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:
Latvia
[q01b]
Contact information:
Full name of institution:
Ministry of Health of the Republic of Latvia
Name of designated national authority:
Ministry of Health of the Republic of Latvia
Title of designated national authority:
leading government authority
Telephone number:
+ 371 67876000
Email:
vm@vm.gov.lv, kristine.klavina@vm.gov.lv
Implementation of the Code
[q1]
1. Has your country taken steps to implement the Code?
Yes
[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.
A non-profit institution Academic Information Centre is an information institution on recognition of professional qualifications in regulated professions and Latvian representative to the European diploma recognition networks ENIC/NARIC. http://www.aic.lv/portal/en/arvalstu-diplomu-atzisana Academic Information Centre has developed a data base on regulated professions in Latvia. https://www.latvijaskvalifikacijas.lv/en/
2.b Measures have been taken or are being considered to introduce changes to laws or policies consistent with the recommendations of the Code.
Human resources for health care is one of the priorities of health care system in Latvia, which is included in the strategy of Health care system reform approved by the Latvian government in July 2017. This policy document contains measures to achieve sufficient human resources, including wage increases, attraction of medical practitioners to regions, providing support for continuing professional development (CPD), and to continue improving the infrastructure of the medical institutions, which, among other things, will significantly improve the working environment and working conditions for medical staff. At the same time, the planned activities for the further development of the nursing profession are highlighted. These measures are largely in line with Code Article 3 – 3.6. guiding principle.
2.c Records are maintained on all recruiters authorized by competent authorities to operate within their jurisdiction.
2.d Good practices, as called for by the Code, are encouraged and promoted among recruitment agencies.
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.
2.f Other steps:
[q3]
3. Is there specific support you require to strengthen implementation of the Code?
3.a Support to strengthen data and information
Strengthening the availability of data and appropriate use of information makes it possible and necessary to improve the analytical capacity of responsible authorities and planning of medical practitioners.
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:
The Health Inspectorate, which is the subordinate institution of the Ministry of Health, registers in the Register of Medical Persons and Medical Support Persons information regarding: 1) medical practitioners who have graduated accredited educational programs in Latvia and have obtained a diploma in the corresponding profession and / or specialty; and 2) graduated recognized educational institutions abroad and whose foreign qualification is recognized in Latvia in accordance with the Law "On Regulated Professions and Recognition of Professional Qualifications".
[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 | 6657 | 6218 | 422 | 17 | ? | ? | Health inspectorate | Please note that the education and professional qualifications issued by the former USSR educational institutions were recognized in the Republic of Latvia. As a result of statistics, they appear as foreign trained medical doctors. https://likumi.lv/ta/en/en/id/26021-on-the-regulated-professions-and-the-recognition-of-professional-qualifications |
| Nurses | 8702 | 8425 | 273 | 4 | ? | ? | Health inspectorate | Please note that the education and professional qualifications issued by the former USSR educational institutions were recognized in the Republic of Latvia. As a result of statistics, they appear as foreign trained nurses. https://likumi.lv/ta/en/en/id/26021-on-the-regulated-professions-and-the-recognition-of-professional-qualifications |
| Midwives | 474 | 458 | 15 | 1 | ? | ? | Health inspectorate | Please note that the education and professional qualifications issued by the former USSR educational institutions were recognized in the Republic of Latvia. As a result of statistics, they appear as foreign trained midwives. https://likumi.lv/ta/en/en/id/26021-on-the-regulated-professions-and-the-recognition-of-professional-qualifications |
| Dentists | 1419 | 1353 | 66 | 0 | ? | ? | Health inspectorate | Please note that the education and professional qualifications issued by the former USSR educational institutions were recognized in the Republic of Latvia. As a result of statistics, they appear as foreign trained dentists. https://likumi.lv/ta/en/en/id/26021-on-the-regulated-professions-and-the-recognition-of-professional-qualifications |
| Pharmacists | 1574 | ? | ? | ? | ? | ? | Pharmacists’ Society of Latvia | Please note that the education and professional qualifications issued by the former USSR educational institutions were recognized in the Republic of Latvia. As a result of statistics, they appear as foreign trained pharmacists. https://likumi.lv/ta/en/en/id/26021-on-the-regulated-professions-and-the-recognition-of-professional-qualifications |
[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:
No comment
[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
Specific technical or financial support for the implementation of the Code is not provided by Latvia, but there are various cooperation models, including the exchange of information and experience with other countries related to the exhibition and implementation of health policy to strengthen the health system.
