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:
Sweden
[q01b]
Contact information:
Full name of institution:
Socialstyrelsen (The National Board of Health and Welfare)
Name of designated national authority:
Natalia Borg
Title of designated national authority:
Head of Department
Telephone number:
+4675-2474005
Email:
Natalia.Borg@Socialstyrelsen.se
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.
The National Board of Health and Welfare coordinate these efforts by publishing regular reports and by coordinating dialogues with stakeholders.
2.b Measures have been taken or are being considered to introduce changes to laws or policies consistent with the recommendations of the Code.
The government has introduced several national inquiries in order to make medical education more efficient.
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
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:
We do not keep record of the country of birth but we do have records of foreign-trained health personnel. Which country of training is however only stated if it is an EU/EES member state.
[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 | 67727 | 41190 | 26537 | n/a | n/a | n/a | Registret över legitimerad hälso- och sjukvårdspersonal (HoSp) The National Board of Health and Welfare | n/a |
| Nurses | 201849 | 190139 | 11710 | n/a | n/a | n/a | Registret över legitimerad hälso- och sjukvårdspersonal (HoSp) The National Board of Health and Welfare | n/a |
| Midwives | 12667 | 11939 | 728 | n/a | n/a | n/a | Registret över legitimerad hälso- och sjukvårdspersonal (HoSp) The National Board of Health and Welfare | n/a |
| Dentists | 17535 | 14503 | 3032 | n/a | n/a | n/a | Registret över legitimerad hälso- och sjukvårdspersonal (HoSp) The National Board of Health and Welfare | n/a |
| Pharmacists | 15388 | 14039 | 1349 | n/a | n/a | n/a | Registret över legitimerad hälso- och sjukvårdspersonal (HoSp) The National Board of Health and Welfare | n/a |
[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:
Country of training for foreign-trained health personnel
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
6.b Support for health system strengthening
Through general governemental financial and human assistance
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
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
The 21 counties in Sweden are responsible for supplying health care, which includes making sure there are enough health care personnel with the right level of competence to ensure patient safety. The government can support the counties through various financial contributions. There are many examples of this. For instance the government contributes with 300 million SEK for 2017 and 2018, funds that the counties are supposed to use for nurses training to become specialist nurses or midviwes.
9.2 Measures taken to retain the health workforce
The counties perform several activities aimed at retaining health workforce. For instance they develop ways for different professions to advance in their career, offering ”career steps” that include education and training as well as an increase in wage for the employees.
The counties also develop new digital methods that may allow personell to work, as well as live, in one physical spot treating patients at a distance. This may also include the personell taking part in in this digital develop-ment.
The counties also understand the importance of a good and healthy working environment as well as offering their employees the opportunity of working full time.
9.3 Measures taken to ensure the sustainability* of the health workforce
In Sweden, where we have 21 different regions, there are a number of different strategies that vary among the regions.
9.4 Measures taken to address the geographical mal-distribution of health workers
The 21 counties have very different prerequisites due to, for example, diffe-rences in geographical size and demography. Thus, they all have different chal-lenges concerning this issue that is addressed in question 9.4.
The counties have taken several measures to address this mal-distribution, including offering higher salaries to people working in rural areas and using digitalisation as a way of overcoming long distances, where a doctor in a hospital may assist a nurse who meets a patient at a smaller health care center. Through digitalisation patients may also see a doctor or a nurse through his or hers phone or computer.
Other measures taken include team work where different professions work together or task shifting where the lack of enough numbers of a profession may be resolved through another profession performing certain tasks.
[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:
When it comes to health care workforce planning in general, including foreign-trained personnel, the government has assigned a mission to the National Board of Health and Welfare and the Swedish Higher Education Authority to develop collaborative fora where universities and care provi-ders may meet and discuss mutual challenges. In this mission there is thus a collaboration across governmental ministries (the Ministry of Health and Social Affairs and the Ministry of Education).
[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:
The National Board of Health and Welfare is responsible for providing official data of the supply of health care personnel as well as issuing licenses to trained health care personnel, including foreign-trained, which includes a register of issued licenses.
[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:
[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.
Both domestic and foreign-trained heath personnel must have a license to practice to be able to work in their profession if it is one of the 21 regultated professions i Sweden.
[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.
Once you have a licence to practise there are no limitations whether you have domestic training or foreign training. The same rights and obligations are applicable. In order to get a license to practice you must meet the regulations stated in Swedish legislation or European Union directive. In order to get a license to practise if you have training from a country outside EU/EES you must show that your knowledge and skills meet the Swedish standards. One of the ways to do that is to take a proficiency test provided by the National Board of Health and Welfare at no cost for the applicant. Please see https://legitimation.socialstyrelsen.se/en/educated-outside-eu-and-eea for more information on the steps towards a Swedish license to practise. There are also language requirements for all foreign-trained applicants.
[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
n/a
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 | |
|---|---|---|
| Lack of consensus regarding the balance of competence and health needs of the population | Increased dialogue between key actors | |
| n/a | n/a | |
| n/a | n/a |
[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