In this regard, he stated that the MOIA has already initiated to

start a department of non-resident Indians (NRIs) at the state level.

Two-level structure for skilled migrants should be established -- to fill the gaps in

knowledge.

All agencies, including the Ministry for External Affairs (MEA), the Ministry of Overseas

Indian Affairs (MOIA), the Ministry of Home Affairs (MHA), the Ministry of Human Resource

Development (MHRD) and the Ministry of Labour and Employment (MOLE) need to

coordinate their efforts.

Recruitment agencies and other players involved in student migration, such as tour

agencies, should all be put under one ministry.

Programme-related recommendations

Dr Rajan explained that programmes for skilled migration should be done systematically

and expanded overtime.

There was a need for decentralization of activities through the Ministry of Panchayati Raj

institutions.

Unions can engage in providing information services to migrants.


Professional organizations should engage in skills recognition.

Recruitment agencies should provide more services and asked to carry out assessments of

labour market needs.

Information on national market for returnees.

Dr Marilyn Lorenzo, University of the Philippines, College of Public Health Assessment of services for skilled migrants from the Philippines • Dr Lorenzo began by stating that after seafarers, nurses were the second group from which

maximum migration was observed.

• The Philippines implicitly supports emigration of its citizens who are able to work abroad and

sustain the economy with remittances sent back home. Increased demand from developed

countries that are in shortage of health professionals to care for their aging population has

resulted in massive external migration.

• Filipino policy aims to meaningfully manage migration so that health professional migration

benefits both destination countries as well as source countries like the Philippines. There is high

interest in participating in international policy making to forge agreements towards ensuring

mutually beneficial migration arrangements. Best practices are now in place for bilateral

agreements between the Philippines and other countries needing nurses such as Canada and

Bahrain.

• Specifically, the study aimed to:

• Review and confirm mapping of existing pre-orientation, pre-departure, and return

services in the Philippines that are available to skilled migrants specifically for health-

care professionals;

• Describe services utilized by health professional migrants;

• Assess the effectiveness of existing services to health professional migrants;

• Identify gaps and needs for new services;

• Conduct a group consultation through round-table discussion regarding the results of

the assessment of services for skilled migrants;

• Formulate draft recommendations based on the results of the data collection; and

• Develop relevant final recommendations to address identified needs and gaps.

Key findings and conclusions

• Dr Lorenzo explained that the policies for the protection of the rights and welfare of Filipino migrant workers were developed as early as the 1960s. The explosion of services was observed around the year 2000 and up to 2010, when many non-government agencies -- including private recruiters -- began to complement government’s work by providing migrant services. However, these new services were mostly provider driven and were not organized based on migrants’ felt needs.


• Results of the research showed that some government agencies had a crucial role to play in terms of the number of services provided. The private sector, specifically the recruitment agencies, provided very critical services, supplementary or complementary, to what the government agencies were already giving.

• Dr Lorenzo further explained that a number of agencies shared the responsibility of providing the same service. Therefore, there was a need to coordinate migrant services that are provided by a multiplicity of government and non-government agencies to prevent gaps and overlaps.

Key recommendations

Stakeholder recommendations

Dr Lorenzo suggested that there was a need to streamline services and segregate health

professional migrant workers from other migrant workers.

In terms of recruitment services, placement fees needs to be abolished.

To address the gap on skills and competencies of professional migrant workers, even before

the health professionals decided to work in foreign countries, Dr Lorenzo suggested that

they must be guided by a defined career progression framework relevant both locally and

internationally.

Improving data and information sharing and collaboration, monitoring, and performance

evaluation through proper feedback mechanisms are also needed.

Another recommendation was that the government should form bilateral and multilateral

agreements with foreign countries to implement social security measure for workers.

Policy recommendations

Dr Lorenzo shared that there was a need for a policy scan to determine whose agencies’

mandates needed to be updated. Organizational policies need to be harmonized to

minimize programme gaps.

Primary or prioritized services should be assigned to key migration-related agencies.

There was also a need to empower migrants, their families, and providers of services. Their

roles need to be made clear.

