CIAO DATE: 07/2010
April 2010
There is limited international structure to manage the ever important phenomenon of human migration and its associated challenges. This is particularly true with respect to the international migration of health workers, where bilateral agreements between sending and receiving nations have been repeatedly and urgently called for in the context of a global health workforce crisis. There remains, however, significant lack of clarity on the precise role, form, and content bilateral agreement should take to serve a health-related purpose. The authors through this Guidebook, including presentation of two model bilateral agreements, aim to provide some initial but concrete guidance to further international cooperation around the critical and highly sensitive area of health worker migration. There is clear evidence that the international migration of health workers is increasing and that the movement is, for the most part, not bidirectional, particularly for the low-income sub- Saharan African and Caribbean nations who are among the most affected. Encouragingly, the last decade has witnessed the emergence of an international structure, albeit largely voluntary, attempting to manage health worker migration flows in a manner that ensures mutual benefits for source nations, destination nations, and migrant health workers themselves. Central to this structure, including within the recently developed draft WHO Code of Practice on the International Recruitment of Health Workers, is a call for bilateral agreements to serve as a health solution to the challenges associated with the international migration of health personnel. There remains, however, significant lack of clarity on the precise role, form, and content of bilateral agreements to serve a health-related purpose. This lack of clarity poses a particular challenge for developing countries, which have the most at stake. The authors of this report, with particular focus on serving the needs of particularly affected developing countries, hope to provide some initial but concrete guidance on the development of bilateral agreements as necessary to further international cooperation to mitigate the negative effects associated with health worker migration. The Guidebook provides an introduction to bilateral agreements, their legal status, and points to the heterogeneity and challenges present in relation to bilateral agreements serving as a solution to the issue of health worker migration. Challenges include the differing approaches to bilateral agreements necessary in relation to differing forms of national immigration policy and the failure in the past of bilateral agreements to fully engage with the concept of migration and development. There have been recent innovations in developing comprehensive bilateral migration agreement that seek to simultaneously facilitate the movement of health workers and respond to challenges associated with such migration. Recent procedural innovations in other sectors, including importantly in climate change cooperation, also provide an approach to bilateral agreements aiming to further cooperation between nations on complex and sensitive issues. The Guidebook presents two bilateral agreement prototypes. They are relevant both to countries who recruit and facilitate admission through bilateral agreements and to countries who instead rely on ‘quality-selective’, ‘non-discriminatory’ immigration, as well as decentralized recruitment, policies. Model Bilateral Agreement I presents a comprehensive approach to managing health worker migration flows. It been developed through collection and analyses of a significant variety of existing instruments (available through Annex A). The model is useful both as a reflection of existing practice and also as a means to implement the recommendations presented in the draft WHO Code of Practice on the International Recruitment of Health Personnel. Model Bilateral Agreement II presents an innovative process of dialogue and cooperation for countries as yet unable to agree upon the precise measures to address the negative effects of health worker migration. Just as important as what this guidebook presents is what it does not. The report provides guidance on the formulation of bilateral agreements, with particular emphasis on text. The guidebook is not an analysis of the operation in practice of collected bilateral agreements, where little documentation or rigorous evaluation exists. Much work needs to be done here, as pointed to in the report, particularly around the operation of bilateral implementation and coordination-related bodies. The Guidebook additionally raises the open questions of whether liberalization of trade in services and the associated mutual recognition agreements can serve to address the challenges associated with health worker migration or are in conflict with efforts to do so. The report concludes by calling for greater efforts to increase transparency in making the texts of bilateral agreements available so that the international community can continue to learn from existing practice and to encourage accountability to what is agreed within them.
Resource link: A Guidebook on Bilateral Agreements to Address Health Worker Migration [PDF] - 987K