1. Presentation by: Cédric Depollier PERC Youth Conference on Migration Baku, 10-11 September 2014

2. Presentation Outline 1. Introduction – Who we are, why are we concerned with migration? 2. Migration – the global picture, what are we facing? 3. Overview of PSI Migration Programme 4. PSI Ethical Recruitment Campaign 5. WHO Code of Practice 2

3. Public Services International Global federation of public sector trade unions, representing more than 20 million workers involved in the delivery of public services such as health, social services, utilities, municipal and state services. Represents over 7 million workers in the health and social care sectors – currently seeing an increasing phenomenon of migration. PSI promotes the right of people to quality public services across the globe as a way to fight poverty, promote equity and address inequality PSI supports opening legal channels for migration. However, migration should not replace promotion of decent work in home countries; nor to be used as a strategy for development. 3

4. Why Are We Concerned? Impact of migration on health workers, community, health systems and quality of public health services Workers’ rights – Migrant Workers’ Rights especially Women Fighting precarious work Labour migration is a trade union issue 4

5. Migration – the global picture UN estimates 214 million international migrants in 2010 (3% or world population, population size: Brazil) 90 million are economically active (ILO) ‘feminization of migration’: around 95 million women migrants Remittances: $414 billion globally in 2009 ( WB, 2011) Gender component of remittances 5

6. Impact of the economic crisis  job loss 205 million jobless in 2010 (ILO, 2011)  precarious employment currently at 1.5billion, i.e. half of global labour force migrant workers, particularly women and young workers disproportionately affected  restrictive & selective migration policies lowered quota; return migration preference for temporary skilled migration  slowing down labour migration flows / return migration  irregular migration  racism & xenophobia 6

7. Global Health Workforce Crisis Global Shortage: 4.3 million health workers (WHO, 2006) 59 million health workers worldwide, but unequally distributed between rich and poor countries 36 of the 57 countries facing critical shortage of doctors and nurses are in sub-Saharan Africa Sub-Saharan Africa -11 per cent of world population - bears 24 per cent of global disease burden - only 3 per cent of the world’s health workers Not enough health workers to meet MDG health needs 7

8. Demographic challenge By 2050, 22 per cent of the world population is projected to be 60 years or over, and 16 per cent will likely be 65 years or over (UN, 2009). 19 of the world’s 20 oldest countries in terms of population age are in Europe, and will see their populations continue to age to unprecedented levels over the next 25 years (Population Reference Bureau). Japan is the oldest country. Nearly 25 percent of people in the European Union in 2030 will be above age 65. 8

9. Demographic change and Migration While the European Union's overall population is projected to increase slightly between 2005 and 2030, the bulk of that increase will come from net immigration. Serious impact on pensions, health systems and care needs, including health & social care staff: USA shortage: 3.5 million health care workers by 2030 UK shortage: 2.5 million adult care workers by 2025 By 2050, over 3.5 million Australians are expected to use aged care services each year (Productivity Commission, 2011) Migration trend: temporary/circular migration 9

10. In short, what are we facing? Global jobs crisis, youth employment, rise in precarious work Bail-outs and austerity measures: breaking workers’ and taxpayers’ backs Attacks on human and trade union rights everywhere Deregulated, neo-liberal economic approach to labour migration – making workers ‘ultra-flexible,’ ‘hire and fire’ according to business cycle 10

11. What else are we facing? More of deregulation, privatisation, outsourcing of public services, including care services Global health workforce crisis Demographics and the increasing need for aged care Shift towards temporary/circular migration 11

12. PSI Policies on Migration EB-132 (2006) Endorsed Policy and Programme of Action on Migration in the Health Sector Congress Resolution No. 2: PSI’s Global Policy and Strategic Objectives (2008-2012) identifies migration as a frontline issue of our time (climate change as the other) Congress Resolution No. 17: “Women Health Workers and International Migration” EB-138 (2009): Endorsed Policy and Programme of Action on Migration, Development and Quality Public Services 12

13. PSI World Congress Resolution No. 2: Global Policy and Strategic Objectives Resolution No. 17: Women Health Workers and International Migration Programme Sponsors: FNV Mondiaal, Abvakabo FNV, IMPACT and ILO Actrav

14. Developed policies on key migration issues and used them to influence global, regional and national policies Policy Work Programme Sponsors: FNV Mondiaal, Abvakabo FNV, IMPACT and ILO Actrav PSI Policy and Programme of Action on Migration in the Health Sector PSI Policy and Programme of Action on Migration, Development and Quality Public Services

