National Reporting Instrument 2015

In the United States, public authorities regulate certain aspects of private recruitment and employment contracts, as set forth in the requirements for temporary labor programs. For example, the U.S. Department of Labor requires employers who are bringing workers to the United States temporarily on an H-1B visa to provide the workers with a copy of the Labor Condition Application (LCA) no later than when the worker reports to work. The LCA informs the foreign worker of the wage to be paid, the job title, period of intended employment, and place of employment. The LCA also informs the worker of how to file a complaint alleging misrepresentation of materials facts or failure to comply with the terms listed on the LCA . The Department of Labor also requires employers who are bringing in H-2B temporary workers to provide the workers with a copy of the job order no later than when the worker applies for the visa, in a language understood by the worker, as necessary or reasonable. The H-2B job order informs the foreign worker of the job duties, period of employment, wage to be paid, any training that will be available, deductions that will be made, and how the employer will provide or pay for the cost of the worker’s transportation, among other things. There is no federal law regulating placement agencies or employment contracts overall. The U.S. does not generally regulate recruitment activities that take place abroad. However, the new H-2B regulations require employers to submit their foreign worker recruitment contracts to the Department of Labor, and those agreements must contain a prohibition against charging the foreign worker recruitment fees. The Department of Labor will also maintain a publicly available list of agents and recruiters who are party to such contracts and the locations in which they are operating. The H-1B program requires that employers first file a Labor Condition Application (LCA) with the Secretary of Labor attesting that the wage paid to the foreign worker is the higher of the actual wage rate (the rate the employer pays to all other individuals with similar experience and qualifications who are performing the same job), or the prevailing wage (a wage that is predominantly paid to workers in the same occupational classification in the area of intended employment at the time the application is filed). Similarly, H-1B employers must provide foreign workers working conditions based on the same criteria as those the employer offers to its U.S. workers, such as hours, shifts, vacation periods, and benefits. Employers wishing to bring in foreign health personnel on a permanent basis must usually obtain a labor certification from the Department of Labor determining that there are not sufficient U.S. workers who are able, willing, qualified, and available in the area of intended employment and that the employment of a foreign worker will not adversely affect the wages and working conditions of workers in the U.S. similarly employed. One of the methods utilized by the Department of Labor to ensure that the wages and working conditions are not affected is to require the employer to offer at least the prevailing wage to all U.S. workers during its labor market test and then to the foreign worker upon receipt of his or her permanent residency. Employers utilizing the permanent labor certification program must offer the foreign workers terms and working conditions that are either the same or no more favorable than those the employer offers to its U.S. workers it recruits into the same job, such as hours, shifts, vacation periods, and benefits. An employer is not required to file a labor certification application with the Department of Labor for those foreign workers (including professional nurses and physical therapists) who qualify for “blanket certification” under the Department’s Schedule A. In those cases, an employer must attach its labor certification application to the immigrant worker petition it files directly with the Department of Homeland Security. Employers who are interested in employing H-2B temporary workers must obtain a labor certification from the Department of Labor. Among other requirements, they must offer and pay the H-2B worker no less than the highest of the prevailing wage, the applicable Federal minimum wage, the State minimum wage, or local minimum wage during the entire period of the approved H-2B labor certification. Foreign workers do not necessarily have the same education and training opportunities as domestic workers, as some federal funding streams have limitations on the non-U.S. citizen individuals that can access them. However, migrant health personnel may enroll in privately-paid educational courses the same as the domestically trained health workforce, and employer-provided training may be provided to domestic and migrant health personnel equally. 1. Wilberforce Trafficking Victims Act: http://travel.state.gov/content/visas/english/general/rights-protections-temporary-workers.html 2. Link to H1B visa protections, 20 CFR Part 655, Subparts H and I: http://www.ecfr.gov/cgi-bin/text-idx?SID=96b00af0b6b7ce8e8fda30ea4c512a6f&node=20:3.0.2.1.28&rgn=div5 - 20:3.0.2.1.28.2#sp20.3.655.h 3. The U.S. Department of Labor Occupational Safety & Health Administration: http://www.osha.gov/law-regs.html 4. The U.S. Department of Labor Wage and Hour Division: http://www.dol.gov/whd/ 5. http://www.foreignlaborcert.doleta.gov/

American Medical Association

Association of American Medical Colleges

Educational Commission for Foreign Medical Graduates

National Council on State Boards of Nursing

Commission on Graduates of Foreign Nursing Schools (CGFNS) International

Authorization is granted according to state regulation, which varies by state.

