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Migration and Women Health Workers


PERC Youth Conference on Migration Baku, 10-11 September 2014 Presentation by: C dric Depollier – PowerPoint PPT presentation

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Title: Migration and Women Health Workers

PERC Youth Conference on Migration Baku, 10-11
September 2014
Presentation by Cédric Depollier
Presentation Outline
  • Introduction Who we are, why are we concerned
    with migration?
  • Migration the global picture, what are we
  • Overview of PSI Migration Programme
  • PSI Ethical Recruitment Campaign
  • WHO Code of Practice

Public Services International
  • Global federation of public sector trade unions,
    representing more than 20 million workers
    involved in the delivery of public services such
    as health, social services, utilities, municipal
    and state services.
  • Represents over 7 million workers in the health
    and social care sectors currently seeing an
    increasing phenomenon of migration.
  • PSI promotes the right of people to quality
    public services across the globe as a way to
    fight poverty, promote equity and address
  • PSI supports opening legal channels for
    migration. However, migration should not replace
    promotion of decent work in home countries nor
    to be used as a strategy for development.

Why Are We Concerned?
  • Impact of migration on health workers, community,
    health systems and quality of public health
  • Workers rights Migrant Workers Rights
    especially Women
  • Fighting precarious work
  • Labour migration is a trade union issue

Migration the global picture
  • UN estimates 214 million international migrants
    in 2010 (3 or world population, population size
  • 90 million are economically active (ILO)
  • feminization of migration around 95 million
    women migrants
  • Remittances 414 billion globally in 2009 (WB,
  • Gender component of remittances

Impact of the economic crisis
  • job loss
  • 205 million jobless in 2010 (ILO, 2011)
  • precarious employment
  • currently at 1.5billion, i.e. half of global
    labour force
  • migrant workers, particularly women and young
    workers disproportionately affected
  • restrictive selective migration policies
  • lowered quota return migration
  • preference for temporary skilled migration
  • slowing down labour migration flows / return
  • irregular migration
  • racism xenophobia

Global Health Workforce Crisis
  • Global Shortage 4.3 million health workers (WHO,
  • 59 million health workers worldwide, but
    unequally distributed between rich and poor
  • 36 of the 57 countries facing critical shortage
    of doctors and nurses are in sub-Saharan Africa
  • Sub-Saharan Africa -11 per cent of world
    population - bears 24 per cent of global disease
    burden - only 3 per cent of the worlds health
  • Not enough health workers to meet MDG health

Demographic challenge
  • By 2050, 22 per cent of the world population is
    projected to be 60 years or over, and 16 per cent
    will likely be 65 years or over (UN, 2009).
  • 19 of the worlds 20 oldest countries in terms of
    population age are in Europe, and will see their
    populations continue to age to unprecedented
    levels over the next 25 years (Population
    Reference Bureau).
  • Japan is the oldest country.
  • Nearly 25 percent of people in the European Union
    in 2030 will be above age 65.

Demographic change and Migration
  • While the European Union's overall population is
    projected to increase slightly between 2005 and
    2030, the bulk of that increase will come from
    net immigration.
  • Serious impact on pensions, health systems and
    care needs, including health social care staff
  • USA shortage 3.5 million health care workers by
  • UK shortage 2.5 million adult care workers by
  • By 2050, over 3.5 million Australians are
    expected to use aged care services each year
    (Productivity Commission, 2011)
  • Migration trend temporary/circular migration

In short, what are we facing?
  • Global jobs crisis, youth employment, rise in
    precarious work
  • Bail-outs and austerity measures breaking
    workers and taxpayers backs
  • Attacks on human and trade union rights
  • Deregulated, neo-liberal economic approach to
    labour migration making workers
    ultra-flexible, hire and fire according to
    business cycle

What else are we facing?
  • More of deregulation, privatisation, outsourcing
    of public services, including care services
  • Global health workforce crisis
  • Demographics and the increasing need for aged
  • Shift towards temporary/circular migration

PSI Policies on Migration
  • EB-132 (2006)
  • Endorsed Policy and Programme of Action on
    Migration in the Health Sector
  • Congress Resolution No. 2
  • PSIs Global Policy and Strategic Objectives
    (2008-2012) identifies migration as a frontline
    issue of our time (climate change as the other)
  • Congress Resolution No. 17
  • Women Health Workers and International
  • EB-138 (2009)
  • Endorsed Policy and Programme of Action on
    Migration, Development and Quality Public Services

PSI World Congress
  • Resolution No. 2
  • Global Policy and Strategic Objectives
  • Resolution No. 17
  • Women Health Workers and International