Organizational recommendations

• Finally, Dr Lorenzo talked about the International Organization for Migration (IOM) service

providers in the Philippines in order to attempt to group agencies according to main

functions available for migrant services.

• Dr Lorenzo also noted that in the case of Philippines, surprisingly, recruitment agencies had

done a good job.

• In the end, Dr Lorenzo shared that presently, a nurse is in the Congress and representing

their interests among the law makers. This was stated proudly by the speaker, thereby

indicating the fact that Filipinos are proud of what their nurses have achieved globally.


Responses

Dr A Didar Singh Secretary General, FICCI • According to Mr Singh, there are only three players in this world of migration: human resources,

business, and the government. Migration is a fact of life. The legal framework is very important,

which determines who and in what way they move. Everything else follows from this. According

to him, guidelines as given in the WHO Code of Practice are meaningless unless they are made

legal.

Dr Noyal Thomas CEO, Norka-Roots • Dr Thomas shared his experiences from Kerala, an area that leads the country in terms of

migration. He believed that no matter what the regulation, people would migrate. The

recommendations he offered were:

• Educating migrants through a pre-departure programme is very important to ensure safe

migration, or else they will suffer. Migrants need to follow the norms in the host country.

• India needs to sign bilateral agreements with other countries, especially with the major

destination countries. As proven, the countries with which there was an agreement were

safe for migrants.

• He emphasized the need to regulate recruitment agencies. People need to be allowed to

migrate legally and they need to be given options.

• There was also a need for reintegration of health professionals. He ended positively saying

that highly qualified people were coming back to Kerala and establishing medical colleges,

etc. This was a positive outcome as it would lead to employment generation.

Open Discussion

• Mr J John of the Centre for Education and Communication, New Delhi, wanted to know what the

differentiated needs of health workers were; what were the specific rights of health workers with

regard to circular migration; and why would a health worker want to return back to her/his

country?

• Mr P Narayan from the Trade Union Centre of India wanted to know why the Immigration Bill had

not been passed after two years, and what was the NOIA doing about it? He also commented on

the need to take serious and vigorous action against opportunistic and corrupt recruitment

agencies. He gave an example of a recruitment agency which, despite being black listed in

Bahrain, had engaged 128 Indian workers who were later jailed, and eventually only released after

intervention with the king of Bahrain.

• Dr Angela Chaudhuri, Director, Swasti Health Resource Centre, wanted to know what the family

rights and entitlements of health workers were, and what protection do Indian consumers have if


a migrant health worker returns home after committing medical malpractice in the destination

country?

• In her response to Mr John’s question, Dr Lorenzo said that since Filipino health workers were

technologically challenged, their expressed needs included skill-based training and development,

and protection in terms of vaccinations, etc. The migrant health workers come back to their

country to reunite with their families, while young people came back because they wanted to get

married and wanted to have a familial social structure. Also, progressive circular migration

needed to be encouraged when these migrants come home for Christmas and holidays.

• Dr Rajan responded by saying that the issue of return of migrants needed to be looked at very

seriously. He agreed that the coordination among Indian ministries was a concern and gave an

example of how presently Indian passports were overseen by three ministries. On the question of

recruitment agencies, he agreed that there were some bad ones, but he emphasized that there

were good ones also, adding that the media often only highlighted the bad practices, which

tended to give an overly negative view.

Session 3: The Assessment of Working Conditions of Foreign-trained

Health Professionals in Europe

Facilitator : Dr Khadria

Dr Davide Calenda, Researcher, Robert Schumann Centre for Advanced Studies, European University Institute Investigating the working conditions of Filipino and Indian-born nurses in the United Kingdom

• According to Dr Calenda, the Philippines and India are the biggest sources of internationally

recruited nurses (IRNs) for the OECD countries, including the United Kingdom. The case of the

United Kingdom provides clear evidence of the importance of the state policy in influencing

employers' utilization of migrant nurses as well as working conditions. The United Kingdom has a

long-standing legacy of international staffing, and has developed changes in migration

management and in entry requirements. Its policy has shifted from massive recruitment from

1998 to 2006, to a period called “openness to mobility” and to the introduction of progressive

restrictions from 2006 onwards.

