1. Meeting of the Technical Subgroup of the task force of International Trade in Services on the Movements of Natural persons – Mode 4 OECD, Paris, September 15-16, 2004WHO GATS and the migration of Human Resources for Health (HRH) Dr Khassoum Diallo EIP/HRH WHO Geneva

2. 2 Outline 1.GATS and the migration of health workers 2.Mode 4 Commitments for health services 3.Issues of concern 4.Beyond GATS, migration of HRH 5.HRH migration monitoring strategies 6.Data sources and indicators

3. 3 GATS and migration of SHPs * * Skilled Health Professionals General SHP migration issues GATS/Mode 4-specific issues

4. 4 Services and commitments under Mode 4 zHealth Services in GATS 1.Business A.Prof. Services h. Medical and Dental services (9312) j. Services provided by midwives, nurses, physiotherapists and paramedical personnel (93191) 8. Health related and social services (other than those listed under 1.A.h-j) A.Hospital services (9311) B.Other Human health services (9319) ServicesMarket access National treatment 1.A.h 32 Unbound 1 None 11 Measures 39 Unbound 5 None 11 Measures 1.A.j 23 Unbound 0 None 8 Measures 21 Unbound 2 None 7 Measures z Mode 4

5. 5 Issues of concern z "Unbound" commitments : Do they influence stocks and flows zWhat basic evidence exist ? What can we learn from it? How do we create new evidence? zWhat evidence for policy makers on the impact of GATS on health systems or on economy z What for further negotiations z Time issue

6. 6 Beyond GATS: Migration of health workforce  What is the size of the problem?  What is the impact of HRH migration on developing countries health systems and labour markets?  What policy responses have there been?  What strategies for monitoring HRH migration?

7. 7 Other areas of interest zFlows of HRH: yNumbers yTypes (disaggregated) yLength of stay zFinancial flows: yValue of trade yRemittances yInvestment in training zImpact on health system performance & financing zSalary levels z Structure of the labour market z Barriers/facilitators z Human resource strategies (methods of recruitment) z Financial compensation mechanisms ?? z Impact of other sectors z Definition of “temporary”

8. 8 Decision to migrate zProbability of employment at destination zProbability of not being deported zRelative earnings if employed at destination z Probability of employment at community of origin z Total costs of movement (financial and psychological) From Stalker (2000)

9. 9 Strategies to monitor HRH migration - 1 Receiving countries: yFormal registration y Data source : Regulatory bodies and professional associations registries y Number and % of foreign workers by occupation yConsidering inter-country agreements

10. 10 Strategies to monitor HRH migration-2 Sending countries: Voluntary "Exporters" yFormal registration and recording y Data source : Governments, HTIs, Regulatory bodies and professional associations, Recruitment agencies based in the country y Number of workers sent abroad by occupation: Ratio vs. current staff or vs. outputs yConsidering inter-country agreements

11. 11 Strategies to monitor HRH migration - 3 Sending countries: Non-Voluntary "Losers" yNo formal registration and recording y Data source : Governments, Private health sector records yStrategy 1: Statistics from main receiving countries (e.g. represents 80% of external workers. yStrategy 2: Attrition-based 1.Big Assumption: The remaining is expected to be international migration

12. 12 GATS mode 4 Censuses and specific surveys Prof. Assoc & Regulatory bodies registers Temporary flows, Recruitment Agencies, Working Visas Immigrant community associations Institutional data e.g. schools, health Facilities, MoH Other data sources

13. 13 Potential Indicators z Inflows and outflows ( numbers or ratios ) z Skill-mix of health migrants z Share of migrants workers in national HRH ( numbers or % ) z Duration of stay (plan/entitlement) zCountry of origin or destination z Level of HRH unemployment in country of origin zRemittances