Reviewing the relevance and effectiveness of the WHO Global Code of Practice on the International Recruitment of Health Second meeting of the Expert Advisory Group Relevance Synthesis of the evidence from 1st round reporting National Reporting Instrument (NRI) Plus the key recommendations of the JAHWPF Dr. SALEHI ZALANI Gholamhossein DG of HRM office, Ministry of Health and Medical Education (I.R Iran ) April2015

Two sets of data we had A. Joint Action Health Workforce Planning and Forecasting (JAHWPF) (2013 till 2016) - The report on the applicability of the Code in the EU countries (Ireland, Germany and Moldova -The (almost) final handbook on planning methodologies across EU. (feasible realization of the methods) - Belgium, Denmark, UK, Finland, Spain and the Netherlands. B. National Reporting Instrument (NRI) 30 th May the data collected through the 1st round reporting on the Code implementation The instrument is distributed among voluntary participants (57 countries) from the WHO regions (EMRO, AFRO,etc) GOALS, FORECASTING MODEL, DATA SOURCES, LINK TO POLICY ACTIONS, ORGANISATION WHO Global Code of Practice on the International Recruitment of Health

The Overall Objectives 1.To synthesize the key recommendations of the JAHWPF in regard to evaluating the Relevance of the Code articles 2.To assess the NRI country reports against the Code provisions and to see whether specific elements can be mapped against the Relevance concept with specific country examples where possible.  Relevance : the extent to which the objectives, principles and articles of the Code continue to be pertinent and can inform solutions related to the global challenges of health personnel and health system strengthening.

Methodology First Stage: ▪Theme Extraction from the Code (10 Articles): 56 Main Themes ▪Theme Extraction from the Instrument: out of 14 questions 22 themes were extracted ▪Theme Extraction from the Handbook (7best practices) & the Applicability Report of the Code in some EU countries (Germany, Ireland and Moldova) Second Stage: ▪Accommodation of the Code themes with the Instrument themes ▪Accommodation of the Code themes with the Handbook & the Applicability Report themes with regard to the five dimensions of HRH planning (GOALS, FORECASTING MODEL, DATA SOURCES, LINK TO POLICY ACTIONS, ORGANISATION) Third Stage: ▪Analysis of the extracted data and their synthesis in Focus Group Discussions 1.1. Precise Translation of the Code to Persian was an essential for better understanding of its articles 2.2. Convened an Expert Committee M. Bayat S.E Mirbahaeddin A. Shokri S. alirezaei F. manafi N. bahmanziari T D

Article code% Frequency Article 1: Objectives50 Article 2 – Nature and scope0 Article 3 – Guiding principles13 Article 4 – Responsibilities, rights and recruitment practices71 Article 5 – Health workforce development and health systems sustainability 29 Article 6 – Data gathering and research50 Article 7 – Information exchange50 Article 8 – Implementation of the Code71 Article 9 – Monitoring and institutional arrangements14 Article 10 – Partnerships, technical collaboration and financial support 67 Total39  In total the instrument covers %39 of the code themes (22 themes out of 56 code themes) ▪The most focus is on article 4 (Responsibilities, rights and recruitment practices) with %71 and article 8 (Implementation of the Code) with %71. ▪the least frequencies respectively belong to article 2 (%0), article 3-Guiding principles (%13) and article 9- Monitoring and institutional arrangements (%14). How far could the instrument themes cover the Code themes? T D

Results from the NRI (Relevancy) Article 7 – Information exchange ▪Questions 11, 13, 9 D and 14 : in order to overcome global challenges (Relevancy) there is a highly essential need for collection and share of the personnel information and recruitment laws of the countries to WHO in a three years period of time and determining a responsible authority regarding the exchange of migrant personnel. Article 4 – Responsibilities, rights and recruitment practices ▪This article is covered by questions 1, 2 parts A & B & C and question 3. This article aims at promoting transparency of rights, obligations and expectations of stakeholders as a solution of global challenges (Relevancy) through legal monitoring mechanisms (to assess the benefits and risks, recruiters are obligated to individual right of the employees and provision of equal opportunities of promotion and etc) and also compliance of stakeholders in different professions with the laws as a means of solution for the ultimate goal of implementing strengthened health human resources systems and strategic plans for education and retention of the workforce (Effectiveness) T D

Relevancy frequency of the code analyzed by the Instrument QuestionsFrequencyPercent Q1: same legal rights in terms of employment and conditions of work Q4: entered into bilateral, regional or multilateral agreements Q6: programs or institutions undertaking research Q 8: steps to implement the Code Q11: database of laws and regulations related to recruitment and migration Q12: technical cooperation agreement - financial assistance Q13: mechanism or entity to maintain statistical records Q 14: mechanism or entity to regulate or grant authorization to practice to recruited Total T D

Key Points ▪The current instrument covers the code content only to some extent (%39); -therefore in order to accurately assess the relevancy of the code it is highly recommended to utilize a more comprehensive instrument  For example in Article 9 (Monitoring and institutional arrangements) most countries failed to pay attention to it - It is one of the most important items in any plan therefore lack of proper attention to this article may cause issues for the future implementations

▪%50 of the countries’ measures has pertinence (is fitting) to the code contents (perhaps had essential infrastructures for the implementation of the codes) ▪there seems to be a non-uniform status among the countries. For instance - %71 of the participant had laws for equal rights and same working conditions - %20 of countries had establishment of information database for laws and regulations and agreements on technical and financial cooperation (referring to articles 7 and 10 which have substantial role in general cooperation of countries in international recruitment)

Final note ▪While this study examines the Relevancy of the code to some extent, there are some limitations to results generalization, to name a few: - countries responded some questions in form of Yes or No, theme extraction of these measures was problematic. -it is not determined if the implemented measures of the participating countries are initiated after or before the time when the code was notified. -Only 39 percentage of the Code themes were covered by the instrument, therefore having a comprehensive analysis is unlikely

Handbook Synthesis

How far could the EU HWP measures cover the Code themes? code Total Frequency Article 1: Objectives440% Article 2 – Nature and scope770% Article 3 – Guiding principles220% Article 4 – Responsibilities, rights and recruitment practices220% Article 5 – Health workforce development and health systems sustainability880% Article 6 – Data gathering and research440% Article 7 – Information exchange550% Article 8 – Implementation of the Code110% Article 9 – Monitoring and institutional arrangements00% Article 10 – Partnerships, technical collaboration and financial support880% T

How far could the EU docs depict the Relevency of Code themes? code Total Frequencypercentage Article 1: Objectives 375% Article 2 – Nature and scope 7100% Article 3 – Guiding principles 00% Article 4 – Responsibilities, rights and recruitment practices 150% Article 5 – Health workforce development and health systems sustainability 225% Article 6 – Data gathering and research 00% Article 7 – Information exchange 480% Article 8 – Implementation of the Code 00% Article 9 – Monitoring and institutional arrangements 00% Article 10 – Partnerships, technical collaboration and financial support 113% total 1844% T