National Reporting Instrument 2018

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Background

Hide [iBG] Adopted in 2010 at the 63rd World Health Assembly (WHA Res 63.16), the WHO Global Code of Practice on the International Recruitment of Health Personnel (“the Code”) seeks to strengthen the understanding and ethical management of international health personnel recruitment through improved data, information, and international cooperation.

Article 7 of the Code encourages WHO Member States to exchange information on the international recruitment and migration of health personnel. The WHO Director General is additionally mandated to report to the World Health Assembly every 3 years. WHO Member States completed the 2nd Round of National Reporting on Code implementation in March 2016. The WHO Director General reported progress on implementation to the 69th World Health Assembly in May 2016 (A 69/37 and A 69/37 Add.1). During the 2nd Round of National Reporting, seventy-four countries submitted complete national reports: an increase in over 30% from the first round, with improvement in the quality and the geographic diversity of reporting.

The National Reporting Instrument (NRI) is a country-based, self-assessment tool for information exchange and Code monitoring. The NRI enables WHO to collect and share current evidence and information on the international recruitment and migration of health personnel. The NRI (2018) has been considerably shortened, while retaining key elements. It now comprises 18 questions. The common use of the instrument will promote improved comparability of data and regularity of information flows. The findings from the 3rd Round of National Reporting are to be presented at the 72nd World Health Assembly, in May 2019.

The deadline for submitting reports is 15 August 2018.

Should technical difficulties prevent national authorities from filling in the online questionnaire, it is also possible to download the NRI via the link: http://www.who.int/hrh/migration/code/code_nri/en/. Please complete the NRI and submit it, electronically or in hard copy, to the following address:

Health Workforce Department
Universal Health Coverage and Health Systems
World Health Organization
20 Avenue Appia, 1211 Geneva 27
Switzerland
hrhinfo@who.int

The data and information collected through the National Reporting Instrument will be made publicly available via the WHO web-site following the proceedings of the 72nd World Health Assembly. The quantitative data collected will be updated on and available through the National Health Workforce Accounts online platform (http://www.who.int/hrh/statistics/nhwa/en/).
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Please describe
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Disclaimer

Hide [disclaim]
 For more information on WHO Data Policy kindly refer to http://www.who.int/publishing/datapolicy/en/
I have read and understood the WHO policy on the use and sharing of data collected by WHO in Member States outside the context of public health emergencies
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Designated National Authority Contact Details

Hide [q01a] Name of Member State:
Nigeria
Hide [q01b] Contact information:
Full name of institution:
FEDERAL MINISTRY OF HEALTH
Name of designated national authority:
UDOH, UKO ANTHONY
Title of designated national authority:
CHIEF RESEARCH OFFICER
Telephone number:
+234 (0)706 - 226 - 2010
Email:
UKOUDOH631@ROCKETMAIL.COM
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Implementation of the Code

Hide [q1] 1. Has your country taken steps to implement the Code?
Yes
Hide [q2] 2. To describe the steps taken to implement the Code, please tick all items that may apply from the list below
2.a Actions have been taken to communicate and share information across sectors on the international recruitment and migration of health personnel, as well as to publicize the Code, among relevant ministries, departments and agencies, nationally and/or sub-nationally.
Communication about the Code was presented at the highest Policy making body in Health – 59th National Council on Health in 28 January, 2016 where Top Health Managers across the country: Hon. Ministers, 36 State Commissioners, all Directors of Ministry of Health (Federal and State), Chief Medical Directors and all 14 Health regulatory Agencies, and Health Professional Associations were present. In addition the development of Nigerian policy on Labour Migration has brought together a National stakeholders be aware of the Code
2.b Measures have been taken or are being considered to introduce changes to laws or policies consistent with the recommendations of the Code.
Please describe: There is National Policy on Labour Migration (2014) and which was endorsed by Mr President in September 2016 . In addition, Federal Ministry of Health has adapted the Policy on Health Workforce Migration in line with the holistic National Policy on Labour Migration.
2.c Records are maintained on all recruiters authorized by competent authorities to operate within their jurisdiction.
There is a Desk on Labour Migration which has been established in Ministry of Labour and productivity which take care of such documentation
2.d Good practices, as called for by the Code, are encouraged and promoted among recruitment agencies.
Recruiters are encouraged to visit Ministry of Labour Migration Desk for negotiations but not particularly on Health workforce recruitment as there is no data on this
2.e Measures have been taken to consult stakeholders in decision-making processes and/or involve them in activities related to the international recruitment of health personnel.
Yes, this was during the meeting on the development of the National Policy on Labour Migration and adaptation of Health Workforce Migration Policy
2.f Other steps:
Stakeholders such as Ministerial Departments, Health Regulatory Agencies, State representatives, Professional Associations, Implementing Partners and the Private Sector were involved
Hide [q3] 3. Is there specific support you require to strengthen implementation of the Code?
3.a Support to strengthen data and information
Support to all Data submitting entities on data collection and entries
3.b Support for policy dialogue and development
Technical Support to complete the Draft National Policy on Health Workforce Migration and development of strategy for its implementation
3.c Support for the development of bilateral agreements
Technical Support on strengthening stakeholders coordination
3.d Other areas of support:
Capacity building for DNA on effective reporting on NRI, Stakeholders coordination, data collecction and analysis and equipment for maintaining Data Bank
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Data on International Health Personnel Recruitment & Migration

