Posted by: davidjolson | 05/18/2010

Debate stalls progress on health personnel code

This guest blog was written by Dr. Amy Hagopian, assistant professor of global health at the University of Washington; senior health workforce policy advisor at Health Alliance International; and member of the international section of the American Public Health Association. Dr. Hagopian is a member of the Global Health Council delegation to the World Health Assembly in Geneva May 17-21.

GENEVA, Switzerland – The “drafting committee” assigned to make revisions to the Code of Practice on the International Recruitment of Health Personnel has just broken for lunch here at the World Health Assembly.  I imagine they will have indigestion over their sandwiches.
Sandra Kiapi (Action Group for Health in Uganda) and I went to the drafting meeting this morning, and sat against the back wall for the first 90 minutes.  Until, that is, the room monitor discovered we were there and threw out us because we were only badged as civil society, not official country delegates.  The explanation?  “Country delegates don’t want to be watched in case they want to say anything…”  Wow, really?
The remarks we watched were relatively harmless discussions of issues such as How Voluntary is Voluntary?  All agreed Voluntary meant Voluntary.  Moving on, there was discussion of monitoring and evaluation and data sources, but that petered out, as clearly there was nothing yet to monitor or evaluate. Switzerland’s delegation encouraged more than once that the discussion move to debating the articles one by one. After an hour and a half, they finally were ready to do that… but we had been tossed by then.
Nonetheless, we waited outside and queried each person as they emerged for news. Finally, at noon, the Swedish delegate informed me as she came out that the entire rest of the morning was spent (wasted) on a request from the U.S. delegation that the word “ethical” be removed from the first article’s sentence: “The objectives of this code are: a) to establish and promote voluntary principles, standards and practices for the ethical international recruitment of health personnel…”
Seriously?  We can’t use the word ethical in a “Code of Practice?”  Does the Obama administration really want to be on record opposing “ethical” recruitment?  (For a clearer view of the ethics involved, may I refer you to Ed Mills’ essay in the Lancet?  Mills EJ, et al. Should recruitment of health workers from Africa be considered a crime?  The Lancet 2008; 371:685-688).
So I waited for the U.S. delegation to emerge (they were last to come out of the room). Mark Abdoo, the director of Global Health, National Security Staff, Executive Office of the President,  assured me the delegation wants to pass the code, and I informed him we would believe him when a strong code passes the Assembly.  The current trajectory is not good.
More tonight after the side event. Stay tuned.

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