His study raised the following questions:

what are the working conditions of Filipino and Indian IRNs in the United Kingdom;

what factors shape their working conditions;

how do working conditions shape IRNs’ orientation towards the UK labour market;

what lessons can be learnt from the UK’s case; and

what policy directions and recommendations can be drawn.

Main observations made by Dr Calenda:


• A majority of the respondents reported a worsening of several dimensions of their working

conditions since their arrival in the United Kingdom (i.e. job security, security in the workplace,

career perspectives). Job insecurity has increased for five out of ten respondents since they

started working in the United Kingdom, despite the fact that almost nine out of ten respondents

are currently employed on a permanent basis. Only one out of 10 respondents considers that

their position in the UK labour market had become more secure over the years.

• A majority of the respondents consider their working conditions worse compared to the working

conditions of their colleagues working as a nurse in the same team or department, with the

proportion highest among IRNs working in teams predominated by colleagues with UK origins.

• A majority of the respondents have personally experienced practices of harassment, bullying or

abuse in the workplace, mainly by colleagues and patients, but many report unfair treatment

from managers as well. Most of the respondents consider these practices as driven by ethnic

discrimination.

• Problems with the recruitment process are widely diffused among IRNs across health-care

facilities throughout United Kingdom. A large number of IRNs surveyed reported that they had

been provided misleading information during the recruitment process, and had been charged a

high fee by the recruitment agencies.

Implications

• Demotivation and detachment: the more IRNs suffer from bad working conditions, the less they

identify themselves with the organization they work for. Therefore the satisfaction with the

quality of care they are able to provide to patients/service users also decreases.

• Re-emigration or return: according to Dr Calenda, many IRNs reported that they were planning to

leave the United Kingdom to work as a nurse in another country or return home, as they were

disappointed with their current working conditions, lack of career perspectives, and uncertain

about their future in the United Kingdom. Examples included the high cost of living there and

tightening immigration rules.

Policy implications

• With regard to recruitment, Dr Calenda suggested that bilateral agreements should include clear

measures to monitor the implementation of codes of ethical recruitment and to assess the impact

of recruitment practices on the working conditions of IRNs after the arrival in the destination

country. Trade unions and professional associations should be actively engaged in the monitoring

system. Also, awareness needs to be generated among IRN candidates about what the real

opportunities and risks are.

• Working conditions should be addressed both at the national level and at the level of health

facility.

• Dr Calenda emphasized that there was no reliable data on how many migrants were in the United

Kingdom and how many were leaving the country. According to his rough estimates, more than

400 nurses had reached the United Kingdom.


Dr Tina Kuriakose Jacob, Head of Research, India Centre for Migration International mobility of nurses from Kerala to the EU: prospects and challenges • According to Dr Jacob the number of Indian nurses in European countries is negligible with the

exception of the United Kingdom and Ireland.

• For Indian nurses abroad, there are significant push and pull factors. The Gulf countries are seen

as a stepping stone for nurses from Kerala. Overseas employment for these women had

generated increased wealth, better conditions of work and prospects for professional

improvement.

• Despite this positive impact documented in various studies, concerns remained on the “supply

side” and the availability of an adequate nursing workforce in India. However, the push factors for

such a choice are significant, given the poor salary structures, long working hours and bond

system prevalent among private institutions in India, due to the high demand for nursing

education.

• The mobility of nurses is demand-driven and network-enabled. Permanent residence is preferred

by them, with migration seen as a life strategy. Interestingly, Dr Jacob also mentioned that

migration of health professionals was not the sole reason for the health system collapsing in India.

• Dr Jacob explained that an EU survey in the Netherlands and Denmark was done to add to the

existing literature and build a perspective on destination countries. Shortages in nursing staff

were not particular to developing countries alone, and both Denmark and the Netherlands had

experienced nursing deficiencies.

• A brief assessment of working conditions for Indian-trained nurses in Denmark revealed that

while there was some scepticism over the portability of skills in a European context, experience

with Malayalee nurses recruited by a private hospital in Denmark showed them well-endowed in

practical skills once the language barrier was overcome.

