Managing the ‘Brain Drain’ — WHO Code

Written by Harriet, originally an academic essay so forgive the amount of references.

Many countries that do not meet the minimum World Health Organisation (WHO) threshold of skilled health professionals needed to deliver basic health interventions fall in the South East Asia or Sub Saharan Africa Region (1,2). International migration of skilled health professionals from these countries is an important contributing factor to this shortage (3).

Though the international migration patterns of skilled health professionals are complex, it is the general movement of skilled health professionals from low income countries to middle- and high income countries is known as the ‘brain drain’ (4,5). The loss of skilled health workers disproportionately affects Sub-Saharan Africa because of the existing weak health systems(6,7).

Nurses in the isolation unit during a media briefing to discuss the first case of Covid-19 at Tygerberg Hospital in Cape Town, South Africa, on March 11, 2020. Photo: Misha Jordaan/Gallo Images via Getty Images

In order to manage the critical shortages and the rights of the skilled health professional, multiple bilateral agreements and international frameworks regarding ethical health worker recruitment from developing countries have been created (1,2). Cumulating in the most recent iteration of a global code known as ‘WHO Global Code of Practice on the International Recruitment of Health Personnel’(from now‘WHO Code’ or ‘the Code’) (8). This article intends to briefly discuss the strengths and weaknesses of the WHO Code and ways the WHO Code could be improved.

There have been multiple bilateral and international agreements to regulate the migration of skilled health professionals (2). Each code introduced a larger scope, new idea or framework to address the shortage i.e. The Commonwealth Code, UK DoH code and WFPHA code (9)(10,11). Arguably, these codes are version updates of one another and as such, all have similar limitations — limited by their geographical coverage and scope. They make heavy reference to the public sector but not enough to the private sector recruitment which can undermine the purpose of the codes. Loopholes can occur because none of the mentioned codes had a meaningful and tangible monitoring and evaluation mechanism (12,13).

In this way, the WHO Code was significantly different as it sets out a framework for data collection, information exchange, code implementation and monitoring. Furthermore, it presents the NRI as a monitoring…