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Handbook
of
WMA
Policies
World
Medical
Association
⏐
S-‐2003-‐03-‐2014
WMA
STATEMENT
ON
ETHICAL
GUIDELINES
FOR
THE
INTERNATIONAL
MIGRATION
OF
HEALTH
WORKERS
Adopted by the 54th
WMA General Assembly, Helsinki, Finland, September 2003
and revised by the 65th
WMA General Assembly, Durban, South Africa, October 2014
PREAMBLE
The WMA acknowledges that temporary stays of physicians in other countries help both
the receiving and the sending countries to exchange medical knowledge, skills and
attitudes. The exchange of medical professionals is therefore beneficial for the develop-
ment of medicine and healthcare systems and in general deserves the support of national
medical associations as well as governments.
The WMA Statement on Medical Manpower – 1 (1983, 1986) called upon all National
Medical Associations to work with their governments towards solutions to the emerging
problems related to the medical workforce.
The WMA Resolution on the Medical Workforce (1998) identified the major components
of the medical workforce situation that need to be taken into account when developing a
national workforce policy.
For several decades many governments, employers and medical associations have mis-
interpreted demographical data regarding the number of physicians that are required.
Young people seeing employment as physicians have often been seriously affected by
poor medical workforce planning.
In many countries, including the wealthiest ones, there is a shortage of physicians. A
major reason for the shortage is a failure to educate enough physicians to meet the needs
of the country. Other reasons for the net loss of physicians are the recruitment of physi-
cians to other professions, early retirement and emigration, and the problems of combining
professional and family responsibilities, all of which are often due to poor working con-
ditions for physicians.
Some countries have traditionally solved their need for physicians by recruiting medical
graduates from other countries. This practice continues today.
The flow of international migration of physicians is generally from poorer to wealthier
countries. The poorer countries bear the expense of educating the migrating physicians
and receive no recompense when they enter other countries. The receiving countries gain a
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S-‐2003-‐03-‐2014
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Durban
International
Migration
of
Health
Workers
valuable resource without paying for it, and in the process they save the cost of educating
their own physicians.
Physicians do have valid reasons for migrating, for example, to seek better career oppor-
tunities and to escape poor working and living conditions, which may include the pursuit
of more political and personal freedoms and other benefits.
RECOMMENDATIONS
1.
1. National medical associations, governments and employers should exercise utmost
care in utilizing demographic data to make projections about future requirements
for physicians and in communicating these projections to young people contem-
plating a medical career.
2. Every country should do its utmost to educate an adequate number of physicians,
taking into account its needs and resources. A country should not rely on immi-
gration from other countries to meet its need for physicians.
3. Every country should do its utmost to retain its physicians in the profession as well
as in the country by providing them with the support they need to meet their
personal and professional goals, taking into account the country’s needs and re-
sources.
4. Countries that wish to recruit physicians from another country should only do so in
terms of and in accordance with the provisions of a Memorandum of Under-
standing entered into between the countries.
5. Physicians should not be prevented from leaving their home or adopted country to
pursue career opportunities in another country.
6. Countries that recruit physicians from other countries should ensure that recruiters
provide full and accurate information to potential recruits on the nature and re-
quirements of the position to be filled, on immigration, administrative and con-
tractual requirements, and on the legal and regulatory conditions for the practice of
medicine in the recruiting country, including language skills.
7. Physicians who are working, either permanently or temporarily, in a country other
than their home country should be treated fairly in relation to other physicians in
that country (for example, equal opportunity career options and equal payment for
the same work).
8. Nothing should prevent countries from entering into bilateral agreements and
agreements of understanding, as provided for in international law and with due
cognizance of international human rights law, so as to effect meaningful co-
operation on health care delivery, including the exchange of physicians.
9. The WHO Global Code of Practice on the International Recruitment of Health
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Handbook
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WMA
Policies
World
Medical
Association
⏐
S-‐2003-‐03-‐2014
Personnel (May 2010) was established to promote voluntary principles and prac-
tices for the ethical international recruitment of health professionals and to facili-
tate the strengthening of health systems. The Code takes into account the rights,
obligations and expectations of source countries and migrant health professionals.
The WMA was involved in the drafting of the Code and supports its implementa-
tion.
10. The WHO Code states that international recruitment should be “conducted in ac-
cordance with the principles of transparency, fairness and promotion of sustain-
ability of health systems in developing countries.”
11. The monitoring and information-sharing system established by the WHO should be
robustly supported with the goal of international cooperation. Stakeholders should
regularly collate and share data, which should be monitored and anlaysed by the
WHO. The WHO should provide substantive critical feedback to governments.
Information should be shared about how to overcome challenges encountered.
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