• The working conditions were found to extremely favourable, with the nurses expressing

happiness over the non-hierarchical working style and the flexibility of working hours, among

other advantages. They made remittances to India.

• There was a discernible mismatch between immigration policy and labour market demand, with

employers in the Netherlands having used loopholes in the Highly Skilled Migrants Scheme to

recruit operation theatre assistants.

• Return migration: plans for returning to India were varied among the nurses, despite knowing that

working and staying in Denmark was limited. However, none of the nurses saw themselves

returning to work in India.

Recommendations

• Medium-term policies needed for an organised and well-coordinated international

recruitment;

• Online integrated labour market information system including a registry of skilled and

qualified nurses in India;


• Implementation of standards in nursing education through consultations with various

stakeholders, and formal collaboration in nursing education to align training requirements

with that of the EU;

• Encourage private recruiters towards ethical recruitment practices such as sharing credible

and adequate information prior to recruitment on matters related to contract, salary,

working conditions, etc;

• Apprenticeship/student exchange programmes/staff exchanges in nursing and allied services

could be considered to facilitate mutual learning; and

• Incentives for return should include increased salaries, promotions and improved working

conditions for nurses in India.

Responses

Mr Krishna D Rao Public Health Foundation of India • According to him, both papers have brought out interesting observations and thereby made a

good contribution to the understanding of health worker migration.

• He lamented the fact that there was very little data on migration of health sector professionals to

other countries. According to one study by All India Institute of Medical Sciences, in New Delhi 50

per cent of doctors pursuing their studies left the country -- a double loss to the country as these

aspiring doctors attained their degrees from government institutions.

• Mr Rao said it needs to be seen how migration is affecting local capacities in different states.

Kerala, for example, has an over capacity of nurses unlike in northern states like Uttar Pradesh.

Mr Shiv Kumar

• Mr Kumar commented that both papers have a perspective and have moved knowledge forward.

They have brought out important issues regarding gender, local unemployment, the negative

impact of immigration laws on migration and anecdotal references to discrimination. On a lighter

note, he mentioned that there’s a joke that goes around in Kerala that “the similarity between

prawns and doctors is that the best ones are found in the Middle East”. Unfortunately for him,

that was the state of affairs of the health sector in Kerala.


Session 4: The Effects of the Migration of Health Professionals on the

Health Sector of the United Kingdom

Facilitator: Dr SK Sasikumar, Senior Fellow, V.V. Giri National Labour Institute

Dr Piyasiri Wickramasekara, Researcher and Vice President, Global Migration Policy Associates, Geneva Assessment of the impact of migration of health professionals on the labour market and health sector performance in destination countries • Dr Wickramasekara began by mentioning the changing context of health professional migration,

which included a concern about the high outflow of health professionals from poor origin

countries, and development of codes of practice culminating in the WHO Global Code of Practice.

With the global economic crisis, there has been a tightening of health budgets and moves towards

self sufficiency in countries of destination, such as in the United Kingdom, which has set up more

medical schools/nurse training. Frequent changes in immigration policies in the United Kingdom

and less reliance on bilateral agreements and Memorandum of Understanding (MOUs) by

countries of destination were some other aspects of the changing context for health professional

migration.

The objectives of Dr Wickramasekara’s study were:

• Identify and analyse the impacts and effects the migration of health professionals are likely

to have on host countries;

• Propose policy recommendations to enhance the positive impact of the migration of health

professionals in host countries and mitigate any related negative effects; and

• Focus on the impact of health professionals’ migration on destination countries with regard

to the labour market, the health system performance and the quality of care.

• With regard to the impact on the labour market, the questions were whether international health

professionals (IHPs) drive down wages of IHPs and do they cause displacement of native health

professionals? According to Dr Wickramasekara, most research does not support this view of

immigration’s negative impacts on wages and earnings. The general finding of a wide range of

studies was that any negative effect of immigration on wages is small, if it exists at all. Also,

numerous studies on Europe and the United States suggest immigrants do not displace natives in

employment in any significant way.

