Relevance and Effectiveness of the WHO Global Code Practice on the International Recruitment of Health Personnel – Ethical and Systems Perspectives

Brugha, Ruairı́; Crowe, Sophie

doi:10.15171/ijhpm.2015.103

Cited by 14 publications

(12 citation statements)

References 11 publications

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“…As part of efforts to reverse this trend, more stringent staffing norms should be enforced to ensure that the right caliber of health trainees willing to accept postings to rural areas are recruited for training. Moreover, the WHO global code of practice on the International Recruitment of Health Personnel (2015) encourages under-staffed health systems to train and retain the health personnel they need to limit demand for international migration [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

Assessing the Impact of Community Engagement Interventions on Health Worker Motivation and Experiences with Clients in Primary Health Facilities in Ghana: A Randomized Cluster Trial

et al. 2016

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BackgroundHealth worker density per 1000 population in Ghana is one of the lowest in the world estimated to be 2.3, below the global average of 9.3. Low health worker motivation induced by poor working conditions partly explain this challenge. Albeit the wage bill for public sector health workers is about 90% of domestic government expenditure on health in countries such as Ghana, staff motivation and performance output remain a challenge, suggesting the need to complement financial incentives with non-financial incentives through a community-based approach. In this study, a systematic community engagement (SCE) intervention was implemented to engage community groups in healthcare quality assessment to promote mutual collaboration between clients and healthcare providers, and enhance health worker motivation levels. SCE involves structured use of existing community groups and associations to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements made and rewards given to best performing facilities for closing quality care gaps.PurposeTo evaluate the effect of SCE interventions on health worker motivation and experiences with clients.MethodsThe study is a cluster randomized trial involving health workers in private (n = 38) and public (n = 26) primary healthcare facilities in two administrative regions in Ghana. Out of 324 clinical and non-clinical staff randomly interviewed at baseline, 234 (72%) were successfully followed at end-line and interviewed on workplace motivation factors and personal experiences with clients. Propensity score matching and difference-in-difference estimations were used to estimate treatment effect of the interventions on staff motivation.ResultsIntrinsic (non-financial) work incentives including cordiality with clients and perceived career prospects appeared to be prime sources of motivation for health staff interviewed in intervention health facilities while financial incentives were ranked lowest. Intervention health facilities that were assessed by female community groups (Coef. = 0.2720, p = 0.0118) and informal groups with organized leadership structures like Artisans (Coef. = 0.2268, p = 0.0368) associated positively with higher intrinsic motivation levels of staff.ConclusionCommunity-based approach to health worker motivation is a potential complementary strategy that needs policy deliberation to explore its prospects. Albeit financial incentives remain critical sources of staff motivation, innovative non-financial approaches like SCE should complement the latter.

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Section: Discussionmentioning

confidence: 99%

Assessing the Impact of Community Engagement Interventions on Health Worker Motivation and Experiences with Clients in Primary Health Facilities in Ghana: A Randomized Cluster Trial

et al. 2016

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“…Little of this literature focuses on the speci c case of source country policy responses to the migration of health workers, regardless of the utilization of an explicit gender lens or not. Even international guidance for both source and destination countries from the World Health Organization (2010) in the form of its global code of practice on the international recruitment of health personnel fails to make visible sex and gender-based analyses (Bourgeault et al, 2016b;Brugha & Crowe, 2015). Invisible in particular are the perspectives in sending countries, experiences of health workers, and the lack of knowledge of gender and gender-based analysis by stakeholder decision-makers.…”

Section: Gendered Nature Of Source Country Emigration Policiesmentioning

confidence: 99%

Hiding in Plain Sight: The Absence of Consideration of the Gendered Dimensions in ‘Source’ Country Perspectives of Health Worker Migration

Bourgeault

Runnels

Atanackovic

et al. 2020

Preprint

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Background: Gender roles and relations affect both the drivers and experiences of health worker migration, yet policy responses rarely consider these gender dimensions. This lack of explicit attention from source country perspectives can lead to inadequate policy responses. Methods: A Canadian-led research team with co-investigators in the Philippines, South Africa, and India examined the causes, consequences and policy responses to the international migration of health workers from these ‘source’ countries through documentary, interview and survey data with workers and country-based stakeholders. Here we undertake an explicit gender-based analysis highlighting the gender-related influences and implications that emerged from the published literature and policy documents from the decade 2005 to 2015; in-depth interviews with 117 stakeholders; and surveys conducted with 3,580 health workers. Results: The literature on health worker migration from South Africa, India and the Philippines reveal that gender can mediate access and participation in health worker training, employment, and migration. Our analysis of survey data from nurses, physicians and other health workers in South Africa, India and the Philippines and interviews with policy stakeholders, however, reveals a curious absence of how gender might mediate health worker migration. Stakeholders in South Africa described female health workers as “preferred” for “innate” personal characteristics and cultural reasons, and in India that men are directed away from nursing roles particularly because they are considered only for women. That inadequate remuneration was identified as a key migration driver amongst survey respondents in India and the Philippines, where nurses predominated in our sample, may be linked to the impact of underlying gender-based pay inequity. The literature suggests that migration may improve social status of women nurses, but it may also expose them to deskilling, as a result of intersecting racism and sexism in their destination country. Regardless of these underlying influences in migration decision-making, gender is rarely considered either as an important contextual influence or analytic category in the policy responses.Conclusion: An explicit gender-based analysis on health worker migration could offer useful insights for health and social policy responses and emphasize the importance of equity considerations to their decisions in these countries.

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“…The authors postulated that the mere adoption of the Code was insufficient to fill the gap between high-level demands for action at the international level and the knowledge and practice of sub-national stakeholders, and called for greater advocacy and awareness of the Code at the national and sub-national levels [ 13 ]. The need for increased prioritization of the Code’s principles was emphasized by multiple studies evaluating its impact in the short-term [ 13 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

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

2016

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

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Relevance and Effectiveness of the WHO Global Code Practice on the International Recruitment of Health Personnel – Ethical and Systems Perspectives

Cited by 14 publications

References 11 publications

Assessing the Impact of Community Engagement Interventions on Health Worker Motivation and Experiences with Clients in Primary Health Facilities in Ghana: A Randomized Cluster Trial

Assessing the Impact of Community Engagement Interventions on Health Worker Motivation and Experiences with Clients in Primary Health Facilities in Ghana: A Randomized Cluster Trial

Hiding in Plain Sight: The Absence of Consideration of the Gendered Dimensions in ‘Source’ Country Perspectives of Health Worker Migration

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

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