Policy Work
  • Developed policies on key migration issues and
    used them to influence
  • global, regional and national policies
  • PSI Policy and Programme of Action on Migration
    in the Health Sector
  • PSI Policy and Programme of Action on Migration,
    Development and Quality
  • Public Services

Programme Objective
  • Strengthen the capacity of public sector trade
    unions in addressing the causes, impact and
    challenges of migration and assist migrant and
    potential migrant workers in the health and
    social care sectors through capacity building,
    education and information, organising and
    outreach, lobbying and advocacy, public
    campaigns, union representation and collective

Programme Aims
  1. Women health and social care workers make
    informed decisions about whether or not to
    migrate work collectively to advocate for their
    rights and receive support and protection from
    trade unions.
  2. Enhanced capacity of public sector trade unions
    in influencing migration, trade and labour
    policies to be gender sensitive, pro-sustainable
    development and rights-based.

Programme Aims
  • Unions establish outreach programmes to organise,
    assist and empower migrant health and social care
  • Unions establish collective agreements in the
    health and social care sectors defending job
    security, training and promotion, pay equity and
    decent work.

PSI Ethical Recruitment Campaign
  • Adoption of the WHO Code of Practice on the
    International Recruitment of Health Personnel
  • Development of regional and national codes of
  • EPSU/HOSPEEM Voluntary Code of Practice in the
    Hospital Sector in the EU
  • Code of Practice for Recruitment of Health
    Workers in the Pacific
  • USA Voluntary Code of Ethical Conduct for the
    Recruitment of Foreign- Educated Nurses.

PSI Statement of Principles
  • PSI is increasingly concerned about the negative
    impact on health care systems in developing
    countries and its impact on health care workers,
    the majority of whom are women. International
    migration should not be used as an alternative to
    adequate funding in public health services and
    decent employment conditions at home.

(No Transcript)
PSI Ethical Recruitment Campaign
  • Ensure the application of ethical recruitment
  • Operations of recruitment agencies
  • Human rights and labour standards for all health
    and social care workers
  • Shared responsibility between countries
  • WHO Code of Practice (adopted, May 2010)
  • EPSU-HOSPEEM Code of conduct
  • USA Voluntary Code (Alliance for Ethical
  • Code of Practice in the Pacific

History of the Code
  • May 2004, World Health Assembly Resolution 57.19
    requesting development of a code
  • 2004-2009 series of consultations
  • January 2009, WHO Secretariat presented draft
    Code to WHO Executive Board
  • January 2010, WHO Executive Board submitted the
    draft to the WHA
  • 21 May 2010, World Health Assembly adopted the

Objectives of the Code
  • To establish and promote voluntary principles and
    practices for the ethical international
    recruitment of health personnel.
  • To serve as reference for all WHO Member States
    in setting legal and institutional framework
  • To provide guidance in formulation and
    implementation of bilateral and international
  • To facilitate and promote international
    discussion and cooperation

Global in scope
  • The Code is global in scope
  • Sets out guidance to governments of all Member
  • Sets out guidance to all interested stakeholders

Ethical International Recruitment
  • Discourages active international recruitment from
    developing countries facing shortages (Art. 5.1)
  • Outstanding legal responsibility of health
    personnel to the health system in their own
    country should be considered in recruitment (Art.
  • These recommendations are intended for
    policymakers, employers and recruitment agencies

Health workforce development and health systems
  • Addresses underlying causes of migration and
    makes recommendations towards health workforce
    development and sustainability
  • Urges countries to implement health workforce
    planning, education, training and retention
    strategies to address their own needs and in
    order to reduce the need to recruit

Fair treatment of migrant health personnel
  • Emphasizes importance of equal treatment for
    migrant health workers and domestically trained
    health workers
  • Takes on a holistic view of health workforce
    recruitment, that health workers should assess
    benefits and risks and make informed decisions
  • Enjoyment of legal rights and responsibilities
    ranging from hiring, promotion, remuneration,
    incentives for training, education and career

International cooperation
  • Mitigate negative effects of migration and
    maximize impact on health systems of source
  • Principle of mutuality of benefits
  • Proposes use of bilateral and multilateral
    arrangements, to include support for training,
    technology and skills transfer, support for
    return migration, whether temporary or permanent
  • Code encourages circular migration for both
    origin and destination countries to benefit from
    knowledge and skills

Support to developing countries
  • Highlights importance of taking into account
    specific needs and special circumstances of
    developing countries and economies in transition,
    notably detrimental impact of active
    international recruitment
  • Encourages Member States, international
    organizations, donor agencies, development
    institutions to provide technical assistance and
    financial support to developing countries facing
    critical shortages and to assist with
    implementation of the Code