• With regard to impact on labour mobility, Dr Wickramasekara stated that the studies did not find

any evidence to suggest that health-worker migration led to movement of native health workers

from areas of high concentration of immigrant health workers. The impact was either absent or

insignificant in most cases where an impact was found.

• With regard to the impact of IHPs on health sector performance, Dr Wickramasekara stated that

migrant health workers have contributed considerably to expansion of the delivery of services,


since they are often brought in to address particular shortages, and they positively influence the

geographical distribution, skill mix and size of the health workforce. Immigrant health workers are

also used to address less popular specialities and under-served regions of the country.

• With regard to the implications on the financing function of the health system, Dr

Wickramasekara said the United Kingdom has saved considerably by recruiting health workers

trained at public expense of other (mostly developing ) countries. The British Medical Association

(BMA) estimated that the National Health Service (NHS) has saved up to £250,000 for each doctor

trained elsewhere. Inflow of foreign-trained nurses has also has saved the United Kingdom

considerable amounts in training costs. Other major destination countries such as Australia,

Canada and the United States also continue to make substantial savings in recruiting overseas-

trained doctors and nurses, often at the expense of developing countries.

• With regard to the impact on quality of care, Dr Wickramasekara mentioned that studies have

found that there is a higher incidence of complaints, and higher impact decisions against IHPs. Yet

there has also been concern about the effect of racism and discrimination regarding complaints

procedures in the health systems at many levels. There is a lack of transparent procedures and he

emphasized that recent quality issues in the United Kingdom have not been related to IHPs.

• However, Dr Wickramasekara noted there was documented evidence that the constraints faced

by IHPs affected their performance. These constraints included retrospective legislation, no

proper inductions on expected standards of ethical and regulatory conduct, and institutionalised

racism and discrimination (there is documented evidence of racism and discrimination in the

workplace by fellow workers and patients). Limited career prospects was another constraint faced

by IHPs in the United Kingdom as they were confined to general practitioner level and unpopular

disciplines (like geriatrics, psychiatry), unpopular shifts, limited access to further training and few

promotions for nurses.

Mutually beneficial forms of health professional migration

• According to Dr Wickramasekara, there is limited circular migration of health professionals

between European countries and developing origin countries, and the only programme

resembling a circular migration initiative was the UK Medical Training Initiative (MTI) of the

Academy of Medical Royal Colleges. Designed to provide short-term training opportunities for

selected postgraduate medical specialists from developing countries, this scheme -- with limited

duration and limited scope -- was criticised as a means to get cheap labour into the United

Kingdom.

• Circular migration involving short-term temporary migration back and forth between origin and

destination countries has been advocated to address this situation, but Dr Wickramasekara

shared that it had not been seriously considered by any country as an option to minimise brain

drain, while ensuring migrant rights and welfare. Circular and temporary migration for health

workers had its limitations; there were not many good examples in Australia (according to one

study, nurses were exploited under the temporary migration programme).


Suggested policy directions

• Credible immigration policies in destination countries;

• Greater transparency was required and retrospective legislation was to be avoided as in the

UK Highly Skilled Migrant Programme (HSMP) of 2004, which was found to be unfair

towards nurses and doctors;

• The need to go beyond impact assessments and document the contributions of immigrant

health professionals, as well as addressing skill recognition and brain waste;

• Better respect for rights of IHPs: equal treatment and non-discrimination as recognized by

Article 4.5 of the WHO Global Code of Practice;

• More transparency in fitness to practice procedures;

• Proper induction and orientation for IHPs on good medical practice;

• Effective collaboration between countries of origin and of destination;

• technical assistance, supporting country of origin medical training, and more opportunities

for circulation including a diaspora of health professionals in these initiatives;

• two-way flows between country of origin and country of destination, through voluntary and

partnership initiatives; and

• Promotion of social dialogue: the European Federation of Public services Unions (EPSU) and

the European Hospital and Healthcare Employers’ Association (HOSPEEM) Code Of Conduct

and follow up on Ethical Cross-Border Recruitment and Retention in the Hospital Sector was

a good practice.

