Global code aims to ensure benefits of migration are evenly distributed

At the end of this month the World Health Organization (WHO) will review the comments made on its draft Global Code of practice for the international recruitment of health workers following a month of public consultation. This amended draft will then be considered by the WHO’s Executive Board in January 2009.

If implemented, this code will be only the second code to be accepted by the World Health Assembly in 27 years, highlighting the importance given to the issue of health worker migration. The only code yet to have been passed by the World Health Assembly concerns the ethical marketing of breast milk substitutes.

The draft Global Code was discussed at a meeting of the Health Worker Migration Initiative Global Policy Advisory Council at the Commonwealth’s headquarters in London, UK. This is the third meeting since the group was formed in May 2007 in Geneva.

The meeting, which took place on 18 and 19 September 2008, was jointly organised by WHO, the Global Health Workforce Alliance (GHWA), and Realizing Rights: the Ethical Globalization Initiative.

“It is a privilege to be a part of such a historic event,” said Dr Francis Omaswa, Executive Director of GHWA, who was co-chair of the meeting with Mary Robinson, President of Realizing Rights and the former President of the Republic of Ireland.

The final draft will be submitted to the WHO’s decision-making body on 30 September for review.

At this meeting the council made a number of suggestions for amending the draft code, which will be documented in a formal submission to the WHO on behalf of all their members. It was felt that amendments were necessary to better reflect the concerns of source countries, to establish the health worker crisis as an important contributory factor to the need for this code, and to give better guidance for the implementation of the code.

Peggy Vidot, Health Adviser at the Commonwealth Secretariat, asserted that the draft code did not sufficiently balance the needs and concerns of Commonwealth source countries, stating that “the Global Code must explicitly refer to the need to protect health systems in developing countries.”

The rights of the migrants were also discussed and the council members agreed that the code should emphasise the need for destination countries to safeguard the rights of the health worker migrants, and also that the destination and source countries must act to facilitate the migrant’s return to their home country should they wish to return.

Council members stressed that the code is only part of the solution to the severe shortages of health workers facing many source countries, and that any sustainable and effective solution must focus holistically on health systems strengthening. The council also asserted that the code should form the basis to negotiate other laws which govern the migration of health workers.

The council stated it would help with the process of developing the abilities of countries to implement this code.

“The right to health is being seriously compromised because of an estimated 4.2 million health workers shortage worldwide,” said Commonwealth Secretary-General Kamalesh Sharma.

Speaking at the opening of the meeting, he noted that “this is possibly the most profound problem health systems are facing and the crisis is most acutely felt in Sub-Saharan Africa.”

Mr Sharma pointed out the Commonwealth stands to benefit significantly from the implementation of the International Code of Practice on Health Worker Migration as 17 of the 51 most affected countries in the world are members of the Commonwealth.

“Commonwealth countries have long complained of the targeted recruitment of its health workers, starting in the 1990s,” he said.

Ms Robinson advised the group that essential to reviewing the draft code is an understanding of the strain that this type of ‘brain drain’ has on vulnerable health systems such as in Sub-Saharan Africa which has the highest HIV/AIDS cases in the world.

“In our work at Realizing Rights we focus a lot on strengthening health systems in the poorest countries, but you cannot strengthen health systems without health workers,” she said.

Elisabeth Sterken, National Director of International Baby Food Action Network in Canada, which was instrumental from the civil society standpoint in the drafting and adoption of the international code of marketing breast milk substitutes that was eventually passed by the WHO in 1981, was invited to share the challenges they have faced keeping this code alive and up-to-date for 27 years.

Ms Sterken said: “I can’t really emphasise how important implementation is and the challenges that persist up to this day on that topic. The monitoring component is equally critical and these need to be put into the code itself.”

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