World Health Assembly Day 2: Drafting Committee Meets About the Code of Practice
As a member of the Global Health Council's delegation to the 63rd World Health Assembly, Amy will be blogging from Geneva this week on the discussions and vote related to the Global Code of Practice on the International Recruitment of Health Personnel. See her first post.
The "drafting committee" assigned to make revisions to the Code of Practice on the International Recruitment of Health Personnel has just broken for lunch. I imagine they will have indigestion over their sandwiches.
Sandra Kiapi (Action Group for Health in Uganda) and I went to the drafting meeting this morning, and sat against the back wall for the first 90 minutes. Until, that is, the room monitor discovered we were there and threw out us because we were only badged as civil society, not official country delegates. The explanation? "Country delegates don't want to be watched in case they want to say anything...." Wow, really?
The remarks we watched were relatively harmless discussions of issues such as How Voluntary is Voluntary? All agreed Voluntary meant Voluntary. Moving on.... Then there was discussion of monitoring and evaluation and data sources, but that petered out, as clearly there was nothing yet to monitor or evaluate. Switzerland's delegation encouraged more than once that the discussion move to debating the Articles one by one. After an hour and a half, they finally were ready to do that... but we had been tossed by then.
Nonetheless, we waited outside and queried each person as they emerged for news. Finally, at noon, the Swedish delegate informed me as she came out that the entire rest of the morning was spent (wasted) on a request from the US delegation that the word "ethical" be removed from the first article's sentence, "The objectives of this code are: a) to establish and promote voluntary principles, standards and practices for the ethical international recruitment of health personnel...."
Seriously? We can't use the word ethical in a "Code of Practice?" Does the Obama administration really want to be on record opposing "ethical" recruitment? (For a clearer view of the ethics involved, may I refer you to Ed Mills' essay in the Lancet: Mills et al. Should active recruitment of health workers from sub-Saharan Africa be considered a crime? Lancet. 2008;371:685-688.
So I waited for the U.S. delegation to emerge (they were last to come out of the room). Mark Abdoo is (according to Google) Acting Deputy Director of the Office of Global Health Affairs (under the new director, Nils Daulaire) in the Office of the Secretary of Health and Human Services. He assured me the delegation wants to pass the Code, and I informed him we would believe him when a strong Code passes the Assembly. The current trajectory is not good.
More tonight after the side event... stay tuned.
UPDATE 5/19/10, 12:26 am GMT:
The Honorable Mary Robinson, President of Realizing Rights and the former UN High Commissioner for Human Rights and President of Ireland, led a spirited pep rally for the Code of Practice tonight in the Palais des Nations (UN Headquarters). The event was organized by the Health Workforce Advocacy Initiative and its partner organizations (including HAI), originally in hopes that the Code would have passed the Assembly on Tuesday and we would be discussing how to implement it.
Sadly, while we were talking about how great it would be to have a Code, a "drafting committee" of WHA delegates was meeting two doors down to discuss the Code in a session that had bogged down completely. Delegates were nitpicking definitions of "ethical" and what it means to balance the right to migrate with the right to health. (We understand from informal reports the U.S. delegation, headed by State Department attorney Ann Blackwood, were fairly consistently obfuscatory; for example, one of their objections to the use of the word "ethical" in the code is that the word was "unnecessarily stigmatizing.")
Speakers at the Code's side event included Mary Robinson ("Shall we lock them in until they do the right thing?"), Mubashar Sheikh, director of the WHO's Global Health Workforce Alliance ("Millions of health workers need our help!"), Peggy Clark of Realizing Rights/the Aspen Institute ("The brain drain first came before the UN General Assembly in 1968"), and Francis Omaswa of the African Centre for Global Health and Social Transformation and former Global Health Workforce Alliance director ("The future belongs to civil society"). Ibadat Dhillon, also of Realizing Rights, spoke about his new guidebook on bilateral agreements that could serve to support Code implementation. I spoke on the panel about how research needs to support Code implementation.
Perhaps most moving was Anneleis Allain, of the UK's International Baby Food Action Network, who spoke about the year the World Health Assembly voted to adopt its FIRST and LAST voluntary code: The Code of Marketing of Breast-milk Substitutes. She reminded us the vote on that Code was 118 to 1, with 3 abstentions. (Can you guess who the one no vote was?) But it took many years to get the World Health Assembly to get to that vote, and she encouraged us to be persistent. She said the advocates work to pass a resolution every two years to keep the Code current with science and marketing practices, and the use the important power of shaming to call out industry practices that are inconsistent with the admittedly voluntary code. (Perhaps that is what the world's largest country involved in importing health workers from poor countries is worried about?)
The drafting committee was meeting until 11 pm tonight, and plans to reconvene at 9 am on Wednesday. I'll be hanging around outside hoping for stories to leak out of the room. While Francis Omaswa may believe the future belongs to civil society, we are still not allowed in the room while the Code sausage is being made.
More tomorrow!
(A version of this post also appeared on the Global Health Council blog.)
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