The Impossible Dream? Codes of Practice and the International Migration of Skilled Health Workers

• DOI: http://doi.org/10.2202/1948-4682.1175
• Author: John Connell,James Buchan
• Published date: 01 September 2011
• Date: 01 September 2011

Volume 3, Issue 3 • 2011 • Article 3

The Impossible Dream? Codes of Practice and the

International Migration of Skilled Health Workers

John Connell, University of Sydney

James Buchan, Queen Margaret University, Edinburgh

Connell, John and Buchan, James (2011) "The Impossible Dream? Codes of Practice and the

International Migration of Skilled Health Workers," World Medical & Health Policy: Vol. 3: Iss. 3,

Article 3.

Available at: http://www.psocommons.org/wmhp/vol3/iss3/art3

DOI: 10.2202/1948-4682.1175

©2011 Policy Studies Organization

The Impossible Dream? Codes of Practice and

the International Migration of Skilled Health

Workers

John Connell, University of Sydney

James Buchan, Queen Margaret University, Edinburgh

Abstract

The international migration of skilled health workers has increased significantly from the

1990s. Many source countries have expressed concern over losses of health workers, resulting

in regional Codes of Practice and bilateral Memoranda of Understanding being established since

1999 to achieve more effective, equitable and ethical international migration. The finalisation of

a Global Code in 2010 drew attention to continued migration concerns. Codes have three key

objectives – protecting rights of migrant workers, adequate workplace support for migrant workers

and ensuring that migration flows do not disrupt health services in source countries. There is no

agreed definition of ethical international recruitment, and no consensus on the significance and

location of harmful recruitment practices. Most codes have covered relatively few regions and

exhibit a high degree of generality. Several source countries encourage rather than discourage

migration. Migration is a right and occurs in contexts that do not necessarily involve health issues.

There are no incentives for recipient countries and agencies to be involved in ethical international

recruitment. All codes are voluntary which has restricted their impact. Substantial migration and

recruitment have occurred outside their scope, and codes have diverted skilled health workers

beyond regulation. The private sector is effectively excluded from codes. Bilateral agreements and

memoranda have a greater chance of success, enabling managed migration and return migration, but

are more geographically limiting. The most effective constraints to the unregulated flow of skilled

health workers are the production of adequate numbers in present recipient countries and provision

of improved employment conditions in source countries.

KEYWORDS: migration, health workers, codes of practice, policy

Author Notes: Conflict of interest: None declared. Corresponding author: John Connell, Professor,

The University of Sydney, Australia Email: john.connell@sydney.edu.au