National Reporting Instrument

The WHO Global Code of Practice on the International Recruitment of Health Personnel (“the Code”) was adopted by the 63rd World Health Assembly (WHA Res 63.16) in 2010 to strengthen the understanding and ethical management of international health personnel recruitment through improved data, information, and international cooperation. 

The Code was developed after a six-year negotiation process to address the growing concerns of the adverse effects of international migration of health personnel on source countries.

The Code provides ethical principles for the international recruitment of health personnel in a manner that strengthens the health systems of countries, transitional economies and small island states.

The Code is non-binding in nature but applies to Member States as well as all relevant stakeholders (health personnel, recruiters, employers, health professional organizations, relevant organizations, public, private and non-government sectors). Although adoption of the Code is voluntary, Member States are required to report on the implementation every three years. To date, Member states were asked to report using the National Reporting Instrument in 2012, 2015 and 2018. 

The objectives of the code are to:

1. Establish and promote principles and practices for the ethical international recruitment of health workers taking into account the rights, obligations and expectations of source countries, destination countries and migrant health personnel.
2. Serve as a reference for all Member States to strengthen legal and institutional frameworks for the international recruitment of health personnel.
3. Provide guidance in the development of bilateral and international agreements to minimize the adverse effects of health personnel migration.
4. Promote international discussion and advance cooperation on matters related to the ethical international recruitment of health personnel as part of strengthening health systems, with a particular focus on the situation of developing countries

The guiding principles of the Code are as follows:

1. Member States should take the Code into account when developing their national health policies and cooperating with each other.
2. Voluntary international principles and the coordination of national policies on international health personnel recruitment are desirable to equitably strengthen health systems worldwide, mitigate the negative effects of health personnel migration on the health systems of developing countries, and safeguard the rights of health personnel.
3. The specific needs of countries, especially developing countries and transitional economies with health workforce vulnerabilities and capacity limitations to implement the Code, should be considered. Developed countries should provide technical and financial assistance to these countries to strengthen health systems, including health personnel development.
4. The right to the highest attainable standard of health of the populations of source countries and individual rights of health personnel to leave any country in accordance with applicable laws needs to be taken into account.
5. International recruitment of health personnel should be conducted in accordance with the principles of transparency, fairness and promotion of sustainability of health systems in developing countries. 
6. Member States should strive, to the extent possible, to create a sustainable health workforce and work towards establishing effective health workforce planning, education and training, and retention strategies to reduce their need to recruit migrant health personnel. 
7. Effective gathering of national and international data, research and sharing of information on international recruitment of health personnel are needed to achieve the objectives of this Code.
8. Member States should facilitate circular migration of health personnel to that both source and destination countries benefit from their skills and knowledge.

Ethical international recruitment: The Code discourages the active recruitment of health personnel from countries facing critical shortages of health personnel.

Monitoring the implementation process: Member States should periodically report measures taken on the implementation of the Code, results achieved, difficulties encountered and lessons learnt to the WHO Secretariat. The WHO Director-General will subsequently report to the World Health Assembly on the effectiveness of the Code implementation in achieving its stated objectives and make suggestions for improvement. 

As per Article 7 of the Code, the WHO Director General is mandated to report on the Code implementation to the World Health Assembly every 3 years. 

Developed by the WHO Secretariat, the National Reporting Instrument (NRI) is a country-based, self-assessment tool for information exchange and monitoring of the Code implementation and associated challenges. The WHO Secretariat collates and analyzes the data collected by the NRI to report findings to the World Health Assembly.

The WHO Director General reported the latest progress report on implementation of the Code to the 72^nd World Health Assembly in May 2019 (72/23) based on the findings of the third round of the National Reporting. The findings from the 4th Round of National Reporting will be presented at the 75th World Health Assembly in May 2022.  

The information received from Member States through the NRI also helps WHO to identify areas requiring technical assistance, to coordinate between countries and stakeholders, and to provide informed advice and recommendations on policies related to health personnel mobility that eventually benefit all countries in their path to Universal Health Coverage (UHC).

As per Article 7 of the Code, the Designated National Authority (DNA) is the nominated individual by each Member State who has been authorized to share information on the implementation of the Code and data on international health personnel migration, both nationally and internationally. A registry of DNA is maintained by the WHO Secretariat that is regularly updated before sharing the new rounds of the NRI.

The WHO Secretariat communicates with the DNA from each Member State to report on the implementation of the Code and to liaise with National Health Workforce Accounts (NHWA) focal point on health personnel migration data for consolidated reporting to WHO. The NHWA is a system by which countries progressively improve the availability, quality, and use of health workforce data through monitoring of a set of indicators to support achievement of UHC, Sustainable Development Goals (SDGs) and other health objectives. More information on the NHWA focal points are communicated to DNAs directly and also through the WHO regional and country offices.

Following the decision of the 73rd World Health Assembly on the WHO Global Code of Practice (73/9), the WHO Secretariat updated the list of countries for targeted health workforce-support and safeguards to be used in conjunction with the Code.  It replaces the list of countries facing critical shortage of health workforce as identified by the 2006 World Health Report and will be updated every 3 years.

The countries in the Health Workforce Support and Safeguard List, 2020 have a UHC Service Coverage Index lower than 50 and health workforce (doctors, nurses and midwives) density below the global median of 48.6 per 10,000 populations. 

The countries in the Health Workforce Support and Safeguard List should be prioritized for health personnel related development and health systems support, and provided with safeguards that discourage active international recruitment of health personnel.

Furthermore, it is recommended that any government-to-government agreement on health worker mobility from these countries should be:

1. Informed by a health labour market analysis to ensure adequate domestic health workers supply in countries;
2. Explicitly engage health sector stakeholders, including ministries of health, in the dialogue and negotiation of relevant agreements; and
3. Be notified to the WHO Secretariat through the respective National Health Workforce Accounts and Code reporting mechanisms.