15. Programme Objective Strengthen the capacity of public sector trade unions in addressing the causes, impact and challenges of migration and assist migrant and potential migrant workers in the health and social care sectors through capacity building, education and information, organising and outreach, lobbying and advocacy, public campaigns, union representation and collective bargaining. 15

16. Programme Aims 1. Women health and social care workers make informed decisions about whether or not to migrate; work collectively to advocate for their rights; and receive support and protection from trade unions. 2. Enhanced capacity of public sector trade unions in influencing migration, trade and labour policies to be gender sensitive, pro-sustainable development and rights-based. 16

17. Programme Aims 3. Unions establish outreach programmes to organise, assist and empower migrant health and social care workers. 4. Unions establish collective agreements in the health and social care sectors defending job security, training and promotion, pay equity and decent work. 17

18. PSI Ethical Recruitment Campaign Adoption of the WHO Code of Practice on the International Recruitment of Health Personnel Development of regional and national codes of practice:  EPSU/HOSPEEM Voluntary Code of Practice in the Hospital Sector in the EU  Code of Practice for Recruitment of Health Workers in the Pacific  USA Voluntary Code of Ethical Conduct for the Recruitment of Foreign- Educated Nurses. Programme Sponsors: FNV Mondiaal, Abvakabo FNV, IMPACT and ILO Actrav

19. 19 PSI Statement of Principles “PSI is increasingly concerned about the negative impact on health care systems in developing countries and its impact on health care workers, the majority of whom are women. International migration should not be used as an alternative to adequate funding in public health services and decent employment conditions at home.”

20. 20

21. PSI Ethical Recruitment Campaign Ensure the application of ethical recruitment principles Operations of recruitment agencies Human rights and labour standards for all health and social care workers Shared responsibility between countries WHO Code of Practice (adopted, May 2010) EPSU-HOSPEEM Code of conduct USA Voluntary Code (Alliance for Ethical Recruitment) Code of Practice in the Pacific 21

22. History of the Code May 2004, World Health Assembly Resolution 57.19 requesting development of a code 2004-2009 – series of consultations January 2009, WHO Secretariat presented draft Code to WHO Executive Board January 2010, WHO Executive Board submitted the draft to the WHA 21 May 2010, World Health Assembly adopted the Code 22

23. Objectives of the Code To establish and promote voluntary principles and practices for the ethical international recruitment of health personnel. To serve as reference for all WHO Member States in setting legal and institutional framework To provide guidance in formulation and implementation of bilateral and international agreements To facilitate and promote international discussion and cooperation 23

24. Global in scope The Code is global in scope Sets out guidance to governments of all Member States Sets out guidance to all interested stakeholders 24

25. Ethical International Recruitment Discourages active international recruitment from developing countries facing shortages (Art. 5.1) Outstanding legal responsibility of health personnel to the health system in their own country should be considered in recruitment (Art. 4.2) These recommendations are intended for policymakers, employers and recruitment agencies 25

26. Health workforce development and health systems sustainability Addresses underlying causes of migration and makes recommendations towards health workforce development and sustainability Urges countries to implement health workforce planning, education, training and retention strategies to address their own needs and in order to reduce the need to recruit internationally 26

27. Fair treatment of migrant health personnel Emphasizes importance of equal treatment for migrant health workers and domestically trained health workers Takes on a holistic view of health workforce recruitment, that health workers should assess benefits and risks and make informed decisions Enjoyment of legal rights and responsibilities ranging from hiring, promotion, remuneration, incentives for training, education and career progression 27

28. International cooperation Mitigate negative effects of migration and maximize impact on health systems of source countries Principle of ‘mutuality of benefits’ Proposes use of bilateral and multilateral arrangements, to include support for training, technology and skills transfer, support for return migration, whether temporary or permanent Code encourages ‘circular migration’ for both origin and destination countries to benefit from knowledge and skills 28

29. Support to developing countries Highlights importance of taking into account specific needs and special circumstances of developing countries and economies in transition, notably detrimental impact of active international recruitment Encourages Member States, international organizations, donor agencies, development institutions to provide technical assistance and financial support to developing countries facing critical shortages and to assist with implementation of the Code 29

30. Data gathering Stresses need for effective national and international data and research Need to share information on international recruitment of health workers Establish and strengthen health personnel information systems, research programmes, and translate those data into effective health workforce policies and planning 30

