Notes on IH Section Conference Call: Discussion of the Global Code of Practice on the International Recruitment of Health Personnel (April 11, 2011)

The IH Section held its second topic-focused conference call on the Global Code of Practice on the International Recruitment of Health Personnel on Monday, April 11, 2011 from 1:00 to 2:00 EST.  We had several excellent speakers and panelists and a very productive discussion.  Unfortunately, due to members of leadership being unavailable due to travel and limited connectivity, the call experienced some technical difficulties.  Many attendees who called in to listen may have missed the discussion due to its late start; therefore, we have posted a detailed summary of the discussion (graciously recorded by Dr. Amy Hagopian) here for those interested.

John Palen (Sr. Technical Advisor, State Department’s Office of the Global AIDS Coordinator)
Pascal Zurn (World Health Organization’s Global Health Workforce Alliance team)

Polly Pittman (George Washington University),
Cheryl Peterson (American Nursing Association),
Estelle Quain (USAID), and
Anke Tijtsma (Netherland’s Wemos organization)

Moderator and note-taker: Amy Hagopian (University of Washington)

We opened with Pascal describing the process so far, and how WHO is organizing to update member States at this year’s upcoming World Health Assembly. John talked about how the U.S. is organizing to respond to the guidelines and prepare data reports. He also noted the numerous HRH activities supported by the PEPFAR mechanism to train and retain health providers in PEPFAR supported countries.

Polly updated us on the pace of medical immigration to the U.S. in the last year or two. While physician migrants are up (pushing 30% of the total number of US physicians now), nurse migration is currently down. Clinical auxiliary personnel are immigrating at a greater pace (lab scientists, PTs, OTs). These latter personnel, along with nurses, are coming from the Philippines, Canada and Mexico, among other places. The Alliance for Ethical International Recruitment Practices is getting organized now, however, for the coming influx of nurses that is anticipated when the economy improves in the U.S. For-profit recruiting firms are also gearing up.

Cheryl talked about the role of labor in keeping working conditions strong in the U.S., and protecting the rights of immigrant health workers.

There was a question about whether there might a role for the Alliance as a part of the National Authority process.

Estelle said the Global Health Initiative continues to have a focus on human resources for health as a part of health system strengthening. The focus of USAID and the PEPFAR side of the U.S. government, is on the “push factors” motivators such as source country working conditions, wages and supervision.

Anke talked about how the Netherlands is responding. The Ministry of Health will be the reporting authority, which was transmitted to the WHO months ago. There is a role for labor unions and professional organizations as well. After the Code was translated to Dutch, a meeting was organized at the Hague to inform national stakeholders about the content of the Code and what will be expected of each party. They are now working on data flows, and revisions to law and regulation. Anke did express concern that the “other stakeholders” page of the reporting form from WHO was a little too brief and unfocused.

Pascal confirmed that WHO plans to hold conversations with interested member States (such as the U.S.) to offer guidance on how to complete the reporting form, after the web hearing is completed on April 17.

Polly and others noted there is a bifurcation in the U.S. government of people working on the Push factors and those working on the Pull factors pertaining to health workforce immigrants. There is a strong need to bring together these parties. The significant number of U.S. medical residency training positions (that exceeds the number of medical school graduates by about a third) creates a strong pulling force on medical migrants, and there has been no discussion about addressing this. (To the contrary, one of last summer’s health reform bills called on an expansion of the residency training program in the U.S.)

John called our attention to the proliferation of private for-profit training schools in Southeast Asia, creating further fodder for the migration stream.

We discussed where the discussion should take place, and there was consensus that HRSA (Health Resources and Services Administration) was the most probably agency to host discussions about the combination of push and pull factors that create health worker migration flows. Further, there is a strong need to generate appropriate data for reporting purposes, some of which is now only in the private sector and not organized. HRSA can address all these issues, given its portfolio of work. There is also probably a role for universities on the data, research and reporting side.

Amy noted that neither the State Dept nor HHS had responded to either letter sent to them (one from the “community of interest” and one from APHA). The APHA also has a resolution endorsing the Code.

Note: We discovered later that there Nils Daulaire, from HHS, has issued a letter in response to Dr. Benjamin’s letter on the Code of Practice.  We are very grateful to our excellent speakers and panelists, and to Dr. Hagopian for organizing and moderating this call.  Many thanks to our members who called in to listen – please call in for our June discussion!

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