National Reporting Instrument 2024

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Background

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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 mandated to report to the World Health Assembly every 3 years.

WHO Member States completed the 4th round of national reporting in May 2022. The WHO Director General reported progress on implementation to the 75th World Health Assembly in May 2022 (A75/14). The report on the fourth round highlighted the need to assess implications of health personnel emigration in the context of additional vulnerabilities brought about by the COVID-19 pandemic. For this purpose, the Expert Advisory Group on the relevance and effectiveness of the Code (A 73/9) was reconvened. Following the recommendations of the Expert Advisory Group, the Secretariat has published the WHO health workforce support and safeguards list 2023.

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 findings from the 5th round of national reporting will be presented to the Executive Board (EB156) in January 2025 in preparation for the 78th World Health Assembly.

The deadline for submitting reports is 31 August 2024.

Article 9 of the Code mandates the WHO Director General to periodically report to the World Health Assembly on the review of the Code’s effectiveness in achieving its stated objectives and suggestions for its improvement. In 2024 a Member-State led expert advisory group will be convened for the third review of the Code’s relevance and effectiveness. The final report of the review will be presented to the 78th World Health Assembly.

For any queries or clarifications on filling in the online questionnaire please contact us at WHOGlobalCode@who.int.

What is the WHO Global Code of Practice?

Disclaimer: The data and information collected through the National Reporting Instrument will be made publicly available via the NRI database (https://www.who.int/teams/health-workforce/migration/practice/reports-database) following the proceedings of the 78th World Health Assembly. The quantitative data will be used to inform the National Health Workforce Accounts data portal (http://www.apps.who.int/nhwaportal/).
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Disclaimer

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[1] Note: Case-based facility data collection as that in the WHO Global Bum Registry does not require WHO Member State approval.
[2] The world health report 2013: research for universal coverage. Geneva: World Health Organization; 2013 (http://apps.who.int/iris/bitstream/10665/85761/2/9789240690837_eng.pdf)
[3] WHO statement on public disclosure of clinical trial results: Geneva: World Health Organization; 2015 (http://www.who.int/ictrp/results/en/, accessed 21 February 2018).
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
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Contact Details

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Hide [CI] Contact Details
Name of Member State:
Jamaica
Name of designated national authority:
Stephanie Bernard-Stephens
Title of designated national authority:
Director of Health Planning
Institution of the designated national authority:
Ministry of Health and Wellness
Email:
stephanie.bernard-stephens@moh.gov.jm,WHOGlobalCode@who.int,cavalcaana@paho.org
Telephone number :
8768013452
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Contemporary issues

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Hide [NRIxI] The questions marked * are mandatory. The system will not allow submission until all mandatory questions are answered.
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Contemporary issues on health personnel migration and mobility
Hide [Q1x1] 1.1 In the past 3 years, has the issue of international recruitment of health personnel been a concern for your country?
Yes, and it is increasing in intensity

Private recruiters are coming into the country to recruit healthcare workers, paying off their bond agreement with the government. We are losing HCWs at a steady rate

Hide [Q1x2] 1.2 In the past 3 years, has the issue of international reliance on health personnel (international recruitment of health personnel to meet domestic needs) been a concern for your country?
Yes, and there has been no change in the intensity

We have bilateral agreements that aid this process, but the number has not changed.

