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:
Italy
Name of designated national authority:
Cristina Sabatini
Title of designated national authority:
Director
Institution of the designated national authority:
Ministry of health
Email:
riginao@who.int,c.sabatini@sanita.it,WHOGlobalCode@who.int
Telephone number :
+39 065994 2507
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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?
No, this is not a problem in my country

In Italy we have a shortage of some health personnel (specialists, nurses) in the national/regional health systems, but we tried to solve inside this problem increasing the number of accesses to the university courses and get the healthcare professions more attractive by introducing social security benefits.

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?
No, this is not a problem in my country

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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 [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.
The capacity of health care systems to provide health services and meet new demands for care is highly dependent on the availability of a flexible workforce with the appropriate skills. From this perspective, the shortage of healthcare professionals must be addressed on an international framework, as it is a critical issue not only in European countries, but also in many other parts of the world, at least for some professions. Beyond the "age issue", the real shortage concerns the DEMAND for services, care and therefore professionals, as also highlighted and underlined by the COVID 19 pandemic. Further, new challenges and new phenomena are to be considered, like the 'disaffection' of professionals for employment in NHS facilities. About less sought-after medical specialisations and unallocated specialisation contracts, the MoH is studying several actions in order to correct the current system and lead a redistribution of contracts in the aim of ensuring greater coverage of the most lacking and least attractive specializations and to respond effectively and efficiently to the needs for healthcare of the population. The need for a clearer and more specific contractual framework emerged during a number of audits held witht he representatives of the postgraduates, including a review of remuneration and contributions, but also benefits to support parenthood and other forms of insurance and social protection. About shortage of general practitioners connected to the age of these professionals and to a crisis of vocation, the MoH is studying to transforme the specific training course in general medicine into a medical specialisation school. About nursing shortage and vocational crisis, the MoH is studying measures to solve these issues by introducing, for instance, social security benefits. The situation is complicated, connected to several domestic issues and the text above couldn't be complete.
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
Directive 2005/36/CE of recognition of professional qualifications for European citizens
Law/policy 2
Legislative decree n. 286 del 1998 about immigration and conditions of foreign people
Law/policy 3
DPR 394 of 1999, implementation of previous decree
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?
Yes
Hide [Q4x1] Please describe
MoH is the competent authority of recognition of professional qualifications in the sanitary field. At the same time, MoH has a role of protector of the constitutional right to health, exercises the functions of the State in the following areas: protection of human health, coordination of the national health system, veterinary health, protection of health in the workplace, hygiene and safety. Italy does not actively recruit healthcare personnel, for example through agencies or private facilities. There is a system of quotas (by decreto flussi) that defines the maximum number of non Europeans who can work in Italy.
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
Any form of recruitment of health personnel, through international agreements or through agreements stipulated by the Regions is in line with the principles of the Italian Constitution, Italian laws and to the Code too. In bilateral agreements the code is referred to within the text, in agreements of regional competence the legislation on labor guarantees the absence of discrimination and exploitation.
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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 Bilateral Agreement on Migration and Mobility between Italy and India of 2023 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
Bilateral Agreement on Migration and Mobility between Italy and India of 2023
IND,ITA
Hide [Q6x1xAx2] d. Coverage
Bilateral Agreement on Migration and Mobility between Italy and India of 2023
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
Bilateral Agreement on Migration and Mobility between Italy and India of 2023 1 1 1 1 1 1
Hide [Q6x1xAx3xoth] If other mechanism in main focus of agreement (Please specify:)
Bilateral Agreement on Migration and Mobility between Italy and India of 2023
Recruitment of Indian workers in general by introducing dedicated quotas.
Hide [Q6x1xAx4] f. Categories of Health Personnel (check all that apply)
Doctors Nurses Midwives Dentists Pharmacists Other occupations
Bilateral Agreement on Migration and Mobility between Italy and India of 2023 1 1 1 1 1 1
Hide [Q6x1xAx4xoth] Please specify category of health personnel:
Bilateral Agreement on Migration and Mobility between Italy and India of 2023
This agreement regulates both mobility and migration of different kind of people (e.g. workers, artists, entrepreneurs, students) also professionals in the healthcare area, with a system of reserved quotas
Hide [Q6x1xAx5] g. Validity period
Start Year End Year
Bilateral Agreement on Migration and Mobility between Italy and India of 2023 2024 2029
Hide [Q6x1xAx6] h. Signatory of the agreement from your country
Bilateral Agreement on Migration and Mobility between Italy and India of 2023
Ministry of Foreign Affairs
Hide [Q6x1xAx6x1] If Ministry of Health is not a signatory, did the Ministry of Health participate in the development of the agreement?
Bilateral Agreement on Migration and Mobility between Italy and India of 2023
Yes
Hide [Q6x1xAx7] i. Signatory of the agreement from the partner country (ies)
Bilateral Agreement on Migration and Mobility between Italy and India of 2023
Ministry of Foreign Affairs
Hide [Q6x1xAx7x1] If Ministry of Health is not a signatory, did the Ministry of Health participate in the development of the agreement?
Bilateral Agreement on Migration and Mobility between Italy and India of 2023
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)?
Bilateral Agreement on Migration and Mobility between Italy and India of 2023
Yes, has elements to
benefit the health system of my country and partner country(ies)
Hide [Q6x1xAx8x1x] Please explain:
Bilateral Agreement on Migration and Mobility between Italy and India of 2023
Every person who is on Italian territory is protected by the national health system.