Generation of better health workforce data at origin and destination

Available data is not useful for policy: countries of destination do not track outflows of national

and other health workers, and due to free EU mobility, there was no obligation to report entry or

exit from EU member states.

There is a need for strong national capacity in all countries to regularly collect, collate, analyze

and share data to inform policymaking, planning, and management. New benchmarks will be

required. Attention should be paid to aspects such as geographic distribution, retention, gender

balance, minimum standards, competency frameworks, and reflect the diverse composition of the

health workforce.

Key messages

• Immigrant health professionals face major induction and orientation problems, often neglected

by host countries.

• Two-way circular migrations of health professionals between origin and destination countries

consistent with migrant rights may be promoted for mutually beneficial migration.


Responses

Mr Basant Potnuru India Centre for Migration • Mr Potnuru summarized the main findings of Dr Wickramasekara’s paper. He highlighted the fact

that thorough research done by Dr Wickramasekara had thrown up the fact that there is an

insignificant or less-significant adverse effect on employment and wages of natives, and a

significantly positive impact on the performance of health systems and quality of health care in

the destination countries.

• Studies in the United States from the 1980s and 1990s, and in 2010 and 2012, clearly indicate that

there is no significant adverse impact on the employment opportunities and wages of natives in

the high-density immigrant areas of the country. However, there is some negative impact of the

immigration of low-skilled labour on the wages of low-skilled native workers. But overall, this has

also benefitted the economy through the lowering of industrial costs and prices of goods, which in

turn promoted the welfare of consumers.

• Thus, even in the high-density immigration areas, the macro-economic impact is positive, and

there may be negative micro impact on specific categories of people only in the short run.

However, if these findings are analysed with respect to immigration of health workers, Mr

Potnuru stated that it’s likely that even negative micro effects like those seen in the general

immigrant case will not be found, because:

• Immigration of health workers is not free flowing or something that happens under the

open market. Instead these flows are highly controlled, regulated and policy driven.

They are conscious decisions taken by the policy-makers on fixing the quotas and

numbers of international recruitment, not decisions taken by private employers

themselves; and

• The immigration of health workers is small in number and happening in the public

sector only.

• However, Mr Potnuru emphasized that even if the assumption of controlled immigration is

relaxed (i.e. the destination countries allow foreign health providers freely), in the long run this

would help the destination country. Benefits would include a significant reduction in the cost of

health care by promoting the welfare of people through transfer of surplus health-care resources

to other uses, and also through enhancement of the productivity of people due to cheap and easy

access to health care.

• With regard to the issue of poor performance of foreign medical graduates as compared to US

medical graduates, Mr Potnuru felt that this would be true in the initial period of their career in

the destination country. He added it would have been interesting if Dr Wickramasekara could

have commented on the assimilation rates of these foreign medical graduates, as compared to

their earnings in the latter part of their career in comparison with the native workers. Mr Potnuru

pointed out that US studies had revealed that the assimilation rates of immigrants are higher, as


they progress into their careers and subsequently earned higher wages than native workers in the

same profession.

• According to Mr Potnuru, policies like ethical recruitment practices are not going to help increase

the supply of health workers in the backward and deprived sections of society. This is because the

emphasis in the international fora has always been to manage migration of health workers (i.e.

redistribution of health workers in favour of the developed countries with efforts to minimise the

losses of developing source countries).

• In his opinion, the real focus should have been to enhance the capacities of supply of health

workers in the backward societies facing a health crisis, through innovative efforts to promote

adequate training and retention of health workers in those regions. Such practices would have

commanded better ethical practices than the one advocated now.

Dr Khadria

• Dr Khadria found Dr Wickramasekara’s paper excellent and he raised a few issues for reflection

and discussion. With regard to the migration of health-care professionals, he felt that the

nomenclature has changed. Earlier it was assimilation, then it was called integration -- and he

wondered if it would later be called “harmonization”. This, he believed, was due to political

economy considerations.

• Presently “brain gain” meant return migration; but his opinion was that this design camouflages

the impact of brain drain.

