Download 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”
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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
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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
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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
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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
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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
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