National Reporting Instrument 2024

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Background

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Hide [BGxINT] Background
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:
Lesotho
Name of designated national authority:
Lipolelo Molapo, Mapaballo Mohololi, Mapabala Makara
Title of designated national authority:
Government
Institution of the designated national authority:
Ministry of Health
Email:
lipolelomolapo@gmail.com,mohololigrace@yahoo.com,WHOGlobalCode@who.int,kbediakon@who.int,okoroafors@who.int,mapabala.makara@gov.ls
Telephone number :
+26658730667
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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

Due to Labour market dynamics the issue of recruitment differs in health cadres. Most health professionals at the entry level, the country is able to produce but cannot absorb resulting in unemployment, except for Doctors, whom the country does not produce and can still absorb

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 [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
There is strategic plan for human resource for health, to guide the countries workforce needs
Aligning domestic health and care workforce education with health system needs
Through the 5 year strategic plan and other departmental situational analysis
Improving quality of education and health personnel in alignment with service delivery needs
The Ministry of Health in conjuction with Ministry of Health and Council of Higher Learning institutions
Creating employment opportunities aligned with population health needs
Ministry of Health in collaboration with Ministry of Labour in analyzing the labour market
Managing international recruitment of health personnel
Collaboration with Professional regulatory councils in regulation
Improving management of health personnel
Donor and government as inspecting
Specific provisions on health personnel regulation and recruitment during emergencies
development of the multisectoral strategy
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 [Q2x2x1x1] 2.2.1.1 Education Measure
Education institutions based in rural/underserved areas
Institutions are located all around the country even in remote areas
Student intake from rural/underserved areas and communities
Student are admitted on merit only
Scholarships and subsidies for education
The country and donors offer scholarship and are granted on merit
Relevant topics/curricula in education and/or professional development programmes
Ministry of education and Ministry of health through Council of Higher Education Learning collaborate to ensure relevance
(Re)orientation of education programmes towards primary health care
Others
Hide [Q2x2x2x1] 2.2.2.1 Regulation Measure
Scholarships and education subsidies with return of service agreements
Scholarships and subsidies do have bond agreements
Mandatory service agreements with health personnel that are not related to scholarships or education subsidies
all students are bound by the agreement to serve
Enhanced scope of practice of existing health personnel
Task sharing between different professions
Provisions for pathways to enter new or specialised practice after rural service
Others
Hide [Q2x2x3x1] 2.2.3.1 Incentives Measure
Additional financial reimbursement
Nonoe
Education opportunities
None
Opportunities for career advancement or professional growth
None
Professional recognition
None
Social recognition
None
Opportunity for pathways to permanent residency and/or citizenship for international health personnel
only for specialized professionals
Others
Hide [Q2x2x4x1] 2.2.4.1 Support Measure
Decent and safe working conditions
yes, Quality assessed
Decent and safe living conditions
Livable conditions in cities but not for remote areas
Distance learning/e-learning opportunities
Only in areas with internet network
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.
Institutions production for the professional entry not for specialization, for the following , Laboratory, Pharmacy, Nursing, Environmental Health. Doctors and others do not have institutions. The private sector and public absorb the workforce, the latter absorbing more. The government only pays the market price with retaining allowances for those working in remote areas
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?
No
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?
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.
All migrant workers are hired on renewable contracts of 3 years based on performance
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.
yes
Migrant health personnel enjoy the same opportunities as the domestically trained health workforce to strengthen their professional education, qualifications and career progression.
No, their work relationship is strictly based on the contract
Institutional arrangements are in place to ensure safe migration/ mobility and integration of migrant health personnel.
Yes Professional regulatory council are in place for that function
Measures have been taken to promote circular migration of international health personnel
NO
Other measures (including legal and administrative) for fair recruitment and employment practices of foreign-trained and/or immigrant health personnel (please provide details)
Positions are advertised on international platforms especially for Doctors
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
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
Nurses 0 0 0 0
Midwives 0 0 0 0
Dentists 1 0 0 0
Pharmacists 0 0 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
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 0 0
Nurses 0 0 0 0
Midwives 0 0 0 0
Dentists 0 0 0 0
Pharmacists 0 0 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
Other occupations 0 0 0 0
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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:
Fill in the table below
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Total Place of training-Domestic Trained Place of training-Foreign trained-total Place of training-Foreign trained-national born Place of training-Foreign trained-foreign born Place of birth-National Born Place of birth-Foreign Born Data Source* Year of data Does the data represent active stock? Does the data represent active stock?
Medical Doctors (generalist + specialists) 361 0 361 355 6 355 6 Regulatory Bodies 2024 1
Nurses 7836 7836 0 0 3 7833 3 Regulatory body 2024 1
Midwives 2780 2780 0 0 0 2780 0 Regulatory Bodies 2024 1
Dentists 22 0 22 17 5 17 5 Regulatory Bodies 2024 1
Pharmacists 25 0 25 25 0 25 0 Regulatory Bodies 2024 1
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 361 22 25
Country 1: Top country of training ZAF ZAF ZAF
Country 1: No. of foreign trained health personnel 341 22 25
Country 2: Top country of training ZMB
Country 2: No. of foreign trained health personnel 10
Country 3: Top country of training ZWE
Country 3: No. of foreign trained health personnel 10
Country 4: Top country of training
Country 4: No. of foreign trained health personnel
Country 5: Top country of training
Country 5: No. of foreign trained health personnel
Country 6: Top country of training
Country 6: No. of foreign trained health personnel
Country 7: Top country of training
Country 7: No. of foreign trained health personnel
Country 8: Top country of training
Country 8: No. of foreign trained health personnel
Country 9: Top country of training
Country 9: No. of foreign trained health personnel
Country 10: Top country of training
Country 10: No. of foreign trained health personnel
Source (e.g. professional register, census data, national survey, other) Lesotho Medical Pharmacy, Dentist Council Lesotho Nursing Council Lesotho Nursing Council Lesotho Medical Pharmacy, Dental Council Lesotho Medical Pharmacy Dental Council
Year of data (Please provide the data of the latest year available) 2024 2024 2024 2024 2024
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.)?
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)
USAID Financial and Technical Assistance
Global Fund Financial and Technical Assistance
Millenium Challenge Account MCA Financial and Technical Assistance
World Bank Financial and Technical Assistance
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)
USAID Human Resources for Health Information System
MCA Health Information Systems
World Bank Health Financing
Global Fund Health Leadership and governace
Hide [Q14x3] Please specify other areas of support
Supporting country/entity: Support Area: Type of support:
UNICEF Community health Workers Training and Development Financing and health information system
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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
Lack of legal frameworks Development of legal frameworks
Lack of strategies, policies and stipulated procedures Development of strategies, policies and stipulated procedures
Transparency and clear communication Development of communication and advocacy strategies
Hide [Q16] 16. What support do you require to strengthen implementation of the Code?
Support to strengthen data and information on health personnel
Regular trainings and resources
Support for policy dialogue and development
Development of advocacy strategies
Support for the development of bilateral/multi-lateral agreements
Development and advocacy of 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 not been fully implemented
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?
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)
Lesotho does appear on the List. Unemployment rate is high for all cadres produced from our local institutions such as nursing, pharmacy Laboratory, But there is scarce for specialization in other medical cadres
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’.