Opinion: As the world seeks migration solutions, the health sector can help

A Filipino health worker. Photo by: © ILO / R. Cabangal / CC BY-NC-ND

Last month, at a conference in Marrakech, Morocco, an overwhelming majority of United Nations member states adopted the Global Compact for Safe, Orderly and Regular Migration.

The global compact is the first intergovernmentally negotiated agreement to cover all dimensions of international migration. But while adoption of the global compact is an achievement of historic importance, it is also the commencement of an even more challenging phase: one in which ideals must give rise to action and objectives are transformed into results.

“Migrant workers in the health sector — motivated by their quest for a better life and to make life better for others through the care they provide — can lead us down a path of dialogue, cooperation, and innovation.”

The good news is that this phase does not begin with a blank slate. An important way to hit the ground running after Marrakech would be to focus on developing actions and solutions in the health sector, where the mobility of health workers — doctors, nurses, pharmacists, social workers, and others — not only presents a range of critical challenges but also has already generated promising cross-sectoral partnerships and innovation. Similarly, long-standing work and partnerships toward delivering universal health coverage across countries can directly serve to meet the health needs of the 258 million migrants worldwide.

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In opening the Marrakech conference, the U.N. Secretary-General António Guterres’ remarks point to the importance of the health sector as focus shifts to the implementation of the global compact. With his statement, the secretary-general eloquently linked the vital importance of migrants to the delivery of health and social services across countries with the collective responsibility to ensure that the health needs of migrants are met. Secretary-General Guterres’ opening remarks echo the report of the UCL-Lancet Commission on Migration and Health that challenges the preconception of migrants as a drain on the economy and social services, and as carriers of disease. The UCL-Lancet Commission instead evidences the role of migrants in bolstering health and social services.

There are several reasons why attention to the health sector is especially important to the implementation of the global compact.

First, the World Health Organization’s constitutional mandate, with over 70 years of work and partnerships, toward advocating and supporting the right to the highest attainable standard of health for everyone can help ensure that health needs of migrants are fully addressed. An accelerated effort towards expanding universal health coverage across countries, as well implementation of the WHO Framework of Priorities and Guiding Principles to Promote the Health of Refugees and Migrants and the associated forthcoming global action plan, will directly contribute to realizing the global compact’s 15th objective: Providing access to basic services for migrants.

Second, often unrecognized, the health sector is a leading job creator, comprising 11 percent of employment in OECD countries. Unlike other sectors, such as agriculture and industry, the number of health care jobs is growing. The sector is also an especially important source of jobs for women: worldwide women comprise over 70 percent of those formally employed in the sector.

Third, the international migration of health workers is increasing rapidly. There has been a 60 percent increase over the past decade in the number of migrant doctors and nurses working in OECD countries. The flows of migrant health workers are actually quite intricate and not limited to the movement of health workers from the “global south” to the “global north.” Countries such as Nigeria, South Africa, Uganda, and Zimbabwe, often only considered as suppliers of health workers to richer countries, are now destinations for migrating health workers, as well.

Temporary mobility of health workers and student mobility in the health professions is also growing. Together the increasing volume and complexity of health worker migration demand improved management, with national action and international cooperation fundamental.

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The fourth reason can be found in the global compact’s 23 objectives for better managing migration, five of which are directly related to health worker migration. These include the collection of accurate and disaggregated data (#1), enhancing availability and flexibility of pathways for regular migration (#5), facilitating fair and ethical recruitment (#6), investing in skills development and mutual recognition (#18), and strengthening international cooperation and global partnerships (#23). The implementation of the Global Skill Partnerships holds particular promise in addressing long-standing challenges related to health worker migration.

More broadly, the fact that in Germany health workers make up over three-quarters of migrants and refugees applying for recognition of their qualifications through the streamlined 2012 German Recognition Act speaks volumes about the health sector’s importance when it comes to issues related to legal migration.

Finally, the global health sector has nearly a decade of experience working under a multilateral framework that is similar in many ways to the global compact, and that is the WHO Global Code of Practice on the International Recruitment of Health Personnel. The code’s comprehensive and non-binding approach to managing health worker mobility, complemented with a robust monitoring framework and regular national reporting, has resulted in the strengthening of data, dialogue, and international cooperation on health worker migration. Over 70 countries are regularly sharing information on data and promising practices during the triennial rounds of national reporting, with 75 separate bilateral agreements notified to the secretariat in the current round of reporting.

Implementation of the WHO Global Code has also cemented partnerships across U.N. agencies, civil society, and the private sector. Notably, the establishment of the International Labour Organization, OECD, and the WHO International Platform on Health Worker Mobility is already showcasing positive practices to better manage and deliver mutuality of benefit from health worker migration. For example, Sudan’s government has adopted a health worker migration policy that promotes health worker retention in rural areas; has resulted in the development of bilateral agreements on health important countries such as Saudi Arabia and Ireland; and has more strategically engaged the Sudanese diaspora to fill gaps in health professional training.

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Meanwhile, South Africa’s government has taken steps to streamline and accelerate the employment authorization process for nonnationals in the sector. And Germany, in its efforts to attract foreign nurses, has added provisions to bilateral agreements with Bosnia-Herzegovina, Serbia, Tunisia, and the Philippines, that seek to assure fair treatment and decent work for those who are recruited. All these policies have been enacted consistent with the WHO Global Code.

Through these and other examples, what comes through loud and clear is that migrant workers in the health sector — motivated by their quest for a better life and to make life better for others through the care they provide — can lead us down a path of dialogue, cooperation, and innovation that delivers the kinds of solutions that are envisioned in the global compact. Working with them, and by strengthening support to established instruments and platforms in the health sector, we can help realize the vision and cooperative framework of the Global Compact for Safe, Orderly and Regular Migration.

About the authors

  • Naoko

    Naoko Yamamoto

    Naoko Yamamoto serves as assistant director-general for universal health coverage and health systems at the World Health Organization. Dr. Yamamoto has nearly 30 years of experience working on health in Japan and most recently served as senior assistant Minister for global heath in Japan’s Ministry of Health, Labour and Welfare.
  • Guerra

    Ranieri Guerra

    Ranieri Guerra serves as assistant director-general for special initiatives at the World Health Organization. A physician from Italy, he has more than 30 years of public health experience. Since 2014, he has served as director general for preventive health and chief medical officer of the Italian Ministry of Health.
  • Jimcampbell

    Jim Campbell

    Jim Campbell is the director of the health workforce department at the World Health Organization. He oversees the development and implementation of global public goods, evidence and tools to inform national and international investments in the education, development and retention of the health and social sector workforce in pursuit of global health security, universal health coverage and the Sustainable Development Goals.
  • Dhillon

    Ibadat Dhillon

    Ibadat Dhillon is a technical officer in the Department of Health Workforce at the World Health Organization. Ibadat’s work has focused on human resources for health and health systems at the national and global levels. He has previously served as a health advisor for the Danish government, the Irish government, and the United States Center for Disease Control and Prevention.