Data gathering
  • Stresses need for effective national and
    international data and research
  • Need to share information on international
    recruitment of health workers
  • Establish and strengthen health personnel
    information systems, research programmes, and
    translate those data into effective health
    workforce policies and planning

Information exchange and monitoring
  • Promotes information exchange nationally and
    internationally and to share information with WHO
  • Member States encouraged to collect and provide
    both qualitative and quantitative information,
    maintain up-to-date and accessible database of
    laws and regulations related to recruitment and
  • Member States should designate a national
    authority for information and implement ationof
    the Code
  • Member States to submit periodic national reports
    to WHO Secretariat beginning 2012.
  • Interested stakeholders may also submit periodic
    national reports to WHO Secretariat (Art. 9.4)

In summary, what are the practical steps?
  • Member State designates a national authority
    responsible for exchange of information on health
    personnel migration and implementation of the
  • Member State conducts multi-stakeholder
    consultation on the implementation of the Code
    (good practice)
  • Collaboration and partnership between Government
    and stakeholders (key is Social Dialogue)
  • National periodic reporting to WHO Secretariat
    beginning 2012 (Member State Stakeholders)

Global Migration Project Activities
  • Participatory Research and Mapping of Migration
    in the Health and Social Care Sector (building
    our evidence base)
  • Training Capacity Building
  • Information drives (PDK, Photo-Documentation,
    Materials Development)
  • Union outreach Migrant Desks
  • Organising
  • Advocacy campaigns (Ethical Recruitment,
    Migration Development, Dec18)
  • Social dialogue on HRH, Migration WHO Code of
  • Union-to-union bilateral cooperation

Advocacy and Engagement
Policy advocacy and engagement at various levels
brought visibility to PSI as the authority and
voice of public sector trade unions in global,
regional and national processes
  • Advocacy at
  • Global Forum on Migration and Development
  • World Trade Organization
  • International Organization for Migration
  • International Labour Organization
  • World Health Organization
  • Global Migration Group

Programme Showcase
PSIs Migration and Health and Social Care
Workers Programme is a showcase of how we
successfully carried out trade union outreach,
research, information dissemination and
  • Programme Accomplishments
  • Actively engaged 37 affiliates in 20 origin and
    destination countries
  • Strengthened the capacity of our unions
  • Through union outreach and information provided
    in the Pre-Decision Kits and
  • the Union Passports to Workers Rights,
    health care workers reconsidered their
  • migration and joined the unions
  • Affiliates organized migrant workers and
    defended their rights
  • Unions used the argument of migration to win
    better salaries and conditions

Programme Showcase
GFMD - Geneva, Dec 2011
  • Ghana, Kenya, South Africa, Philippines,
  • Mapping and Participatory Research on Migration
  • Training and Capacity Building
  • Union outreach Migrant Desks
  • Organizing, organizing, organizing!
  • Social dialogue on HRH, Migration WHO Code of
  • Union-to-union bilateral cooperation

Migrant Desk Launch South Africa, 10/10/12
Programme Work
  • PSI Secretariat provided technical assistance to
    affiliate-driven migration initiatives
  • ILO-EU Decent Work Across Borders Project in the
  • Euro-Mediterranean Migration Project
  • Both projects were initiatives that build our
    affiliates capacity in protecting migrant
    workers rights and promoting quality public

Moving Forward
  • PSI Migration Seminar and Workshop Objectives
  • Share Experiences
  • Exchange Best Practices
  • Define Strategies and Actions
  • Take Stock of our Achievements
  • Prepare for a New Set of Challenges
  • Define our new Migration Programme of Action
    for 2013-2017

Building Union Solidarity and Protection for
Workers on the Move
PSI-EPSU Labour Migration Project in Europe
  • Europe Central Asia Russia, Armenia, Georgia
    and Tajikistan
  • Collaboration with ILO ACTRAV
  • In 2013 PSI organized a workshop in Armenia,
    Georgia and Tajikistan in cooperation with ILO
    ACTRAV (Moscow office)
  • At each of these workshops for trade union
    leaders from PSI affiliates, we shared experience
    on labour migration, how to raise awareness on
    the risks of labour migration and how to improve
    cooperation between sending and receiving
    countries. At the same time, we also discussed
    how PSI can strengthen the capacity of affiliates
    in the region on trade union rights, collective
    bargaining and communication strategies. Of
    course our affiliates prefer a national labour
    market that provides jobs for all, instead of
    promoting migration.
  • 2014 Follow-up (autumn 2014), workshop for young
    workers in each of project countries

For more information
  • Visit
  • www.world-psi.org/migration
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