NA

U.S. Department of Health and Human Services (HHS) has been implementing cooperative agreements since 2004 through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) programs. These programs all have specific objectives and program activities in many countries across Africa, the Caribbean, South America and Asia. The overall intent of these programs is to build human resource capacity for health (HRH) and strengthen health systems which in turn will encourage the retention of HRH in their countries, especially in underserved communities. These PEPFAR HRH Programs include: Medical Education Partnership Initiative (MEPI) 2010-Present MEPI is funded through the HHS/Health Resources and Services Administration (HRSA) and the HHS/ National Institutes of Health (NIH). MEPI supports foreign institutions in Sub-Saharan African countries to develop or expand and enhance models of medical education. These models are intended to support PEPFAR’s goal of increasing the number of new health care workers by 140,000, strengthening medical education systems in the countries in which they exist, and building clinical and research capacity in Africa as part of a retention strategy for faculty of medical schools and clinical professors. In the last five years MEPI has provided grants to African institutions in 12 countries. Program activities are implemented in South Africa, Tanzania, Mozambique, Nigeria, Ethiopia, Botswana, Kenya, Uganda, Zambia, Zimbabwe, Ghana, and Malawi. MEPI activities have resulted in the development a network of about 30 regional partners, including in-country health and education ministries. Nursing Educational Partnership Initiative (NEPI) 2010-Present HRSA’s NEPI supports foreign nursing schools and institutions in Sub-Saharan African countries to expand the quantity, quality and relevance of the nursing and midwifery profession to address the country’s population based health needs. HRSA’s NEPI programmatic objectives include: strengthening the capacity, quality and effectiveness of nurse and midwifery training and education programs; identifing innovative models to increase the number of qualified health care workers; strengthening research and professional development opportunities; and the development of evidence-based strategies to guide future human resources for health investments in the host countries. NEPI activities are implemented in Zambia, Malawi, Lesotho, Ethiopia, and the Democratic Republic of Congo. NEPI supports 3-6 nursing schools in each of these countries. International AIDS Education and Training Centers (I-TECH) 2004-Present HRSA’s I-TECH program works with foreign local partners to develop skilled health care workers and strong national health systems especially in resource limited countries. The I-TECH program provides technical assistance primarily in health workforce development, prevention, treatment and care of infectious diseases; operations research and evaluation; and in-country health system strengthening. I-TECH promotes local ownership to sustain effective health systems. I-TECH programs are implements in Haiti, India, Vietnam, Cote d’ Ivore, Kenya, Malawi, Mozambique, Namibia, South Africa, Tanzania, and China. Twinning Programs 2004-Present HRSA’s Twinning Programs use institution-to-institution partnerships and peer-to-peer relationships for HIV/AIDS-related human resource capacity building in PEPFAR countries. Twinning emphasizes professional exchanges and mentoring for the effective sharing of information, knowledge, and technology. Since the inception of the program, Twinning Programs have provided in-service training for more than 29,300 health and allied care providers and graduated more than 11,000 individuals from pre-service programs at partner institutions. This includes training for needed mid-level cadres such as clinical associates, nurses, pharmacy technicians, lab technicians, biomedical technicians, para social workers, and social welfare assistants. Currently, HRSA Twinning Programs are implemented in Botswana, Ethiopia, Kenya, South Africa, Zambia, and Tanzania. In addition: The U.S. Agency for International Development’s (USAID) investments in strengthening human resources for health are guided by principles of country ownership and building sustainability through health systems strengthening (HSS). Based on these principles, USAID collaborates closely with countries to design and implement programs that will address both the quality and quantity of workers available to serve their population’s health care needs. Through this collaboration process, the needs of developing countries and countries with economies in transition are taken into account. Building upon a 30 year history of support to training and education, USAID focuses on the development of innovative pre-service education approaches that address the systemic challenges that educational institutions are facing. While continuing its traditional efforts in curricular reform and faculty development - which improve the quality of graduates but rarely result in an increase in graduates - USAID is now addressing institutional reform in line with the global movement for educational reform and transformative learning to also increase the production of qualified health care workers. In an effort to improve retention of health workers, USAID has developed a catalog of approaches and toolkits that build stakeholder capacity for workforce planning and assess and respond to underlying human resources management and retention issues facing a country’s health system. Tools such as the Rapid Retention Survey Toolkit and iHRIS Retain can be adapted to the needs each country’s stage of development and particular health workforce challenges.

Peter Mamacos

peter.mamacos@hhs.gov

U.S. Department of Health & Human Services

Peter Mamacos RADM Kerry Nesseler

330 C St, SW Suite 2200 Washington, DC 20520