• India was not just a source country, but also a destination country as seen through the entry of

Bangladeshi migrants. However, Indian policy towards such migrants is not clear. According to

him, due to circular migration, migrants unfortunately were not allowed to stay even a day

beyond what was necessary. He blamed source countries, not destination countries, for the

problems faced by IHPs and felt that Indian policy-makers do not do their homework. Therefore,

there was a strong need for “equitable adversary analysis”.

• He wondered why bilateral agreements could not be multilateral agreements.

• Dr Khadria felt that there was a need to revaluate our philosophy where we think of benefits only

for the source and destination country. There should be benefits even for a third country: the

poorest of the poor. He ended by asking why there can’t be an “ILO Health Seeking Force” along

the lines of a UN Peacekeeping Force.

Dr Mehta could not be present due to unavoidable circumstances.

In the lively discussion that followed, Dr Jacob mentioned that it was imperative to take into account the

gendered dimensions of this sector, as there was a large presence of women -- especially in the lower

hierarchy of the health sector.

• In response, Dr Wickramasekara agreed with Mr Khadria that the role of migrants should not be

seen simply from the “impact perspective”, but also from the perspective of their contributions to

that nation. Dr Wickramasekara welcomed the suggestion of going beyond bilateral agreements


and looking at multilateral ones. He also noted that UK migration policies, by looking at ways to

reduce the number of migrants entering their country, had taken a narrow view point of

migration. He felt circular migration to policy-makers often meant “bringing labour without the

people”.

• Dr Sasikumar summed up the presentation and discussion by saying that there was a link between

migration and the labour market, but there is a need to go beyond the labour market impact for

health-care migrants.

• The topic of circular migration required more research, especially with regard to the

vulnerabilities that creep into it. Skill development was required, and immigration policies should

be looked at from a political economy point of view.

• Ms Vaillancourt-Laflamme summed up the sessions of the day by making the following

observations:

• The thorough political setting done by the Indian ministries representatives, the EU

representative and the ILO Director gave a good start to the morning discussions and she thanked

all of them.

• This fairly honest discussion saw a dialogue between health and labour, between the Indian

model and that of the Philippines, between research and policy, and between source and

destination countries.

• She wished she could replicate this dialogue in Europe.

Round Table Discussions Policy Implications and Recommendations

1. There needs to be a definition put to “ethical recruitment for agencies” and better work

done in this field.

2. Countries of destination need more credible policies to optimize the impact of health

professional immigration.

3. Formulation of long-run health worker immigration policies should take into account

ethical dimensions of brain drain from developing origin countries.

4. There is a need to look into skills and enhancing the skills system between the origin and

destination countries.

5. New and upcoming research should look at the employee perspective in health worker

immigration.

6. The ILO will later this year hopefully present some findings on ethical labour migration

recruitment practices.

Policy-related recommendations with regard to India

1. Need for a comprehensive national policy on migration;

2. Legislation to protect interests of health-care workers;

3. Programmes to reorient the returnee migrants within the workplace;

4. Government needs to negotiate social security agreements with destination countries; and


5. Trade unions and professional associations should be involved in the framing of bilateral

labour agreements and social protection agreements.

Policy-related recommendations with regard to the EU

1. On health migration, the EU Member States should ensure that their migration policies do

not undermine the availability of health professionals in third countries, whilst respecting

the individual freedom of movement and personal and professional aspirations; and

2. EU Member States should step up their efforts to ensure that everyone -- including migrants

-- in the EU has access to quality health service without discrimination.

Closing of the Policy Dialogue

Ms Panudda Boonpala, Deputy Director, ILO New Delhi

• In this consultation, some stimulating research on circular migration was presented. Fortunately,

a number of excellent national and international specialists were present who shared their

research in order to facilitate the dialogue.

• Ms Boonpala thanked all the ministry representatives for their collaboration with ILO. All the

resource persons, researchers, colleagues from other UN organizations and NGOs were thanked

for having prioritized spending time on this very important subject, which resulted in very

constructive and stimulating discussions -- thereby making this first-time event under this project

a success.

• She hoped it would be a win-win situation for everyone, and the ILO looked forward to working

together with all stakeholders on this very important work.

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