Hide [iq4] Improving the availability and international comparability of data is essential to understanding and addressing the global dynamic of health worker migration.
Hide [q4] 4. Does your country have any mechanism(s) or entity(ies) to maintain statistical records of foreign-born and foreign-trained health personnel?
Yes
Hide [q4x1] Please describe:
Please describe: Nigeria currently has in place 14 Health Regulatory Bodies that maintain these record but they do not have the capacity to do so. The Regulatory Bodies only have records of foreign health workers who may apply to work in Nigeria.
Hide [iQ5] For the latest year available, consistent with the National Health Workforce Accounts (NHWA) Indicators 1-07 and 1-08, please provide information on the total stock of health personnel in your country (preferably the active workforce), disaggregated by the country of training (foreign-trained) and the country of birth (foreign-born). Please consult with your NHWA focal point, if available, to ensure that data reported below is consistent with NHWA reporting.
Hide [q5x1] 5. Data on the stock of health personnel, disaggregated by country of training and birth

5.1 Consolidated stock of health personnel
Total Domestically Trained Foreign Trained Unknown Place of Training National Born Foreign Born Source* Additional Comments#
Medical Doctors 83565 65784 14235 N/A 79,565 4000 MDCN 2016 data source
Nurses 188,291 185,101 3,190 N/A 187,135 1156 NMCN 2016 data source
Midwives 141,275 141,275 N/A N/A 141,275 N/A NMCN 2016 data source
Dentists 4081 3,106 975 N/A 3106 N/A NMCN 2016 data source
Pharmacists 20,035 19,365 400 N/A 19,165 870 PCN 2015 data source
Hide [iq5x2] 5.2 Country of training for foreign-trained health personnel

Please provide detailed data on foreign-trained health personnel by their country of training, as consistent with NHWA Indicator 1-08. This information can be provided by one of the following two options:
Hide [q5x2x1] Option A: Completion of the template in Excel
Download and Upload
Please upload file
Hide [q5x2x2] Option B: Uploading any format of documentation providing such information (e.g. pdf, excel, word).
Please upload file
Hide [Q5fn] *e.g. professional register, census data, national survey, other
#e.g. active stock, cumulative stock, public employees only etc.
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Partnerships, Technical Collaboration and Financial Support 1/2

Hide [q6] 6. Has your country provided technical or financial assistance to one or more WHO Member States, particularly developing countries, or other stakeholders to support the implementation of the Code?
6.a Specific support for implementation of the Code
NO
6.b Support for health system strengthening
NO
6.c Support for health personnel development
NO
6.d Other areas of support:
NO
Hide [q7] 7. Has your country received technical or financial assistance from one or more WHO Member States, the WHO secretariat, or other stakeholders to support the implementation of the Code?
7.a Specific support for implementation of the Code
WHO through EU funds provided funds to ACHEST, Uganda to assist Nigeria in conducting study on "...from Brain Drain to Brain Gain" Project from 2015 - 2016
7.b Support for health system strengthening
WHO through Global Affairs Canada (GAC) is currently supporting Nigeria on "Enhancing the capacity of Frontline Health Workforce" which is focused mainly on Nurses, CHO and CHEWs
7.c Support for health personnel development
The above project by extension support the Nurse Tutor Programmes. Also Women for Health are supporting fromtline Health Workers by only CHEWs and JCHEWs
7.d Other areas of support:
WHO through GAC , W4H, Marie Stopes International and few other Partners are also supporting Health System Strengthening
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Partnerships, Technical Collaboration and Financial Support 2/2

Hide [q8] 8. Has your country or its sub-national governments entered into bilateral, multilateral, or regional agreements and/or arrangements to promote international cooperation and coordination in relation to the international recruitment and migration of health personnel?
No
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Health Workforce Development and Health System Sustainability

