Meeting of the Technical Subgroup of the task force of International Trade in Services on the Movements of Natural persons

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Meeting of the Technical Subgroup of the task
force of International Trade in Services on the
Movements of Natural persons Mode 4OECD,
Paris, September 15-16, 2004WHO

• GATS and the migration of
• Human Resources for Health (HRH)

Dr Khassoum DialloEIP/HRHWHOGeneva
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Outline

1. GATS and the migration of health workers
2. Mode 4 Commitments for health services
3. Issues of concern
4. Beyond GATS, migration of HRH
5. HRH migration monitoring strategies
6. Data sources and indicators

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GATS and migration of SHPs Skilled Health
Professionals
General SHP migration issues
GATS/Mode 4-specific issues
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Services and commitments under Mode 4

• Mode 4

• Health Services in GATS
• Business
• Prof. Services
• h. Medical and Dental services (9312)
• 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)
• Hospital services (9311)
• Other Human health services (9319)

Services Market access National treatment
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
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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

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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?

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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)
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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
• 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
Censuses and specific surveys
Temporary flows, Recruitment Agencies, Working
Visas
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