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Health Personnel Education

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Health personnel education, employment and health system sustainability
Hide [Q2] 2. Is your country taking measures to educate, employ and retain a health and care workforce that is appropriate for the specific conditions of your country, including areas of greatest need?
Yes
Hide [Q2x1] Please check all items that apply from the list below:
2.1 Measures taken to ensure the sustainability of the health and care workforce
2.2 Measures taken to address the geographical mal-distribution and retention of health and care workers*
2.3 Other relevant measures taken to educate, employ and retain a health and care workforce that is appropriate for the specific conditions of your country
Hide [Q2x1x1] 2.1.1 Measures taken to ensure the sustainability of the health and care workforce
Forecasting future health and care workforce requirements to inform planning
Renewal of Primary Health Care
Aligning domestic health and care workforce education with health system needs
Provision of scholarships to study in health related fields; engaging universities to gather data on training capacity and numbers to support workforce planning
Improving quality of education and health personnel in alignment with service delivery needs
revising of curriculum such as in nursing
Creating employment opportunities aligned with population health needs
Creation of permanent positions such as for doctors to align with health needs
Managing international recruitment of health personnel
Use of bilateral agreements in recruiting health personnel
Improving management of health personnel
Strengthening Human resources for health planning
Specific provisions on health personnel regulation and recruitment during emergencies
Others
Hide [Q2x2x1] Check all that apply for Measures taken to address the geographical mal-distribution and retention of health and care workers
2.2.1 Education
2.2.2 Regulation
2.2.3 Incentives
2.2.4 Support
Hide [Q2x2x2x1] 2.2.2.1 Regulation Measure
Scholarships and education subsidies with return of service agreements
Mandatory service agreements with health personnel that are not related to scholarships or education subsidies
Enhanced scope of practice of existing health personnel
Currently exploring task shifting involving our community health aides
Task sharing between different professions
Provisions for pathways to enter new or specialised practice after rural service
Others
Hide [Q2x3x1] 2.3.1 Please describe - Other relevant measures taken to educate, employ and retain a health and care workforce that is appropriate for the specific conditions of your country.
Creation of scholars for studying in any health-related fields; addressing renumeration through the reclassification of salaries in the public sector Creation of Posts Expansion of Services to provide more opportunities Investment in infrastructural improvements Providing recognition through awards and events such as "Health care worker appreciation month"
Hide [Q3x1] 3.1 Are there specific policies and/or laws that guide international recruitment, migration and integration of foreign-trained health personnel in your country?
Yes
Hide [Q3x1x1] 3.1.1 Please provide further information in the box below:
Law/policy 1
White Paper - National Policy on International Migration and Development
Law/policy 2
Aliens Act (Amendment), 1988
Law/policy 3
Passport Act (Amendment), 1979; Foreign Nationals and Commonwealth Citizens (Employment) Act (Amendment), 2014
Hide [Q3x2] 3.2 Are there any policies and/or provision for international telehealth services in your country through health personnel based abroad?
No
Hide [Q3x3] 3.3 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
Hide [Q4] 4. Recognizing the role of other government entities, does the Ministry of Health have mechanisms (e.g. policies, processes, unit) to monitor and coordinate across sectors on issues related to the international recruitment and migration of health personnel?
No
Hide [Q5] 5. Please describe the steps taken by your country to implement the following Code recommendations.
Check all items that apply from the list below:
5.1 Measures have been taken or are being considered to introduce changes to laws or policies on health personnel consistent with the recommendations of the Code.
5.2 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.
5.3 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.
5.4 Records are maintained on all private recruitment agencies for health
personnel authorized by competent authorities to operate within their jurisdiction.
5.5 Good practices, as called for by the Code, are encouraged and promoted among private recruitment agencies.
5.5a Promotion of the Code among private recruitment agencies.
5.5b Domestic legislation or policy requiring ethical practice of private recruitment agencies, as consistent with the principles and articles of the Code.
5.5c Public or private certification of ethical practice for private recruitment agencies.
5.5d Others
5.6 None of the above
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Government Agreements

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Government-to-Government agreements on migration or mobility of health personnel
Hide [Q6] 6. Has your country or sub-national governments entered into any bilateral, multilateral, or regional agreements and/or arrangements with respect to the international recruitment and/or mobility of health personnel?
Yes
Hide [Q6x1xA] 6.1 A Please use the table below to describe each of the active bilateral, regional or multilateral agreements or arrangements:
a. Title of Agreement b. Type of Agreement
Agreement 1 Technical Cooperation between Jamaica and Cuba 1
Agreement 2
Agreement 3
Agreement 4
Agreement 5
Agreement 6
Agreement 7
Agreement 8
Agreement 9
Agreement 10
Agreement 11
Agreement 12
Agreement 13
Agreement 14
Agreement 15
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Government Agreements - 6.1 A