Hide [q9] 9. Does your country strive to meet its health personnel needs with its domestically trained health personnel, including through measures to educate, retain and sustain a health workforce that is appropriate for the specific conditions of your country, including areas of greatest need?
Yes
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9.1 Measures taken to educate the health workforce
In-service Training (IST), Continuous Professional Development (CPD) and Training of Resident Doctors to attain the status of consultant; Nurses and Pharmacist are equally supported to Fellowship statuses
9.2 Measures taken to retain the health workforce
Government is providing rural allowances as incentives to health workers
9.3 Measures taken to ensure the sustainability* of the health workforce
Regular promotions, salaries; CPDs and rural incentives
9.4 Measures taken to address the geographical mal-distribution of health workers
Government is encouraging all the States especially the Northern States to employ health workers to fill the gap
Hide [q10] 10. Are there specific policies and/or laws, across governmental ministries, for internationally recruited and/or foreign-trained health personnel in your country?
Yes
Hide [q10x1] 10.1 Please provide further information in the box below:
Nigeria has developed a National Policy on Labour Migration (2014), which Mr. President endorsed in September, 2016
Hide [q11] 11. Recognizing the role of other parts of government, does the Ministry of Health have processes (e.g. policies, mechanisms, unit) to monitor and coordinate across sectors on issues related to the international recruitment and migration of health personnel?
Yes
Hide [q11x1] 11.1 Please provide further information in the box below:
Nigeria (FMOH) in addition to appoiinting a DNA on Code has further established a Diaspora Unit to links up with health workforce in diaspora but coordination of data on in-flow and out-flow, and engagement with diaspora has been a serious challenge. Government with the support from ACHEST developed a Draft Health Workforce Migeration Policy (2016) and send information memo to the National Council on Health, whch was widely applauded, as served as means of propagating information on the Code
Hide [q12] 12. Has your country established a database or compilation of laws and regulations related to international health personnel recruitment and migration and, as appropriate, information related to their implementation?
No
Hide [q9x3fn] *Health workforce sustainability reflects a dynamic national health labour market where health workforce supply best meets current demands and health needs, and where future health needs are anticipated, adaptively met and viably resourced without threatening the performance of health systems in other countries (ref: Working for Health and Growth, Report of the High-Level Commission on Health Employment and Economic Growth, WHO, 2016, available from http://apps.who.int/iris/bitstream/10665/250047/1/9789241511308-eng.pdf?ua=1 ).
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Responsibilities, Rights and Recruitment Practices

Hide [q13] 13. Which legal safeguards and/or other mechanisms are in place to ensure that migrant health personnel enjoy the same legal rights and responsibilities as the domestically trained health workforce? Please tick all options that apply from the list below:
13.a Migrant health personnel are recruited internationally using mechanisms that allow them to assess the benefits and risk associated with employment positions and to make timely and informed decisions regarding them
13.b Migrant health personnel are hired, promoted and remunerated based on objective criteria such as levels of qualification, years of experience and degrees of professional responsibility on the same basis as the domestically trained health workforce
13.c Migrant health personnel enjoy the same opportunities as the domestically trained health workforce to strengthen their professional education, qualifications and career progression
13.d Other mechanisms, please provide details below if possible:
Hide [q14] 14. Please submit any other comments or information you wish to provide regarding legal, administrative and other measures that have been taken or are planned in your country to ensure fair recruitment and employment practices of foreign-trained and/or immigrant health personnel.

Hide [q15] 15. Please submit any comments or information on policies and practices to support the integration of foreign-trained or immigrant health personnel, as well as difficulties encountered.
www.nigeriapolicyonmigration.org.ng. FMOH is not yet put up appropriate Laws and policies on this. However, there is a general Desk on the Ministry of Labour to ensure adepate information and negotiations on this
Hide [q16] 16. Regarding domestically trained/ emigrant health personnel working outside your country, please submit any comments or information on measures that have been taken or are planned in your country to ensure their fair recruitment and employment practices, as well as difficulties encountered
As stated above, FMOH has extablished a Diapora Unit to like up healthworkers in diasport. This unit is currently facing some challenges in general data collection due to some foreign policies on Regulations
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Constraints, Solutions, and Complementary Comments

Hide [q17] 17. Please list in priority order, the three main constraints to the implementation of the Code in your country and propose possible solutions:
Main constraints Possible solution
Lack of approriate Capacity Building for DNA on Implementation of Code Specialized training/capacity building for NDA on implementation of the Code
Challenge in data collection and analysis by data submtting entities Capacity building for Heads of ICTs of Regulatory Bodies on data collection and analysis
General Coordination of stakeholders, appropriate Laws and Equipment requirements for data bank Strong Advocacy for support of the Code at all levels and establishment of data BankCompletion of Health Workforce Migration Policy, develop strategy on its implementation and establishing a central Desk for country coordinating mechanism. Completion of Health Workforce Migration Policy, develop strategy on its implementation, enactment of laws on workforce migration and establishing a central Desk for country coordinating mechanism.
Hide [q18] 18. Please submit any other complementary comments or material you may wish to provide regarding the international recruitment and migration of health personnel, as related to implementation of the Code.
I am of the view that for Nigeria to make prograess on the implementation of the Code, there is the need to complete the Draft Health Workforce Migration Policy, develop strategy on its implementation and establishing a central Desk for country coordinating mechanism. There is also the need to make appropriate laws on health workforce migration
Hide [q18x1] Please upload any supporting files