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.

The Executive Board first reviewed the draft Code of Practice on the International Recruitment of Health Personnel in January 2009. The new draft has been updated to reflect comments from the Executive Board at that meeting, as well as six regional consultations that took place in 2009.

The WHO Secretariat reports that:

Two core themes identified by the regional committees and incorporated in the revised draft
code were that Member States should strive to achieve a balance between the rights, obligations and expectations of source countries, destination countries and migrant health personnel, and that international health worker migration should have a net positive impact on the health system of developing countries and countries with economies in transition. To this end, Article 5 on mutuality of benefits has been strengthened. The revised draft text emphasizes that international health personnel should be recruited in a way that seeks to prevent a drain on valuable human resources for health. In accordance with the views expressed by some regional committees, it also recommends that countries should abstain from active international recruitment of health personnel unless equitable bilateral, regional, or multilateral agreement(s) exist to support such recruitment activities. In addition, voluntary technical and financial mechanisms to strengthen the development of health systems in developing countries and countries with economies in transition are proposed in Article 11.

The revised draft code also recommends that Member States should seek to strengthen the
balance between the rights of health personnel to leave their countries and the right of everybody to the enjoyment of the highest attainable standard of health in order to mitigate the negative effects of migration on health systems.

In accordance with the discussion in some regional committees, the revised draft code also
recommends strengthening the provision on self-sustainability by stating that Member States should, to the extent possible, strive to meet their health personnel needs from their own health workforce. In order to make national health workforces sustainable, the revised draft code includes new provisions recommending that Member States consider a variety of measures to retain health workers.

At its meeting this month, the Executive Board will decide whether to submit the Code of Practice for inclusion in the 2010 World Health Assembly in May.

The report from the Secretariat and the revised draft (with annotation) are available online here, and more information and background on the Code of Practice is available on the WHO web site.