Next week, the Executive Board of the WHO will be voting on the “Global Code on International Recruitment of Health Personnel“, which is voluntary, non-binding legislation that will define standards for the international recruitment of health workers, generally from the poorer countries to the richer countries. While interest in such legislation has been recognized for many years, this topic has only received a lot of mainstream attention in recent years due to the increased awareness of low health worker levels in many poor countries, in particular sub-Saharan African countries.

In this week’s Lancet, a news report chronicles the plight of health worker migration from the Philippines, a country that has used the exportation of health workers as an explicit domestic strategy for increasing remittances, education, and lowering unemployment. While most takes I have seen on the Philippines model tend to present the Filipino strategy as a sort of win-win for the country, the health workers, and the receiving countries, this report raises mostly concerns about this strategy, by trying to link the export strategy with poor health care access issues in the Philippines:

“Although Filipino health workers have become one of the country’s most valuable exports, sending billions of pesos back to the Philippines as remittances and taxes, their exodus is crippling the domestic health system.”

While I don’t doubt that much of what this article argues is true, I do caution about jumping to its conclusion: it is the exodus of health workers that is causing poor health system performance in the Philippines. The real question should be: what would the health care situation be like in the Philippines without this practice? The positives from this strategy must also be considered. Other factors of the Filipino system should also receive as much scrutiny as this export strategy as a potential cause of the poor performance of the health system. For example, is the poor level of goverment expenditure hinted at in the article a cause of both the poor performance and the high levels of expressed desire of health workers to move abroad?

So is this new legislation a good thing? I had the chance to read through the text of the draft proposal that will be discussed next week. Most of it seems quite innocuous to me, and some of it even seems to make a great deal of sense. Here are a few examples:

“..migrant health personnel enjoy the same legal rights and responsibilities as the domestically trained health workforce in all terms of employment and conditions of work.” This seems like a nice thing to aspire to.

“In accordance with the principle of mutuality of benefits, both source and destination countries should derive benefits from international recruitment of health personnel.” Perhaps.

And of course, my personal favorite: “Member States should recognize that the formulation of effective policies on the health workforce requires a sound evidence base.” Yes, yes, yes.

I think the more relevant question is: will this code will have any impact at all? To what extent can voluntary, non-binding legislation have much impact? Will non-governmental entities, which frequently do a great deal of the recruitment, alter their behavior in any way? Will the basic standards be enforced when needed? Does international recruitment equal the same thing as someone who wants to migrate abroad going abroad?

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