National Reporting Instrument 2015

The Network Medicus Mundi Switzerland (MMS) is advocating for the WHO Global Code on the International Recruitment of Health Personnel in Switzerland. It has built up a Civil Society Platform consisting of different stakeholders, including Swiss organisations active in the field of international health cooperation, medical associations, trade unions and academic institutions. This coalition has published a manifesto on the issue and is promoting the implementation of the Code here in Switzerland. MMS was already 2012 invited by the Federal Office of Public Health (FOPH) to write a report from a civil society perspective as amendment to Switzerland’s National Reporting.

1 General remarks on the Code’s Relevance in Switzerland According to the still latest study from 2009 Switzerland trains annually 5’000 health workers too few for fulfilling the health system’s needs. Switzerland is highly dependent on foreign health personnel. It is recruiting mainly from neighbouring countries – Germany for the German-speaking part, France for the French-speaking part of the country. There are also work forces from other countries with weaker health systems – like Eastern Europe. This situation could get tightened as notably Germany has improved working conditions for doctors. This could follow to a drying-out of this important labour market for the Swiss Health System. Against this background it is obvious that the Code has a high relevance for Switzerland. The code provides guidelines for Switzerland’s presence on the global health workers market and it provides at least a moral obligation to invest in the working conditions of the health personnel in Switzerland for retaining own health personnel and to invest in the education and training of doctors, nurses and mid-wives. The adoption of the Code by the World Health Assembly provided a very good advocacy tool to the Swiss Civil Society. The Code helped to make a change the way some of the Swiss Health’s Systems stakeholder are addressing the health workforce shortage. That there is an urgent need to make the Code more relevant within the Swiss health care system proves the example of the situation of the personnel in the care of elderly people. Private agencies are allowed to place personnel in the households of elderly people for looking after them. Very often the employees are from Eastern European countries working on a short contract basis. They live in the houses of the elderly person and have to be around 24 hours a day. A Swiss trade union of employees working in the public services (VPOD) is currently campaigning against this situation – also with juridical means. 2 Impact of the Code on Policy level As civil society platform we can clearly perceive a positive change of awareness in addressing the domestic health personnel shortage. In the years before the adoption of the Code the Government relied on the free movement of persons for solving the Swiss shortage. This attitude was reflected by the introduction of the Numerus Clausus for doctors in 1998. Even if the Numerus Clausus is still in force in Switzerland, the Government is much more aware that the free movement of persons in the health sector cannot solve the home made shortage and there is a much better understanding that relying on the free labour market can have negative effects on countries with weaker health systems. We regard it as one of the main impact of the Code – and the civil society advocacy work for it – that the recruitment of foreign health workers is debated in Switzerland not as an issue of the migration policy but as one of international solidarity. If you examine the real impact on the policy level, the impact of the Code remains weak. The Government supports the Universities, which are run by the cantons, in increasing the training positions for doctors. By this 2014 180 additional places could be created. But anyhow this remains a drop in the ocean, and Switzerland is still far away from a sustainable health system, that meets its “health personnel needs with their own human resources for health, as far as possible.”(Code, 5.4). One of the main obstacles in implementing the Code in Switzerland is that the country has a highly fragmented health system with 25 cantons shaping their own health systems. We have the impression that on this level the Code and its relevance isn’t yet enough recognized. Much more must be done to make the Code known at the different stakeholders. 3 Implementation of the Code in Switzerland For implementing the Code in Switzerland the following points have to be addressed by the political decision makers. • Much more must be done in Switzerland to make the Code known and respected by all relevant stakeholders of the Swiss Health System on all levels. • Switzerland has to collect data on its health personnel on a regularly basis, including data on the migration of health personnel. Such an information system would increase transparency and is crucial for planning the needs of the health system. • Swiss actors within the health system only should recruit actively in low- and middle-income countries, if there is an agreement with these that fulfil the ethical criteria of the Code and that foresees transfer benefits for the affected Health System. • Switzerland hast to secure that the labor law is enforced for all in the health system working persons – including those working on a temporary basis. Salaries must respect the competences in any cases and must be in line with the standards. • Especially the working and salary conditions of foreign nurses and other health care personnel must be thoroughly evaluated, as there is more and more evidence of discrimination. • Professional agents of health personnel must be licenced and their work must be controlled. • We support Switzerland’s stronger commitment for strengthening health systems in low income countries. Switzerland’s international cooperation could put a stronger focus on supporting the training of health personnel on all levels in low and middle income countries. MMS/ml 31st August 2015