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

GATS and the migration ofHuman Resources for Health

(HRH)

Dr Khassoum DialloEIP/HRH

WHOGeneva

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Outline

1. GATS and the migration of health workers2. Mode 4 Commitments for health services3. Issues of concern4. Beyond GATS, migration of HRH5. 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

Health Services in GATS

1. BusinessA. 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)

A. Hospital services (9311)B. Other Human health services

(9319)

Services

Market access

National treatment

1.A.h 32 Unbound 1 None11 Measures

39 Unbound 5 None11 Measures

1.A.j 23 Unbound 0 None 8 Measures

21 Unbound 2 None 7 Measures

Mode 4

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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)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-based1. Big Assumption: The remaining is expected to be

international migration

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GATS mode 4Censuses

and specific surveys

Prof. Assoc & Regulatory

bodies registers

Temporary flows,RecruitmentAgencies,

Working Visas

Immigrantcommunityassociations

Institutionaldata e.g.

schools, healthFacilities, MoH

Other data sources

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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

originRemittances