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Hide [Q6x1xAx1] c. Countries involved
Technical Cooperation between Jamaica and Cuba
CUB,JAM
Hide [Q6x1xAx2] d. Coverage
Technical Cooperation between Jamaica and Cuba
National
Hide [Q6x1xAx3] e. Main focus of agreement (check all that apply)
Education and training Health cooperation Promotion of circular migration Philanthropy or technical support Qualification recognition Recruitment of health personnel Trade in services Others
Technical Cooperation between Jamaica and Cuba 1 1
Hide [Q6x1xAx4] f. Categories of Health Personnel (check all that apply)
Doctors Nurses Midwives Dentists Pharmacists Other occupations
Technical Cooperation between Jamaica and Cuba 1 1 1 1
Hide [Q6x1xAx4xoth] Please specify category of health personnel:
Technical Cooperation between Jamaica and Cuba
Perfusionist, medical technologist, eye care specialist
Hide [Q6x1xAx5] g. Validity period
Start Year End Year
Technical Cooperation between Jamaica and Cuba 2020 2023
Hide [Q6x1xAx6] h. Signatory of the agreement from your country
Technical Cooperation between Jamaica and Cuba
Ministry of Health
Hide [Q6x1xAx7] i. Signatory of the agreement from the partner country (ies)
Technical Cooperation between Jamaica and Cuba
Others:
Hide [Q6x1xAx7xoth] If other signatory of the agreement from your country(Please specify:)
Technical Cooperation between Jamaica and Cuba
Cuban Ambassador to Jamaica
Hide [Q6x1xAx7x1] If Ministry of Health is not a signatory, did the Ministry of Health participate in the development of the agreement?
Technical Cooperation between Jamaica and Cuba
Yes
Hide [Q6x1xAx8] j. Content of agreement
Hide [Q6x1xAx8x1] j.i. Does the agreement include elements to benefit the health system of your country and the partner country(ies)?
Technical Cooperation between Jamaica and Cuba
Yes, has elements to
benefit the health system of my country and partner country(ies)
Hide [Q6x1xAx8x1x] Please explain:
Technical Cooperation between Jamaica and Cuba
Healthcare workers to deliver healthcare; taxation from renumeration of his citizens
Hide [Q6x1xAx8x2] j.ii. Does the agreement include elements on health worker rights and welfare?
Technical Cooperation between Jamaica and Cuba
Yes
Hide [Q6x1xAx8x2x] Please explain:
Technical Cooperation between Jamaica and Cuba
In accordance with the clause of the Agreement Cuban health professionals are provided with a compensation package that includes housing, salary, agreed local and Cuban holidays, ticket for travel to Cuba on approved breaks and return airfare when its time to travel to Jamaica.
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Government Agreements - 6.1 B

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Hide [Q6x1xB] 6.1 B Please use the table below to describe the implementation of each of the active bilateral, regional or multilateral agreements or arrangements
Hide [Q6x1xBx1] Has the agreement been implemented?
Technical Cooperation between Jamaica and Cuba
Yes
Hide [Q6x1xBx1x1]
Start year of implementation:
Technical Cooperation between Jamaica and Cuba 2020
Hide [Q6x1xBx2a] How many health personnel have left or entered your country through this agreement since its implementation?
Agreement: Technical Cooperation between Jamaica and Cuba
Number of personnel
Doctors
Nurses
Midwives
Dentists
Pharmacists
Perfusionist, medical technologist, eye care specialist
Hide [Q6x1xBx3] Please explain if and how has the health system of your country benefitted from the agreement.
Technical Cooperation between Jamaica and Cuba
Increase personnel for healthcare delivery
Hide [Q6x1xBx4] Please describe if and how the health system of other country(ies) has benefitted from the agreement.
Technical Cooperation between Jamaica and Cuba
Economic benefit as workers paying taxes
Hide [Q6x1xBx5] Please explain if and how the provisions on health workers rights and welfare were implemented.
Technical Cooperation between Jamaica and Cuba
Provision of airfare; apply to professional bodies for registration and licence; assist in finding suitable accommodations; provision of tools to complete their jobs; provide transportation to work; provision of free health care and urgent dental care including medication and diagnostics; defer the cost that may arise to travel to Cuba for healthcare if service cannot be provided in Jamaica; cover cost of preparation and transportation of cost to return remains to Cuba in the event of death
Hide [Q6x1xBx6] Please provide any other relevant information on the agreement (e.g., context, positive elements, gaps and lessons learnt).
Technical Cooperation between Jamaica and Cuba
Hide [Q6x1xBx7] Full text of the agreement and associated documents (implementation plan, progress report, implementation report, evaluation report, etc.)
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Technical Cooperation between Jamaica and Cuba
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Responsibilities, rights and recruitment practices