6.b Support for health system strengthening
6.c Support for health personnel development
6.d Other areas of support:
[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
Latvia has not received this type of support (see answer to question 6).
7.b Support for health system strengthening
7.c Support for health personnel development
7.d Other areas of support:
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 education of health workforce, measures are being implemented at national level in three main directions: Provision of state budget funded study places; Planning and financing from state budget study places in residency (for specialization); Through the financing of the European Social Fund, medical practitioners are provided with support for the professional development.
9.2 Measures taken to retain the health workforce
In 2018, additional financing was attracted to increase remuneration of medical personnel and other workers in health care sector, as a result percentage increase in wages for doctors and functional specialists is foreseen by 44%, for medical and patient care persons and functional specialists’ assistants by 38%, but for medical and patient care support persons by 24%. The wages of medical personnel working in inpatient institutions will increase more significantly about the mandatory premium for twenty-four hours working mode and the gradual refusal from extended normal working time.
As mentioned in answers before, within the 2014-2020 planning period of EU funds, it is planned to support measures to recruit medical personnel (doctors and nurses) for work in regions outside capital city, and thus reduce the lack of specialists in medical institutions in the regions outside Riga, as well as within postgraduate education support measures financed by EU funds the medical personnel will be provided with the opportunity to raise their qualifications and opportunities for non-practitioners in their specialty to return to the labor market.
Also, to continue to improve the infrastructure of medical institutions (EU fund project), which, among other things, will significantly improve the working environment and working conditions for the staff. At the same time, activities are planned for the further development of the nursing profession in order to simplify the complex process of recognition of education and qualifications, for instance to reduce the administrative burden and obstacles in relation to the educational process and the process of obtaining specialization, as well as to create more qualitative professional development in order to restore and maintain the professional qualifications of the nurse according to the sectoral, employer and nurses individual needs.
9.3 Measures taken to ensure the sustainability* of the health workforce
In the government-approved report on the healthcare system reform there is a plan for gradual wage increases up to 2023 for medical personal. As well measures mentioned above (9.1 and 9.2), including planned development of the nursing profession.
9.4 Measures taken to address the geographical mal-distribution of health workers
To recruit human resources in regions there is requirement for a person after completion of the state paid residential program to work in the specialty for three years in a state or municipal medical institution or in a family doctors practice. While doctors who concluded a “regional agreement”, after completion of 3 years residency will work in the relevant medical institution. This requirement applies to the residential program since 2016/2017.
As well changes in resident admission procedures for state paid higher education were introduced. According to these procedures universities must (in case of identical results) give priority to those applicants who have concluded an agreement with a regional municipality and/or state medical institution outside the capital city for work relations in rural area after the completion of the residency program. In March 2016 this was included in corresponding Regulations of the Cabinet of Ministers. As a result, program admitted 124 residents (medical students) with a "regional arrangement".
Particularly important is the ESF project to recruit medical practitioners in regions (mentioned above (9.1 and 9.2)), which was started in 2018. Financial compensations are intended to promote human resources attraction to medical institutions outside Riga, thus ensuring the availability of services to the inhabitants in cities and rural areas. Human resources capacity in regions outside the capital city will be increased by attracting the necessary specialists from the corresponding profile, also by promoting the replacement of generations in primary health care. Since the beginning of this activity, 48 medical practitioners have received support.
[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:
The Law "On Regulated Professions and Recognition of Professional Qualifications" transposes Directive 2005/36/EC of the European Parliament and of the Council of 7, September (2005) on the recognition of professional qualifications (https://likumi.lv/ta/en/en/id/26021-on-the-regulated-professions-and-the-recognition-of-professional-qualifications).