Hide [Q6x1xAx8x2] j.ii. Does the agreement include elements on health worker rights and welfare?
Bilateral Agreement on Migration and Mobility between Italy and India of 2023
No
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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?
Bilateral Agreement on Migration and Mobility between Italy and India of 2023
No
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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.
Italy does not actively recruit healthcare personnel, for example through agencies or private facilities.After recognition, we apply the same rules between citizens and migrants.
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.
After recognition, we apply the same rules between citizens and migrants. The difference is about level of qualification and experiences.
Migrant health personnel enjoy the same opportunities as the domestically trained health workforce to strengthen their professional education, qualifications and career progression.
The education system and the working conditions are not different between Italian citizens, but the entry to the health academic courses is by preliminary with a system of quotas between European citizens and non Europeans.
Institutional arrangements are in place to ensure safe migration/ mobility and integration of migrant health personnel.
Italian law protects workers in general, migrants are also supported by civil society organizations.
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)
Italy does not actively recruit healthcare personnel, for example through agencies or private facilities.Control of competent authorities on the rules of recruitment and on the working conditions.
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
As part of European Union the free movement of workers is a right. Italy does not actively recruit healthcare personnel, for example through agencies or private facilities.
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 0 0 exchanges among universities Individual application for European citizens, the entry of non- European citizens must comply with a system of quotas or exemptions for international agreements
Nurses 1 1 0 0 idem idem
Midwives 1 1 0 0 idem idem
Dentists 1 1 0 0 idem idem
Pharmacists 1 1 0 0 idem idem
Other occupations 1 1 0 0 idem idem
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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VETS
all healthcare workers
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 0 0 exchanges or agreements among universities individual application
Nurses 1 1 0 0 idem idem
Midwives 1 1 0 0 idem idem
Dentists 1 1 0 0 idem idem
Pharmacists 1 1 0 0 idem idem
Other occupations 1 1 0 0 idem idem
Other occupations 1 1 0 0 idem idem
Other occupations 0 0 0 0
Other occupations 0 0 0 0
Other occupations 0 0 0 0
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VETS
all hc workers
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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?
Yes
Hide [Q10x1] 10.1 Where are the records maintained? (check all that apply)
Employment records or work permits
Ministry of health personnel database
Registry of health personnel authorized to practice
Other
Hide [Q10x2] 10.2 Does the record include gender-disaggregated data on the foreign-born and/or foreign-trained health personnel?
Yes
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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:
Data not available
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:
Fill in the table below
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Doctors Nurses Midwives Dentists Pharmacists
Total foreign trained personnel 1388 11861
Country 1: Top country of training AUT ROU
Country 1: No. of foreign trained health personnel 436 2232
Country 2: Top country of training ROU POL
Country 2: No. of foreign trained health personnel 279 1385
Country 3: Top country of training DEU IND
Country 3: No. of foreign trained health personnel 207 1331
Country 4: Top country of training ESP PER
Country 4: No. of foreign trained health personnel 111 1220
Country 5: Top country of training BGR ALB
Country 5: No. of foreign trained health personnel 102 412
Country 6: Top country of training ARG ESP
Country 6: No. of foreign trained health personnel 90 292
Country 7: Top country of training EGY SRB
Country 7: No. of foreign trained health personnel 76 370
Country 8: Top country of training FRA PHL
Country 8: No. of foreign trained health personnel 65 303
Country 9: Top country of training SVK DEU
Country 9: No. of foreign trained health personnel 61 284
Country 10: Top country of training ALB TUN
Country 10: No. of foreign trained health personnel
Source (e.g. professional register, census data, national survey, other)
Year of data (Please provide the data of the latest year available)
Remarks
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.)?
No
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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
Different organisation of regional health services connect to different level of regional autonomy. National guidelines on the ethics of migration flows drawn up in collaboration with the main public institutions
Lack of data and information on the migration of health personnel already monitored (doctors, nurses) Implementation of reliable and robust data collection systems on migration.
No data on the migration of other 29 healthcare professions Making a data collection system for all healthcare professions
Hide [Q16] 16. What support do you require to strengthen implementation of the Code?
Support to strengthen data and information on health personnel
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.
Principles of the Code are still in Italian Constitution and Italian regulation. Actually, our country does not recruit actively healthcare workers from other countries and the Code strengthens respect for human rights and the principle of collaboration.
Hide [Q17x2] Do any articles of the Code need to be updated?
No

Hide [Q17x3] Does the process of reporting on Code implementation and the review of the Code relevance and effectiveness need to be updated?
Yes

The reporting process could make simpler and more in line with the real situation of every countries, if the forms were diversified according to the kind of countries with reference to the structures of the national health systems, the legislation on work and emigration and the protection of human rights. Filling in forms that are not tailor-made determines the difficulty in providing exhaustive answers. It would be possible to identify subgroups of countries that present similar characteristics and verify the different degree of adherence to the principles of the Code.

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)
The fact that Italy is not included in the list leads to a reflection on the role that countries with better living conditions can play with respect to the countries most at risk.
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’.