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:
Norway
[q01b]
Contact information:
Full name of institution:
The Norwegian Directorate of Health
Name of designated national authority:
Erik Sirnes
Title of designated national authority:
Adviser
Telephone number:
+47 24 16 30 00
Email:
pbx160200asgh@helsedir.no
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 "user manual" explaining the Code has been produced and the Code has been translated into Norwegian. The Minister of Health has requested that the regional health authorities recruit in accordance with the Code. Information seminars has been organized and since 2015 a forum to discuss the Code and its implementation has been organized annually. The intention of implementing the Code has been acknowledged in a government white paper.
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 principles of the Code are promoted in the national guidelines for appointments by employers in the health and care services.
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.
Recruitment agencies are invited to the annual forum (see 2.a) where they are encouraged to comply with the Code and be inspired by good practices.
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.
Relevant stakeholders are invited to the annual forum (see 2.a).
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:
No support required.
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 Norwegian Directorate of Health maintain a register of all health personnel authorized to practice in Norway, including information on citizenship and country of training. Statistics Norway maintain a register on all employed health personnel, including information on citizenship, country of birth and country of training.
[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 | 24500 | 14453 | 9718 | 329 | 18247 | 6253 | Statistics Norway (register) | Active stock. |
| Nurses | 96076 | 84359 | 8393 | 3324 | 83290 | 12786 | Statistics Norway (register) | Active stock. Please note that this include midwives, as midwifery education in Norway builds on a nursing degree. |
| Midwives | 2934 | 2385 | 427 | 122 | 2467 | 467 | Statistics Norway (register) | Active stock. Please note that these midwives are also included in the nurses row above. |
| Dentists | 4564 | 3032 | 1083 | 449 | 3397 | 1167 | Statistics Norway (register) | Active stock. |
| Pharmacists | 1360 | 1061 | 232 | 67 | 1118 | 242 | Statistics Norway (register) | Active stock. Includes pharmacists with bachelors degree or masters degree. |
[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
6.b Support for health system strengthening
Mostly through GFF, Gavi and GFATM (Norwegian Agency for Development Cooperation (Norad) is the responsible authority). Some support is also provided in Europe through the EEA Grants.
6.c Support for health personnel development
Mostly through Fredskorpset (FK Norway), GFF, Gavi, GFATM and bilateral support to Malawi and India (Norwegian Agency for Development Cooperation (Norad) is the responsible authority.
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
Recommendations on education capacity adjusting are submitted to the education authorities annually, based on health workforce planning. 5-year programs on capacity building in primary health care.
9.2 Measures taken to retain the health workforce
Norway does not have an issue retaining health workers in the country. However, retaining health workers in rural areas can be a challenge (see 9.4).
9.3 Measures taken to ensure the sustainability* of the health workforce
Health workforce planning is conducted in cooperation with Statistics Norway to anticipate future supply and demand.
9.4 Measures taken to address the geographical mal-distribution of health workers
Geographical distribution is addressed through decentralized education, grants for recruitment and economic incentives for people settling in rural areas to work.
[q10]
10. Are there specific policies and/or laws, across governmental ministries, for internationally recruited and/or foreign-trained health personnel in your country?
No
[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 Ministry of Health has delegated responsibility of monitoring to the Directorate of Health. Monitoring is conducted with the support of Statistics Norway (subordinate of the Ministry of Finance). The directorate have a dialogue with other relevant authorities in relation to the forum on implementation of the Code (see 2.a).
[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:
The Working Environment Act ensures that all employees have the same fundamental rights, regardless of background.
[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.
The Norwegian Labour Inspection Authority controls that all employers have fair employment practices,regardless of the employees background, and that practices comply with the Working Environment Act.
The Equality and Anti-Discrimination Ombudsman is a low threshold alternative to court proceedings in cases of discrimination.
[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.
A course and test on Norwegian health services, health legislation and society is required for all health workers educated in a country outside of the EEA-area. If there is capacity, the course is also offered to EU-citizens who are not required to take the course. Health workers educated in a country outside of the EEA-area also need to document Scandinavian language proficiency. Language barriers and cultural challenges has been reported from the health and care services, resulting in calls for strengthened systems for integration of foreign health workers.
[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
Norway is a primarily a destination country, and no measures are planned specifically to ensure fair recruitment abroad for emigrant 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 | |
|---|---|---|
| While we have reason to believe that municipalities and public-sector hospitals recruit in accordance with the Code, we know less about the practices of recruitment agencies. These agencies offer personnel to the same municipalities and hospitals, especially during vacations. | Recruitment agencies can be more actively involved and examined. Hospitals and municipalities are actively avoiding agencies with a bad reputation, and a system making it easier for employers to know which agencies are serious could be a solution. | |
| A significant share of the health workforce is foreign-trained, indicating a certain level of reliance on foreign-trained personnel. | Increased educational capacity and completion rate for some professions and better utilization of existing workforce (e.g. more full-time employment, less turnover to other sectors) can decrease the pull-effect. The pull-effect do take place in Norway with its high wages, advanced health services and decent working environment. | |
| While migration data has improved significantly lately, we still need more knowledge. For example, we know little about the motivation of migrants, and hence we do not know if the migration is a result of active recruitment. Also, we dont know enough about migration patterns and the extent of the domino effect. The data shows that Norway is not recruiting from the most vulnerable countries, but we dont know if we contribute to brain-drain in these countries through the domino effect. | A continued focus on strengthening international migration data and research. |
[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