As the professional association of public health workers in the U.S., the APHA each year adopts policy positions on a variety of health topics. This “late breaker” resolution, proposed just before the meeting on behalf of the International Health Section of APHA, recaps the history and content of the WHO Code of Practice, and states that the APHA will:

1.     APPOINT LEADERSHIP
Designate key individuals who will meet to draft a list of eligible “national authority” agencies and work with other stakeholders to sketch out how the lead agency and supporting task force members might be designated and work together.

2.     ASSEMBLE A TASK FORCE
Assemble a task force to identify the data required to make good faith reports to the WHO within the next year or two. This task force would examine existing data sources to identify, coordinate, open, link and report information, as well as to identify new data sources.

3.     CREATE A RESEARCH PROGRAM
Fund a research program to examine the intersections between domestic and international workforce production, recruitment, deployment and retention.

4.     SET A POLICY AGENDA
Invite the national authority task force to recommend modifications to U.S. policy that arise from the WHO Code, such as our heavy reliance on foreign-trained physicians and nurses, the need to expand our own domestic production of health workers, and the need to better distribute the workforce we currently have.

The resolution also references a sign-on letter that a number of organizations sent to the U.S. Secretary of Health and Human Services and the Secretary of State, encouraging the U.S. to move forward on practices that will reduce our reliance on foreign-trained health workers.

The adoption of the resolution indicates the APHA’s support for the WHO Code, which allows the organization to take future advocacy action on the issue.

Read the full APHA resolution, or the sign-on letter.

The authors illustrate this internal brain drain phenomenon by describing the actions of the UK’s Medical Research Council (MRC) in the Gambia.

“…[T]he MRC informed the Ministry of Health and Social Welfare that 28 of the 96 nurses and midwives in the poorest Upper River Region (…) and trained by the government were working for the MRC. (…) Of the 28, three nurses are on the children’s ward helping with MRC study participants and offering about half the nursing care for NHS patients. Six nurses assist in paediatric and adult outpatients where they recruit patients for studies. There is a research nurse assisting in outpatients in minor health centres. Nine of these 28 nurses are qualified midwives but none support maternity services; they are all involved with patients under study.

“The MRC also said they make every effort not to recruit nursing staff who are working in government facilities or have been so employed during the previous six months, pointing out that most of their recent recruits have come from pharmacies. (…) However, our discussions with Gambian-trained staff tell us that MRC posts are so advantageous that, to be eligible, they will circumvent these rules by temporarily working outside the [national health service.”

This problem is not unique to the MRC, nor to the Gambia.

The question is, working in contexts of limited human resources and great need, what can NGOs and other organizations do to prevent the loss of health care workers from the public sector?

The article then outlines six things, one of which is to support the NGO Code of Conduct on Health Systems Strengthening.

Organizations interested in signing onto the Code and supporting public-sector health systems can do so here.

The final version of the Code of Practice is not yet available, although a late draft is here.

You can read more about the proceedings on the Health Alliance International blog, and an editorial on what the new Code of Practice means.

HAI was one of the drafters of the Code of Conduct, and is the current coordinating organization. In all, HAI conducted 29 key informant interviews in 2009 (26 with signatories, 3 with non-signatory organizations). The study was completed by Anjali Sakhuja, and the summary was created by Erin Hurley.

Below is the executive summary, and you can find the full report here.

Executive Summary

The Non-Governmental Organization (NGO) Code of Conduct for Health Systems Strengthening was launched in 2008 to support public sector health systems by  changing industry-wide human resources practices that routinely undermine Ministries of Health in low-income countries striving to meet the Millennium Development Goals.  Health Alliance International interviewed signatories of  the NGO Code of conduct as well as some organizations that did not sign to gauge the success of the Code in practice. In all, we conducted 29 key informant interviews in 2009.

We found that all organizations, signatories and non-signatories alike, are operating in a competitive marketplace for skilled human resources.  Even when they are highly conscious of avoiding hiring practices harmful to the public sector, such as hiring health professionals away from public employment, international organizations seeking to meet their obligations to donors and demonstrate success feel they often cannot avoid selecting both clinical and programmatic personnel who could otherwise be working for Ministries of Health.  A few signatories said they have made attempts to keep salaries closer to the ones offered by the public health sector, but most found it challenging because using such policies made it difficult to recruit or retain staff.  While many signatory organizations, however, have identified other strategies to reduce the burden and contribute positively to the public sector, although they experience disadvantages because other organizations do not have the same restrictions. Most NGOs have not invested in pre-service training programs to generate new health professionals to help overcome these staffing obstacles.

One proposed strategy to level the playing field for NGOs seeking to support the public sector would be for donors and governments to create incentives for more comprehensive adoption of the NGO Code of Conduct principles. In the meantime, international NGOs and other stakeholders can move forward collectively to advocate for change, contribute to research and knowledge sharing, and build health workforce capacity.

Read the full report here.