31. Information exchange and monitoring Promotes information exchange nationally and internationally and to share information with WHO Member States encouraged to collect and provide both qualitative and quantitative information, maintain up- to-date and accessible database of laws and regulations related to recruitment and migration. Member States should designate a national authority for information and implement ationof the Code Member States to submit periodic national reports to WHO Secretariat beginning 2012. Interested stakeholders may also submit periodic national reports to WHO Secretariat (Art. 9.4) 31

32. In summary, what are the practical steps? Member State designates a national authority responsible for exchange of information on health personnel migration and implementation of the Code Member State conducts multi-stakeholder consultation on the implementation of the Code (good practice) Collaboration and partnership between Government and stakeholders (key is Social Dialogue) National periodic reporting to WHO Secretariat beginning 2012 (Member State + Stakeholders) 32

33. Global Migration Project Activities Participatory Research and Mapping of Migration in the Health and Social Care Sector (building our evidence base) Training & Capacity Building Information drives (PDK, Photo-Documentation, Materials Development) Union outreach – “Migrant Desks” Organising Advocacy & campaigns (Ethical Recruitment, Migration & Development, Dec18) Social dialogue on HRH, Migration & WHO Code of Practice Union-to-union bilateral cooperation 33

34. Advocacy and Engagement Advocacy at:  Global Forum on Migration and Development  World Trade Organization  International Organization for Migration  International Labour Organization  World Health Organization  Global Migration Group Policy advocacy and engagement at various levels brought visibility to PSI as the authority and voice of public sector trade unions in global, regional and national processes Programme Sponsors: FNV Mondiaal, Abvakabo FNV, IMPACT and ILO Actrav

35. Programme Showcase PSI’s Migration and Health and Social Care Workers Programme is a showcase of how we successfully carried out trade union outreach, research, information dissemination and organizing. Programme Accomplishments:  Actively engaged 37 affiliates in 20 origin and destination countries  Strengthened the capacity of our unions  Through union outreach and information provided in the Pre-Decision Kits and the Union Passports to Worker’s Rights, health care workers reconsidered their migration and joined the unions  Affiliates organized migrant workers and defended their rights  Unions used the argument of migration to win better salaries and conditions Programme Sponsors: FNV Mondiaal, Abvakabo FNV, IMPACT and ILO Actrav

36. Programme Showcase Ghana, Kenya, South Africa, Philippines, Australia  Mapping and Participatory Research on Migration  Training and Capacity Building  Union outreach – “Migrant Desks”  Organizing, organizing, organizing!  Social dialogue on HRH, Migration & WHO Code of Practice  Union-to-union bilateral cooperation Migrant Desk Launch South Africa, 10/10/12 GFMD - Geneva, Dec 2011 Programme Sponsors: FNV Mondiaal, Abvakabo FNV, IMPACT and ILO Actrav

37. Programme Work PSI Secretariat provided technical assistance to affiliate-driven migration initiatives  ILO-EU Decent Work Across Borders Project in the Philippines  Euro-Mediterranean Migration Project Both projects were initiatives that build our affiliates’ capacity in protecting migrant workers’ rights and promoting quality public services. Programme Sponsors: FNV Mondiaal, Abvakabo FNV, IMPACT and ILO Actrav

38. Moving Forward PSI Migration Seminar and Workshop Objectives:  Share Experiences  Exchange Best Practices  Define Strategies and Actions  Take Stock of our Achievements  Prepare for a New Set of Challenges  Define our new Migration Programme of Action for 2013-2017 Programme Sponsors: FNV Mondiaal, Abvakabo FNV, IMPACT and ILO Actrav

39. “Building Union Solidarity and Protection for Workers on the Move” Programme Sponsors: FNV Mondiaal, Abvakabo FNV, IMPACT and ILO Actrav

40. PSI-EPSU Labour Migration Project in Europe Europe & Central Asia: Russia, Armenia, Georgia and Tajikistan Collaboration with ILO ACTRAV In 2013 PSI organized a workshop in Armenia, Georgia and Tajikistan in cooperation with ILO ACTRAV (Moscow office) At each of these workshops for trade union leaders from PSI affiliates, we shared experience on labour migration, how to raise awareness on the risks of labour migration and how to improve cooperation between sending and receiving countries. At the same time, we also discussed how PSI can strengthen the capacity of affiliates in the region on trade union rights, collective bargaining and communication strategies. Of course our affiliates prefer a national labour market that provides jobs for all, instead of “promoting” migration. 2014: Follow-up (autumn 2014), workshop for young workers in each of project countries 40

41. For more information: Visit: www.world-psi.org/migration 41