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Responsibilities, rights and recruitment practices
Hide [Q7] 7. If your country employs/hosts international health personnel to work in the health and care sectors, which legal safeguards and/or other mechanisms are in place for migrant health personnel and to ensure that enjoy the same legal rights and responsibilities as the domestically trained health workforce?
Please check all items that apply from the list below:
Migrant health personnel are recruited using mechanisms that allow them to assess the benefits and risk associated with employment positions and to make timely and informed decisions on the employment.
Bilateral agreement outline terms
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.
Recognition of qualification
Migrant health personnel enjoy the same opportunities as the domestically trained health workforce to strengthen their professional education, qualifications and career progression.
Institutional arrangements are in place to ensure safe migration/ mobility and integration of migrant health personnel.
Measures have been taken to promote circular migration of international health personnel
Other measures (including legal and administrative) for fair recruitment and employment practices of foreign-trained and/or immigrant health personnel (please provide details)
government to government arrangement
No measures in place
Not applicable – does not host/employ foreign health personnel
Hide [Q8] 8. If health personnel from your country are working abroad in the health and care sectors, please provide information on measures that have been taken or are planned in your country to ensure their fair recruitment and employment; safe migration; return; and diaspora utilization in your country, as well as difficulties encountered.
Please check all items that apply from the list below:
Arrangements for fair recruitment
Arrangements for decent employment contracts and working conditions in destination countries
Arrangements for safe mobility
Arrangements for return and reintegration to the health labour market in your country
Arrangements for diaspora engagement to support your country health system
Other
No measures in place
Health workers are not working through any agreement; no measure in place to track them
Not applicable – health personnel from my country are not working abroad
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International migration

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International migration and mobility pathways for health personnel
Hide [Q9x1] 9.1 If your country hosts international health personnel to work in the health and care sector, how do they come to your country? (check all that apply)
Direct (individual) application for
education,
employment, trade, immigration or
entry in country
Government to
government
agreements that
allow health
personnel mobility
Private
recruitment
agencies or
employer
facilitated recruitment
Private education/ immigration
consultancies
facilitated mobility
Other pathways (please specify) Which pathway is used the most? Please include quantitative data if available.
Doctors 1 1 1 0
Nurses 0 1 1 0
Midwives 0 1 0 0
Dentists 1 1 0 0
Pharmacists 0 0 0 0
Other occupations 0 1 0 0
Other occupations 0 0 0 0
Other occupations 0 0 0 0
Other occupations 0 0 0 0
Other occupations 0 0 0 0
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Hide [Q9x2] 9.2 If health personnel from your country work/study abroad, how do they leave your country? (check all that apply)
Direct (individual) application for
education,
employment, trade,
immigration, or
entry in the
destination country
Government to
government
agreements that
allow health
personnel mobility
Private
recruitment
agencies or
employer
facilitated recruitment
Private education/ immigration
consultancies
facilitated mobility
Other pathways (please specify) Which pathway is used the most? Please include quantitative data if available.
Doctors 1 1 1 0 Ministry of Health offers fellowship
Nurses 1 0 1 0
Midwives 1 0 1 0
Dentists 1 0 1 0
Pharmacists 1 0 1 0
Other occupations 1 1 1 0
Other occupations 1 0 0 0
Other occupations 0 0 0 0
Other occupations 0 0 0 0
Other occupations 0 0 0 0
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Biomedical Technologist
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Recruitment & migration

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Data on international health personnel recruitment & migration


Improving the availability and international comparability of data is essential to understanding and addressing the global dynamic of health worker migration. Please consult with your NHWA focal point, if available, to ensure that data reported below is consistent with NHWA reporting*.
(The list of NHWA focal points is available here. Please find the focal point(s) for your country from the list and consult with them.)

For countries reporting through the WHO-Euro/EuroStat/OECD Joint data collection process, please liaise with the JDC focal point.

Hide [Q10] 10. Does your country have any mechanism(s) or entity(ies) to maintain statistical records of foreign-born and foreign-trained health personnel?
No
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Inflow and outflow of health personnel

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Hide [INFOx7] Inflow and outflow of health personnel
Hide [Q11] 11. Do you have a mechanism to monitor the inflow and outflow of health personnel to/from your country? (check all that apply)
Inflow
Outflow
No
Hide [Q11x3] 11.3 If you have any document with information on health worker inflows and outflows for your country, please upload
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Stock of health personnel

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Hide [INFOx8] Stock of health personnel
Hide [Q12x1] 12.1 Consolidated stock on health personnel, disaggregated by place of training and birth
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 place of training (foreign-trained) and the place of birth (foreign-born).
Hide [Q12x1a] Please provide data on the stock of active health personnel in your country by one of the following ways:
Share data in the NHWA platform through NHWA focal point
Hide [Q12x1x1x] If you have any document with information on stock of active health personnel for your country, their distribution by place of training and place of birth, please upload
Hide [Q12x2] 12.2 Please provide data on the top 10 countries of training for foreign-trained health personnel in your country.
This information can be provided by one of the following two options:
Share data in the NHWA platform through NHWA focal point
Hide [Q12x2x1x] If you have any document with information on the distribution of foreign-trained health personnel for your country by their country of training, please upload
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Technical and financial support

