Summaries of contributions
Gilles Dussault, Instituto de Higiene e Medicina Tropical, Lisboa, Portugal
I am in agreement with the “spirit” of the code.
Comments and suggestions focus on language and the format (excerpted):
- The code should be as brief and as explicit as possible. Suggest cutting the draft to a maximum of 3 pages.
- Guiding principles:
- 3.1 can go into the introduction.
- 3.2: can the code go as far as saying “All Member States have the sovereign duty to develop and strengthen ...”
- 3.8 is not a principle, but a modality of support to implementation of the code
- 3.9 is included in 3.5
- Recruitment practices: 4.1, 4. 2, 2.4, 4.5, 4.6, 4.7 repeat some of 3.5 and could be collapsed into one bullet point.
- National health workforce sustainability:
- 6.1 Suggestion: … and is built upon an evidence-based health workforce development strategy.
- 6.2 can go in the Introduction.
- Under Monitoring, the role of the HRH Observatories can be mentioned.
- Article 11 can be integrated into 9 as it deals with implementation.
Regional Network for Equity in Health in East and Southern Africa (EQUINET)
Note: EQUINET provided a number of specific comments on articles 1 through 11 and these will be duly considered when the draft is revised. Below are selected highlights of EQUINET’s general comments.
- The draft does not explicitly distinguish between destination countries and source countries (and their differentials in resources and bargaining power), as some previous WHO documents on health workforce have.
- As a voluntary code there exist the same fundamental weakness as observed in the application of other ethical codes – it is not sufficiently clear on implementation and on what remedies apply in case of breach.
- Within the public sector and the health sector there is no cross reference to other global instruments that may have more binding force and could strengthen conditions for its application.
- The code should explicitly address the recruitment practices of international institutions (such as global health initiatives) within countries.
- The code is weak on its application outside the public sector and the health sector.
- Given these weaknesses while the intentions are positive it is not clear that the Code as it stands will address concerns motivating it, such as that of developing countries in ensuring a just return on their investment in health worker training, including in relation to areas of highest health need.