Transcript TSG/1/11
GATS and the migration of Human Resources for Health (HRH) Meeting of the Technical Subgroup of the task force of International Trade in Services on the Movements of Natural persons – Mode 4 OECD, Paris, September 15-16, 2004WHO Dr Khassoum Diallo EIP/HRH WHO Geneva Outline 1. 2. 3. 4. 5. 6. GATS and the migration of health workers Mode 4 Commitments for health services Issues of concern Beyond GATS, migration of HRH HRH migration monitoring strategies Data sources and indicators 2 GATS and migration of SHPs* * Skilled Health Professionals General SHP migration issues GATS/Mode 4-specific issues 3 Services and commitments under Mode 4 Mode 4 Health Services in GATS 1. A. Business Prof. Services Services Market access h. Medical and Dental services (9312) 1.A.h 32 Unbound 1 None 11 Measures 39 Unbound 5 None 11 Measures 1.A.j 23 Unbound 0 None 8 Measures 21 Unbound 2 None 7 Measures j. Services provided by midwives, nurses, physiotherapists and paramedical personnel (93191) 8. Health related and social services (other than those listed under 1.A.h-j) A. B. Hospital services (9311) Other Human health services (9319) National treatment 4 Issues of concern "Unbound" commitments : Do they influence stocks and flows What basic evidence exist ? What can we learn from it? How do we create new evidence? What evidence for policy makers on the impact of GATS on health systems or on economy What for further negotiations Time issue 5 Beyond GATS: Migration of health workforce What is the size of the problem? What is the impact of HRH migration on developing countries health systems and labour markets? What policy responses have there been? What strategies for monitoring HRH migration? 6 Other areas of interest Flows of HRH: Numbers Types (disaggregated) Length of stay Financial flows: Value of trade Remittances Investment in training Impact on health system performance & financing Salary levels Structure of the labour market Barriers/facilitators Human resource strategies (methods of recruitment) Financial compensation mechanisms ?? Impact of other sectors Definition of “temporary” 7 Decision to migrate Probability of employment at destination Probability of not being deported Relative earnings if employed at destination Probability of employment at community of origin Total costs of movement (financial and psychological) From Stalker (2000) 8 Strategies to monitor HRH migration - 1 Receiving countries: Formal registration Data source : Regulatory bodies and professional associations registries Number and % of foreign workers by occupation Considering inter-country agreements 9 Strategies to monitor HRH migration-2 Sending countries: Voluntary "Exporters" Formal registration and recording Data source : Governments, HTIs, Regulatory bodies and professional associations, Recruitment agencies based in the country Number of workers sent abroad by occupation: Ratio vs. current staff or vs. outputs Considering inter-country agreements 10 Strategies to monitor HRH migration - 3 Sending countries: Non-Voluntary "Losers" No formal registration and recording Data source : Governments, Private health sector records Strategy 1: Statistics from main receiving countries (e.g. represents 80% of external workers. Strategy 2: Attrition-based 1. Big Assumption: The remaining is expected to be international migration 11 Other data sources Prof. Assoc & Regulatory bodies registers Institutional data e.g. schools, health Facilities, MoH GATS mode 4 Temporary flows, Recruitment Agencies, Working Visas Censuses and specific surveys Immigrant community associations 12 Potential Indicators Inflows and outflows (numbers or ratios) Skill-mix of health migrants Share of migrants workers in national HRH (numbers or %) Duration of stay (plan/entitlement) Country of origin or destination Level of HRH unemployment in country of origin Remittances 13