UN Code to Halt Indiscriminate Drain of Health Workers

The World Health Organization (WHO) has developed a 'global code of practice' to stem the 'brain drain' of health-care workers from developing to high-income countries, which weakens health systems in the countries they quit.

Worldwide, there are around 60 million health workers. About two-thirds provide health services; the other one-third is management and support workers. Without them, prevention and treatment of disease and advances in health care cannot reach those in need.

Against this backdrop, WHO -- a directing and coordinating health authority of the United Nations system -- has drafted a Global Code of Practice on the International Recruitment of Health Personnel, which is intended to achieve "an equitable balance of the interests of health workers, source countries and destination countries".

According to WHO, health-care workers, like workers in other sectors of the economy, tend to go where the working conditions are best. "Income is an important motivation for migration, but not the only one. Other reasons include: greater job satisfaction; career opportunities; the quality of management and governance; moving away from political instability, war, and the threat of violence in the workplace."

Brain drain is often stepwise. People tend to move from the poorest regions to richer cities within a country, and then to high-income countries. In most countries, there is also movement from the public to the private sector, particularly if there are considerable differences in income levels, states a WHO factsheet.

WHO points out that globalization has helped to trigger international migration. At the same time, demand for health workers has increased in high-income countries where not enough required personnel is being trained locally and where the existing workforce is ageing. Demand for health services is also increasing because of ageing populations and the rise of chronic illnesses like diabetes and heart disease, especially in rural areas.

In a number of middle-income countries with good health education systems -- such as Fiji, Jamaica, Mauritius and the Philippines -- a significant proportion of students, especially in nursing schools, begin their education with the intention of migrating, usually in search of a better income. Some countries, notably the Philippines, are seeking to capitalize on the demand for imported health workers by deliberately training graduates for international careers.