1. Code of Practice: Toward Implementation Eric B. Williams Health Workforce Advocacy Initiative Physicians for Human Rights

2. Outline Introduction to HWAI Realities and Tensions Timeline What is the Code of Practice? Approved Code Norway Example Considerations on Implementation

3. Health Workforce Advocacy Initiative (HWAI) Established in 2007 Currently supported by the Global Health Workforce Alliance International civil society coalition Core focus areas: – Right to health – Adequate financing (new and sustained) – Empowering civil society Focus on health workers to strengthen health systems All people should have access to skilled, motivated and supported health workers. Physicians for Human Rights serves as the secretariat

4. Realities and Tensions Global shortage of health personnel – in developed and developing nations – Ethiopia vs. Washington DC – Half of all trained doctors in Ghana lost 604 (1993-2002) – U.S. health reform more 32 million people Aging populations and increased demand Challenge: “between two fundamental rights” ❶ Health workers have the right to migrate ❷ People from source countries have a right to health

5. Timeline 29 years (1981 – 2010) Code Implementation International Code of Marketing of Breastmilk Substitutes (1981, WHA) Global Code of Practice on the International Recruitment of Health Personnel (2010, WHA) WHA57.19: Member States call for Cod e of Practice (2004, WHA) 6 years

6. What is the Code of Practice? “Global Code of Practice on the International Recruitment of Health Personnel” Voluntary (non-binding) Ethical principles to address health worker movement Code Structure Objectives (Article 1)Nature and Scope (Article 2) Guiding Principles (Article 3) Responsibilities, rights, recruitment practices (Article 4) Health Workforce Development and health systems sustainability (Article 5) Data Gather and Research (Article 6) Information Exchange (Article 7) Implementation of the Code (Article 8) Monitoring and Institutional Arrangement (Article 9) Partnerships, technical assistance and financial support (Article 10)

7. Code Intact, yet important edits Three examples: 1.From “should” to “encourage” 2.Article 11.4 Voluntary financial mechanisms supportive of efforts of developing countries and countries with economies in transition to strengthen health systems, including health personnel development, should be explored. 3.Article 9.2 (8.2) Member States should establish and maintain an effective legal and administrative framework at the local and national level, as appropriate, to give effect to the code. Article 8.2 (9.2) Member States are encouraged to incorporate the Code into applicable laws and policies.

8. Norway Example Norway will strengthen efforts to analyze and plan future national health personnel needs Plans will be prepared showing how Norway is to obtain the necessary health personnel. The plan shall be updated regularly on the basis of new data and changes in needs and conditions Compliance with the plan shall be monitored Main rule is that Norway shall fund the training of the health workers who work within the country’s borders Norwegian employers shall not actively recruit health workers in countries that lack health workers. Nor shall recruitment firms or others who do this be used by Norwegian employers

9. Implementation Greater awareness around Code Greater civil society engagement National data collection – “Report card” for data measures on key indicators – Is there a way to include both public and private sectors under one reporting rubric? – How can licensure data be used to track health workers?

10. Implementation (continued) Under-employment of health workers in source countries Address issues of conditionalities Prepare data sharing and systems for first data report for 2012 (Article 7.2c) Work with governments to identify national authority that will report on Code implementation Identify new and sustained financial resources to support Code implementation and monitoring

11. THANK YOU / GRACIAS