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
Effectiveness 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
- The report on the applicability of the Code in the EU
countries (seven best practices plus . Ireland,
Germany and Moldova
A. Joint Action Health Workforce
Planning and Forecasting (JAHWPF)
(2013 till 2016)
-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)
30th May 2012.
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
Effectiveness 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 Effectiveness concept with specific country
examples where possible.
Effectiveness: the extent to which implementation of the Code’s objectives, principles and
article:
- have influenced action and policies concerning the health workforce strengthening (such
as those related to health workforce implementation systems, planning education and
retention strategies) at country, regional and global levels.
- Is there evidence that are changing directives and policies aimed at strengthening human
resources for health in line with the intentions of the Code?
- What is the success of a voluntary instrument in comparison to other governance initiatives
in global health?
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
D
Methodology
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
Article code
% Frequency
Article 1: Objectives
50
Article 2 – Nature and scope
0
Article 3 – Guiding principles
13
How far could the instrument
themes cover the Code themes?
 In total the instrument covers %39 of the
code themes (22 themes out of 56 code
themes)
Article 4 – Responsibilities, rights and recruitment practices
71
▪ The most focus is on article 4
Article 5 – Health workforce development and health
systems sustainability
29
Article 6 – Data gathering and research
50
Article 7 – Information exchange
50
Article 8 – Implementation of the Code
71
▪ the least frequencies respectively belong to
Article 9 – Monitoring and institutional arrangements
14
article 2 (%0), article 3-Guiding principles
67
(%13) and article 9- Monitoring and
39
institutional arrangements (%14).
Article 10 – Partnerships, technical collaboration and
financial support
Total
D
(Responsibilities, rights and recruitment
practices) with %71 and article 8
(Implementation of the Code) with %71.
T
Examples for Results from the NRI (effectiveness)
▪ Article 8 – Implementation of the Code
▪ Article 8 is one of the articles in focus of the instrument as it can be seen in questions 8 and 9 all parts of A, B, C, D,
E and concentrates on the effectiveness (strategic plans of education and retention) through the encouragement of
informing of code implementation, involving stakeholder by consulting in recruitment decisions, provision and update
of recruitment records and utilization of recruitment agencies that comply with the guiding principles of the Code.
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)
D
T
Effectiveness frequency of the code analyzed by the Instrument
Questions
Frequency
100 %
Effectiveness-1
Effectiveness (1): have influenced
action and policies concerning the
health workforce strengthening (such
as those related to health workforce
implementation systems, planning
education and retention strategies)
at country, regional and global levels.
Effectiveness (2): Is there evidence that
are changing directives and policies
aimed at strengthening human
resources for health in line with the
intentions of the Code?
Effectiveness (3): What is the success
of a voluntary instrument in
comparison to other governance
initiatives in global health?
Q2
Percent
(mechanism for same legal rights )
Q2-a: using mechanisms to assess the benefits and risk
Q2-b: promoted and remunerated based on objective criteria
Q2-c:same opportunities to strengthen their career progression
Q2-d: other mechanism
Q3
Q3: evidence of the legal mechanisms identified in Q(2)
Q5
Q5:describe the bilateral, regional or multilateral agreements
Q7
Q7: details about institutions undertaking research
Q9
Q9-a: communicate and share information on recruitment and
migration issues
Q9-b: involve all stakeholders in any decision-making processes
Q9-c: introduce changes to laws or policies on recruitment
Q9-d: recruiters authorized by competent authorities
Q9-e: Good practices are encouraged and promoted among
recruitment agencies
Q9-f: other steps have been taken
Q10
Q10: main constraints to the implementation
Effectiveness-2
Effectiveness-3
8
15
0
0
0
8
12
12
14
14
0
0
0
15
22
22
26
26
4
4
16
28
7
7
34
52
18
19
33
35
12
12
22
22
8
0
0
15
0.00
0.00
0.00 %
0.00 %
Total
20 %
Key Points
▪ The current instrument covers the code content only to some extent
(%39);
- therefore in order to accurately assess the effectiveness 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
- one of the most important items in any plan and may cause issues for the future plans
to be implemented
Key Points
▪ Regarding three components of effectiveness there were no specific
evidences in change of actions or policies
- Hence countries require extensive encouragements to legalize the code imperatives
through national laws and policies and also innovative national-specific plans.
- in monitoring legal mechanisms they are short of effective measures (Article 4).
Final note
▪ While this study examines the Effectiveness 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, therefore 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
Article 1: Objectives
Article 2 – Nature and scope
Article 3 – Guiding principles
Article 4 – Responsibilities, rights and
recruitment practices
Article 5 – Health workforce development and
health systems sustainability
Article 6 – Data gathering and research
Article 7 – Information exchange
Article 8 – Implementation of the Code
Article 9 – Monitoring and institutional
arrangements
Article 10 – Partnerships, technical
collaboration and financial support
Total Frequency of the
countries
4
7
40%
70%
2
20%
2
20%
80
80%
4
5
1
40%
50%
10%
0
0%
8
80%
T
How far could the EU docs depict the effectiveness of Code themes?
Total Frequency of the
countries
percentage
Article 1: Objectives
Article 2 – Nature and scope
Article 3 – Guiding principles
Article 4 – Responsibilities, rights and
recruitment practices
Article 5 – Health workforce
development and health systems
sustainability
Article 6 – Data gathering and research
Article 7 – Information exchange
Article 8 – Implementation of the Code
Article 9 – Monitoring and institutional
arrangements
1
0
2
%25
%0
%100
1
%50
6
75%
4
1
1
100%
20%
100%
0
0%
Article 10 – Partnerships, technical
collaboration and financial support
7
total
23
code
88%
56%
T