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Technical and financial support
Hide [Q13] 13. Has your country provided technical or financial assistance to any source countries or countries in the WHO health workforce support and safeguards list 2023, or other low- and middle-income countries on health workforce development, health system strengthening, or for implementing other recommendations of the Code (e.g., strengthening data, information and research on health workforce for translation to policies and planning, etc.)
No
Hide [Q14] 14. Has your country received technical or financial assistance from any WHO Member State or other stakeholders (e.g., development partners, other agencies) for health workforce development, health system strengthening, or for implementing other recommendations of the Code (e.g., strengthening data, information and research on health workforce for translation to policies and planning, etc.)?
Yes
Hide [Q14x] Please provide additional information below (check all that apply):
Support for health workforce development (planning, education, employment, retention)
Support for other elements for health system strengthening (service delivery; health information systems; health financing; medical products and technology; and health leadership and governance)
Other areas of support:
Hide [Q14x1] Please specify support for health workforce development (planning, education, employment, retention)
Supporting country/entity Type of support (please specify)
Pan American Health Organization Technical Support
Hide [Q14x2] Please specify support for other elements of health system strengthening (service delivery; health information systems; health financing; medical products and technology; and health leadership and governance)
Supporting country/entity: Type of support (please specify)
Inter-American Development Bank Financial
Pan American Health Organization Technical Support
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Constraints, Solutions, and Complementary Comments

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Constraints, Solutions, and Complementary Comments
Hide [Q15] 15. Please list in priority order, the three main constraints to the ethical management of international migration in your country and propose possible solutions:
Main constraints Possible solutions/recommendations
Migration can create competition for jobs and lead to resentment and reduce opportunities for Jamaican workers Implement targeted economic development programmes and job training initiative to boast local employment
Updating or enforcing migration laws and policies effectively strengthen the legal and policy framework by regularly reviewing and updating migration laws to reflect current realities
Social integration and cultural tensions Programmes that promotes social integration and cultural experience exchange
Hide [Q16] 16. What support do you require to strengthen implementation of the Code?
Support to strengthen data and information on health personnel
Assistant to development and implement a HRHIS
Support for policy dialogue and development
Support for the development of bilateral/multi-lateral agreements
Others
No support required
Hide [Q17] 17. Considering that the Code is a dynamic document that should be updated as required, please provide reflections from your country on the past 14 years since the resolution on the Code.
Hide [Q17x1] Please comment on if/how the Code has been useful to your country.
The Code has help bring attention to international migration of healthcare workers and the brain drain effect in the country. The Code has been the foundation for bilateral agreements with countries such as the UK The Code has helped Jamaica advocate for better conditions for its healthcare workers abroad and demand adherence to fair recruitment practices by recruiting countries. The awareness generated by the Code has prompted Jamaica to focus on improving retention strategies within the country. Jamaica's participation in international forums and reporting mechanisms, as encouraged by the Code, has enabled the country to share its experiences and collaborate with other nations facing similar challenges
Hide [Q17x2] Do any articles of the Code need to be updated?
Yes

The Code could include guidelines on international recruitment practices during global health emergencies. The Code could address the role of technology in facilitating international healthcare delivery and worker retention. The Code could explicitly support and provide frameworks for circular migration, encouraging policies that facilitate the temporary return of skilled health workers to their home countries

Hide [Q17x3] Does the process of reporting on Code implementation and the review of the Code relevance and effectiveness need to be updated?
No

Hide [Q17x4] Please comment on the WHO health workforce support and safeguards list (e.g. if your country is included in the list, how has that affected you; if your country is reliant on international health personnel, how has the list affected you; if your country is not in the list, how has it affected you)
Jamaica is not on the list but is one of the countries that recruitment of health workers by other countries is the highest, This has left us vulnerable to increase recruitment of our healthcare workers by recruitment agencies in other countries.
Hide [Q18] 18. 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.

Please describe OR Upload (Maximum file size 10 MB)

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Warning

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Hide [WARN] You have reached the end of the National Reporting Instrument - 2024. You may go back to any question to update your answers or confirm your entry by clicking ‘Submit’.