[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
[q11x1]
11.1 Please provide further information in the box below:
In the field of health there are 5 institutions that issue certificates of recognition of professional qualifications acquired abroad in regulated professions:
1) The Union of Professional Organisations of Medical Practitioners of Latvia issues the certificates of recognition of professional qualifications obtained abroad, in the following regulated professions: physiotherapist, ergotherapist, physiotherapist assistant, ergotherapist assistant, technical orthopedist, audiologist (clinical speech therapist), radiologist assistant, radiographer, biomedical laboratory , dental technician, beauty care specialist in cosmetology, cosmetologist, re-therapist, instructor of rheumatoid arthritis, podologist, nutrition specialist, masseur, art therapist;
2) The Latvian Medical Association issues certificates of recognition of professional qualifications obtained abroad, in the following regulated professions: doctor, basic medical specialty, sub-specialty and additional specialty, dentist, basic specialty of dentistry and sub-specialty;
3) The Latvian Pharmacist Society issues certificates of recognition of professional qualifications obtained abroad, in the following regulated professions: Pharmacist, assistant pharmacist;
4) The Latvian Nurses Association issues certificates of recognition of professional qualifications obtained abroad, in the following regulated professions: Basic specialties and supplementary specialties of nurses (nurses), midwife, dental nurse, dental hygienist;
5) The Latvian Association of Optometrists and Opticians issues certificates of recognition of professional qualifications obtained abroad, in the regulated profession - optometrist.
In Latvia, coordination and information functions in mutual recognition of professional qualifications are provided by the coordinator of recognition of the professional qualifications of the Ministry of Education and Science.
[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?
Yes
[q12x1]
12.1 Please provide further information in the box below:
Information in the website of the Academic Information Centre.
http://www.aic.lv/portal/en/arvalstu-diplomu-atzisana
[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
According to the law “On the Regulated Professions and the Recognition of Professional Qualifications” migrant health personnel shall have the same rights to practice in the relevant regulated profession and the same duties as the persons who, in accordance with the procedures specified in the regulatory enactments of the Republic of Latvia, have acquired the qualifications required in the regulated profession (art.33, (1)).
13.d Other mechanisms, please provide details below if possible:
[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.
Legislation and policies related to the development of human resources in the health sector are planned and implemented in accordance with the Directive 2005/36/EC and in accordance with the principles contained in this Code.
[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.
With its high quality of medical education and low wages, Latvia has been in the position of a human resources for health donor for several years. Therefore, the main priority of Latvia is to overcome internal barriers in order not to lose its personnel; this is primarily a matter of remuneration, simplification of procedures for obtaining and maintaining professional qualifications, as well as reducing administrative barriers, improving the working environment, etc.
Ar savu augsto medicīnas izglītības kvalitāti un zemajām darba algām Latvija jau vairākus gadus ieņem donorvalsts pozīcijas. Tāpēc Latvijas galvenā prioritāte ir pārvarēt iekšējos šķēršļus, lai nezaudētu savu personālu, tas pirmkārt ir atalgojuma jautājums, profesionālās kvalifikācijas iegūšanas un uzturēšanas procedūru vienkāršošana kā arī administratīvo šķēršu mazināšana, darba vides uzlabošana, u.c.
[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
Legislation and policies related to the development of human resources in the health sector are planned and implemented in accordance with the Directive 2005/36/EC and in accordance with the principles contained in this Code.
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 | |
|---|---|---|
| To provide and maintain health system sustainability. | The strategy of Health care system reform approved by the Latvian government in July 2017, in which the main goals to be achieved are: stable and sustainable health financing; health policy, incl. the predictability of financing; improved quality of service; optimal human resources provision; economically organized use of funding. | |
| Factors that have a negative impact on the provision of human resources - aging, uneven regional disposition, insufficient human resource provision mainly for the provision of publicly funded health services. | Measures mentioned above in 9.1., 9.2., 9.3., 9.4. | |
| Insufficient capacity to create a comprehensive information system on the human resources of the healthcare sector, including information on education, professional activities and the migration of medical practitioners. | The strengthening of the capacity and the exchange of international experience to use ICT solutions in the development of information systems, to ensure the quality and reliable of data. |
[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