National Reporting Instrument 2015

• Health personnel are recruited internationally using mechanisms that allow them to assess the benefits and risks associated with employment positions to make timely and informed decisions regarding them. Health personnel is hired, promoted and remunerated based on objective criteria such as levels of qualifications, years of experience and degrees of professional responsibility on the same basis as the domestically trained health workforce. • Migrant health personnel enjoy the same opportunities as the domestically trained health workforce to strengthen their professional education, qualifications and career progression. Belgium has invested in the development of national capacity of life-long-training since 10 years, ensuring that migrant health workforce is as well trained as the domestically trained health workforce (for example our legislation on GP’s: a migrant doctor has the same opportunity to update his knowledge than a domestically trained doctor) • Whilst international recruitment is still in its infancy and some agencies are still in the pilot phase, several healthcare establishments (such as the Cliniques d’Europe in Brussels) have already had positive experiences. These agencies provide tailor-made services and undertake, to various degrees, to facilitate the worker’s integration into Belgian society, notably via language courses and taking charge of administrative formalities. • The Belgian State however cannot directly impose hospitals to hire international health personnel or not, because Belgian hospitals are not Belgian State’s institutions. The Belgian government is thus not involved in the recruitment for the health sector as this resorts under the private sector, causing some practical difficulties for the application of the Code. However, State’s services can ensure the same rights to international health workforce and are more and more open to this issue. The European directive 2005/36 (modified by the directive 2013/55/EU) of the European parliament and the Council enables free movement of health professional, not only from one Member State to another but also from a third State to a Member State. International migrants can thus apply for being recognized as health practitioners in Belgium. • Belgium also invested in targeting the “Southern” elements of the CoP. The Belgian Medical NGOs prepared a document at the beginning of 2005 aiming to set up a dialogue with the Belgian Development Cooperation to take up the question of “rethinking the human capital” and pleading for the Belgian Development Cooperation to have a free and open dialogue on this question, not excluding the possibility of co-funding salaries and/or performance fees for local health workers. Considering the previous, and inspiring from the Charter on drug quality developed in 2008 by Be-cause Health, its Working group on Human Resources took the initiative to develop a Charter aimed at better harmonizing and increasing the equity and effectiveness of Belgian Cooperation Stakeholders’ practices in the field of recruitment and support to health workers coming from partner countries. This is considered as an essential aspect in the efforts towards universal health coverage. As the Charter aims to encourage the implementation of the WHO CoP in Belgium, it translates several of its orientations into concrete commitments and to the reality of our international cooperation. It is voluntary and it encourages respecting a number of principles with regards to partnerships and harmonization, HRH policies and development plans, training, recruitment, as well as in our environment in Belgium. The signatories are member organization from Be-cause Health that adhere to the principles and have the ability to sign it. Even if they could not sign the Charter, the Belgian federal ministries of Cooperation and Health supported the process. By signing the Charter, the organization commits to respecting a number of principles that aim, on the one hand, to actively support capacity building of health workers and reinforce sustainable systems; and on the other hand, to limit the negative consequences that international recruitment of health worker from partner countries may have on local capacities.

The issue of mobility is particularly significant in Belgium for determining and organizing the workforce. Mobility is important in healthcare workforce organization in Belgium for two reasons: the medical training of large numbers of young French students (and to a lesser extent Dutch students) and the fact that the Belgian quota system does not apply to professionals trained abroad. Firstly, Belgium trains healthcare professionals for its neighbors. French students account for a large proportion of enrolments for medical and paramedical studies in the education sector in the French Community. As a result, the French Community has been forced to set a limit of 30% for enrolments by non-resident students in certain healthcare-related subjects to allow enough professionals working in Belgium to be trained. An identical but more recent phenomenon can be seen in the Flemish Community, where increasing numbers of Dutch students swell the numbers of enrolments in the Flemish education system. The current systems that restrict entry to medical and paramedical studies in our neighboring countries to the north and south with which we share a common language, are leading students to move to Belgium. We should also remember that we are witnessing a growth in student mobility at European level as a result of the Bologna agreements. The second reason why Belgium needs a greater understanding of mobility data for organizing the Belgian workforce is linked to the quota system Belgium has introduced for physicians and dentists. The medical planning commission has set up a quota system for the workforce by means of quotas that restrict the number of candidates each year who can access medical and dental specialties in Belgium. The quota only applies to students who obtained their initial degree at a Belgian university. This means that there are no restrictions on the number of graduates from foreign universities who are authorized to come and specialize in Belgium. This migration bypasses the quota system. Professional mobility, based on the recognition of specific professional qualifications obtained abroad, also short-circuits this system. It is now important for Belgian planning to be able to monitor this workforce that comes from abroad and is not subject to the quota, unlike Belgian candidates and students. The fact that this mobility occurs at different stages in the training of healthcare professionals (initial studies, specialties and access to the profession) makes it more difficult to understand the phenomenon. This is all the more true as most students from neighboring countries, who constitute the majority of this student mobility, do not intend to work in Belgium, but intend to return to their country of origin. Mobility among other nationalities is experiencing different patterns: this mobility would seem to be more long-term, as these professionals work in the Belgian employment market for a significant period of time. This two-fold mobility phenomenon needs to be understood correctly in order to optimize the organization of the workforce.

FPS Health

FPS Health