National Reporting Instrument 2018
Background
[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/).
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
Disclaimer
[disclaim]
For more information on WHO Data Policy kindly refer to http://www.who.int/publishing/datapolicy/en/
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
Designated National Authority Contact Details
[q01a]
Name of Member State:
Nepal
[q01b]
Contact information:
Full name of institution:
Ministry of Health and Population
Name of designated national authority:
Yeshoda Aryal
Title of designated national authority:
Senior Public Health Administrator
Telephone number:
+977-9841642903
Email:
aryal.yeshoda@gmail.com
Implementation of the Code
[q1]
1. Has your country taken steps to implement the Code?
No
[q3]
3. Is there specific support you require to strengthen implementation of the Code?
3.a Support to strengthen data and information
3.b Support for policy dialogue and development
3.c Support for the development of bilateral agreements
3.d Other areas of support:
Data on International Health Personnel Recruitment & Migration
[iq4]
Improving the availability and international comparability of data is essential to understanding and addressing the global dynamic of health worker migration.
[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
[q4x1]
Please describe:
There are statistical records with some professional councils however, since records are mostly in hard copy, it is hard to track and has not been used in analysis and decision making, policy and planning.
[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.
[q5x1]
5. Data on the stock of health personnel, disaggregated by country of training and birth
5.1 Consolidated stock of health personnel
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 | 19069 | 0 | 0 | 0 | 0 | 0 | Council | Data limitation |
| Nurses | 49034 | 0 | 0 | 0 | 0 | 0 | Council | Data limitation |
| Midwives | 29661 | 0 | 0 | 0 | 0 | 0 | Council | Data limitation |
| Dentists | 6079 | 0 | 0 | 0 | 0 | 0 | Council | Data limitation |
| Pharmacists | 2711 | 0 | 0 | 0 | 0 | 0 | Council | Data limitation |
[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:
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:
[q5x2x2]
Option B: Uploading any format of documentation providing such information (e.g. pdf, excel, word).
Please upload file
[Q5fn]
*e.g. professional register, census data, national survey, other
#e.g. active stock, cumulative stock, public employees only etc.
#e.g. active stock, cumulative stock, public employees only etc.
Partnerships, Technical Collaboration and Financial Support 1/2
[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
6.b Support for health system strengthening
6.c Support for health personnel development
6.d Other areas of support:
Not applicable related to Code
[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
7.b Support for health system strengthening
7.c Support for health personnel development
7.d Other areas of support:
Not applicable related to Code
Partnerships, Technical Collaboration and Financial Support 2/2
[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
Health Workforce Development and Health System Sustainability
[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
[q9x1]
9.1 Measures taken to educate the health workforce
Regarding the health sector and based on the constitutional commitment to effectively regulate and manage the health sector, the Government of Nepal drafted several plans and policies to guide regulations relating to human resources for health. The Nepal Health Service Act, 1997 broadly incorporates provisions for the management of health workers employed by the Ministry of Health in terms of their recruitment, deployment and promotion. On the other hand, the Nepal Medical Council Act (NMC), 1964, the Nepal Nursing Council (NNC) Act, 1996 and the Nepal Health Professional Council (NHPC) Act, 1997 call for the establishment of autonomous bodies, such as the NMC, NNC and NHPC, which are responsible for the management of the qualification standards and registration of medical practitioners, nurses and health professionals, respectively.
The government has plan to establish academia in each province for the rationale distribution of the production of health workforce. Further, focus has been also given on education of frontline health care providers like, midwives education.
9.2 Measures taken to retain the health workforce
The National Health Policy, 2014 and Nepal Health Sector Strategy (NHSS 2015-2020), which provides the general framework to guide health sector development recognize the migration of health workers as an issue. These identifies the gap that exists between institutions producing health workers and the institutions that utilize them.
Most of retention programs formulated have been to primarily address the challenges of rural retention. For instance, a bonding scheme that mandated physicians who studied under government scholarship to complete a compulsory two-year service in rural health facilities; financial incentive packages to retain doctors, nurses and technicians in rural areas. Apart from these initiatives, there were no programs to specifically address the retention of health workers within the country.
9.3 Measures taken to ensure the sustainability* of the health workforce
There are no such measures to ensure the sustainability of the health workforce.
9.4 Measures taken to address the geographical mal-distribution of health workers
While deploying medical doctors who studied under government scholarship to complete a compulsory two-year service in rural health facilities, the decision taken based on the mal-distribution of health workers and there is also provision of committee which decide the distribution of these health workforce based on criteria. However, there are some managerial and governance issues for the proper functioning of this guideline.
[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
[q10x1]
10.1 Please provide further information in the box below:
There is a set of policies and guidelines related to migration for foreign employment, such as the Foreign Employment Act 2007, the Foreign Employment Rules 2008, the Foreign Employment Policy 2012 and a set of health sector-related regulations, such as National Health Policy 2014 and Nepal Health Service Act 1997. However, these two domains – health and migration – have seldom engaged with each other to address the issue of migration of health workers, even though the process and procedures for the migration of health care workers are defined by the laws guiding foreign employment and signed employment permit for few countries.
[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?
No
[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
[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
).
Responsibilities, Rights and Recruitment Practices
[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:
As guided by respective acts of professional councils
[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.
All these foreign-trained and/or immigrant health personnel must follow rules and regulations as guided by the respective professional councils. They need to be mandatory registered in respective councils for foreign-trained. Some councils has done mandatory provisions of knowledge and skills based test examination and permit to work.
[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.
Ensuring the quality of foreign-trained or, immigrant health personnel is the issue in term of policies and practices. The success rate in the professional councils examination by foreign-trained is minimal.
[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
There are no specific measures taken. Foreign employment act, rules and policy mention about in safe migration in general but not specific to health personnel.
Constraints, Solutions, and Complementary Comments
[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 | |
|---|---|---|
| Availability of data for dialogues and decision | A system should be established for the effective data management of human resources for health and better classification of jobs and occupational categories of migrants in the Department of Foreign Employment database and respective professional councils. | |
| Mandatory provisions / measures for entry and exit of health personnel | Few councils have practice to provide certificate for migration on the request of applicant however, it is not mandatory practice for professional councils to issue letter for such migrations. Solely as per requirements of receiver country, letters are issued from the councils and ministry of education. There is no strong mechanism to update and analyze such migrations which need to be strengthened. | |
| Effective strategy to retain and sustain HRH | The strategy for retaining health workers should be reconsidered, such as comprehensive packages that include both financial and non-financial incentives rather than sanctions and control measures. |
[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.
[q18x1]
Please upload any supporting files