Ethical recruitment of health professionals – Madrid, 17th June 2011

1. Ethical recruitment of health professionals – Madrid, 17th June 2011 Coordinating spaces - The Netherlands example Dr. Remco van de Pas Wemosfoundation, The Netherlands On behalf oftheMedicusMundi International network

3. Current trends in Dutch health sector • Demographic changes (23.7 % pop. > 65 year in 2035) • Health-adjusted life expectancy inceased to 73y. • Increase health care expenditure (25% of income 2020) • Health care reform since 2006 • Government role changed from steering to safeguarding • 1.1 Billion € budget cuts public health care (2011) • Social protection changes (retirement increases to 67y.)

4. Trends in the health workforce • Duetoretirementamount of HCW willnotincrease • Care willbecome more complex duetochronicillnesses • Expectedneed of 470.000 extra HCWs in 2025 • Investments in education, self-sufficiency, carreer-opportunitiesandworkingconditions • Immigration of HCW fromoutside EU: 200 temporarylabour permits in 2008, of which 50% fromLICs • Shift fromrestrictivetowardsselectiveimmigration (Socalledcircular - or knowledge transfer migration)

5. Foreign policy andinternationaldevelopment cooperation • Change of government early 2011 • Migration important topic for current government • ODA reduced from 0.8 % to 0.7 % • Int. cooperation focus on economic development, less on poverty reduction • Thematic focus on water & food security and SRHR • Bilateral assistance on health reduced considerably, multilateral investments for health-related MDGs remain (WB, GAVI,UNFPA, UNICEF, EC, IHP+, GFATM, WHO)

7. The Dutch HRH Alliance • Created on initation by Wemos in 2009 • Recognizing the challenges on workforce development and international shortages, maldistribution and migration • Intersectoral initiative with aim to advocate and facilitate dialogue with government departments and health sector players on HRH related policies • Composed of professional associations, labour unions, INGO’s and CSOs, academia and independent experts • Shared strategic plan, policy papers and media statements, roundtable discussions, advocacy via MP

8. Implementation of the CoP and the role of civil society 1. Contributing to implementation and monitoring framework developed by WHO 2. Translation CoP, awareness raising at national level 3. Creation multisectoral HRH network and observatory 4. Stakeholder analysis and dialogue facilitation 5. Data-collection, research and monitoring 6. Development of bilateral or multilateral agreements 7. Address health governance, SDH and macro- economic conditions that are root causes for health worker migration

9. Principlesforintersectoral approach on HCW developmentandmigration • Right to health in Netherlands and in global context • Freedom of movement of health personnel • Joint responsibility for health as a global public good • ‘Health in all policies’ and ‘coherence for development’ • CoP on the international recruitment of health personnel • Self-regulation via national healthcare governance code • Sustainability and (e)quality within Dutch health system

10. Recruitment of Foreign Health Personnel Ministry of Health, Welfare and Sports National Government Ministry of Education, Culture and Welfare Ministry of Economic Affairs, Agriculture and Innovation Ministry of Social Affairs and Employment Ministry of the Interior and Kingdom Relations Ministry of Foreign Affairs International Affairs (IZ) MEVA Agency SzW Minister of Immigration and Asylum policy DGIS NZa Inspectorate Agencies CIBG UWV Werkbedrijf Executive Governmental Organizations Immigration and Naturalisation Service (IND) Labor Inspectorate (Arbeidsinspectie) Health Care Institutions (Employers) Health Workers (Employees) Social Partners StAZ Abvakabo BoZ V&VN Employer Organizations Dutch labor unions and health professional organizations KNMG O&R Health Care Governance Commission HRH – alliance RVZ Health Council Dutch Civil Society Organizations National CEG Advisory Councils Recruitment Offices WHO SER ZIP International International Organizations Capacity Body Works Council WRR EPSCO EU IOM

11. Current situation Solutions/ actions

12. Information: technical and responsibilities on HCW migration • Technical: Lack of qualitative data • Responsibilities: • MoH is responsible for bilateral agreements • MoSE is responsible for work permits • MoH is responsible for ‘Opleidingsfonds’ • MoE is responsible for numerus fixus • MoFA is concerned with migration and development, but development efforts are targeted at countries with low HDI (not where migrants come from) • SER advice on migration, brain drain and health care is not addressed to MoH

13. Conceptual model of policy implementation (Adapted from Bressers, 2004, Spratt, 2009)

14. Motivation and power

15. Motivation and power – continued

16. Motivation and power – continued

17. First conclusion of mapping stakeholders and powerrelations • Information: Responsibilities are with different actors • Motivation: • Non-matching interests between actors • Stakeholders responsible for implementation code are not highly concerned with the effect of foreign recruitment on health systems in developing countries • Interaction: Seemingly difficult to convince actors of value of making links and intersectoral agreements • What other ‘Powers’ can be targets or strategic alliant? • Eg Ministry of Finance

18. Next steps for research and advocacy • In-depth qualitative information of motivation and interaction between stakeholders: • - Agree general principles in the CoP? • Does the CoP match your goals? • Principles CoP reflected in existing Dutch Code? • Possibilities and limitations implementing CoP in NL? • Ideas stakeholders, roles, powers and responsibilities? • Ideas about incentives, monitoring and enforcement? • Writing of a publication and media involvement • Round table dialogue with ‘champions’ of health sector • Support data-collection and reporting national focal point • Exchange with other alliances and governance platforms

19. International mobility of health workers - an ethical approach For more information, find HRH dossiers at: www.wemos.nl www.medicusmundi.org remco.van.de.pas@wemos.nl