World Health Assembly Day 5: The Code is Officially Adopted!
As a member of the Global Health Council's delegation to the 63rd World Health Assembly, Amy Hagopian has blogged 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, second, third and fourth posts.
The World Health Assembly officially adopted the Code of Practice on the International Recruitment of Health Personnel at the closing plenary on Friday evening. (Amy is in transit, so I am guest-blogging with the latest updates.)
As WHO Director-General Margaret Chan praised in her closing address, "You reached agreement on some very important items that are a real gift to public health, everywhere. Thanks to some all-night efforts, we now have a code of practice on the international recruitment of health personnel."
The Global Health Workforce Alliance (of which the Health Workforce Advocacy Initiative is a part) put out a press release for the occasion. Mary Robinson (former President of Ireland and current president of Realizing Rights) and Francis Omaswa (founding director of the Global Health Workforce Alliance and current president of the African Centre for Health and Social Transformation) wrote an article on the Code's passage on the Global Health Magazine blog.
The version of the Code that made it out of the drafting committee is here, although it may have undergone some final changes before formal adoption, so we'll post the final version once we have it.
First, we should celebrate the passage of this Code, which has been years in the making, and all the hard work that advocates have put in to make this happen.
But eventually, and sooner than later, we'll need to begin the real work of implementing the Code. Since it is a voluntary instrument, this means that health workers, advocates, civil society and anyone who wants to see improvement in health workforce numbers and conditions will need to take action to make sure that governments and others make the policy changes outlined in the Code.
More thoughts on this soon. We would love to hear reaction from others on the passage of the Code, and what this will mean moving forward!
Peggy Clark of Realizing Rights and Francis Omaswa of the African Centre for Global Health and Social Transformation in Uganda celebrate immediately after the vote for the Code of Practice on the International Recruitment of Health Personnel at the 63rd World Health Assembly in Geneva, May 20, 2010.
Here's Amy's description of how the Code was ultimately adopted:
In only the second time in its history, the United Nations' World Health Assembly plenary session voted Friday night in Geneva to adopt a voluntary code directing nations to employ more ethical practices in relation to a major international health problem. The Code of Practice on the International Recruitment of Health Personnel sets forth ten articles advising both source and destination countries on how to regulate the recruitment of health personnel in a way that mitigates damage to low-income countries struggling to meet the basic health needs of their populations in a setting of serious workforce deficits.
The Code recognizes "the severe shortage of health personnel...[which] constitutes a threat to the performance of health systems and undermines the ability ... to achieve the Millennium Development Goals." The Code takes into account both the right of health personnel to migrate, as well as the right of populations to the highest attainable standard of health.
The 63rd World Health Assembly, on its opening day on May 17, 2010, appointed a "drafting committee" to revise a draft of the Code that had previously been approved by the World Health Organization's executive board in January, 2010. The drafting committee, attended by delegates from dozens of countries, and chaired by Thailand's Ministry of Health delegate Dr. Viroj Tangcharoensathien, worked through the night until 4:30 in the morning today to arrive at a compromise that balances the interests of countries that lose and countries that gain health workers through migration.
The Code was championed by an international civil society body, the Health Workforce Advocacy Initiative, which has member organizations from countries on both sides of the sending and receiving equation who care about improving the health of people in low-income countries. It is supported by the Global Health Workforce Alliance (GHWA), which held the first global forum on human resources for health in Kampala, Uganda, in March of 2008-the event that launched international enthusiasm for a Code of Practice on this issue.
The Honorable Mary Robinson, President of Realizing Rights and the former UN High Commissioner for Human Rights and former President of Ireland, led a spirited "pep rally" for the Code of Practice Tuesday night (May 18) in the Palais des Nations (UN Headquarters).
One of the speakers at the rally for the Code was Annelies Allain, of the UK's International Baby Food Action Network, who spoke about the 1981 World Health Assembly, which voted to adopt the World Health Organization's first and, until now, only previous voluntary code of ethical practice, The Code of Marketing of Breast-milk Substitutes. The vote on that infant formula marketing code was 118 yes votes against only one "no" vote, that of the U.S. By contrast, tonight's vote was unanimous.
The United States delegation played a significant part in the negotiations in the drafting committee, however. As a major "receiving country," with 25 percent of its physicians imported from abroad (and two-thirds of them from lower income countries), the U.S. argued for a weaker Code than was preferred by delegates from African countries, which lose a large proportion of their trained doctors to European and American practices. Norway's delegation, headed by Dr Bjørn-Inge Larsen, Director-General, Norwegian Directorate of Health, was an important advocate for the interests of low-income countries. Norway developed a 2007 "framework on global solidarity" pledging to refrain from recruiting health workers from developing countries.
The Obama Administration's new director of the Office of Global Health Affairs, Dr. Nils Daulaire, headed the U.S. delegation. In a session on Wednesday at the Assembly, he was questioned about his delegation's commitment to a strong Code by a member of the Health Workforce Advocacy Initiative, and promised that the Code would be something "of which we would all be proud."
Dr. Francis Omaswa, now director the African Centre for Global Health and Social Transformation in Uganda, and formerly director of the Global Health Workforce Alliance, said after the vote that he most pleased with the results. "The world's nations have come together to do the right thing by the millions of health workers who need our help." Further, he said, civil society "played an important and critical role in moving the process towards a positive result." In addition to the Health Workforce Advocacy Initiative, the Health Worker Migration Global Policy Advisory Council, under the leadership of Mary Robinson and Peggy Clark, were involved in the effort to pass the Code.
Sandra Kiapi, Executive Director of Action Group for Health, Human Rights and HIV/AIDS (AGHA), an NGO in Uganda, said, "The Code is a great victory. However, this is just the beginning of a journey. It is now time to disseminate the Code widely among governments, recruiters, intergovernmental organizations, health professionals and other civil society organizations and all stakeholders with a view to promoting its implementation."
Anke Tijtsma of the Dutch organization, Wemos, said "We are very encouraged by the Assembly's vote tonight." She pledged "Civil society organizations will remain involved in monitoring and implementing the code, as we can play a role in holding all sectors accountable."
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very nice blog, very informative…
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