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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Name of Member State:
Croatia
Name of designated national authority:
Mario Troselj
Title of designated national authority:
MD
Institution of the designated national authority:
Croatian Institute of Public Health
Email:
riginao@who.int,mario.troselj@hzjz.hr,WHOGlobalCode@who.int
Telephone number :
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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 there has been no change in the intensity

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

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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
Aligning domestic health and care workforce education with health system needs
Improving quality of education and health personnel in alignment with service delivery needs
Creating employment opportunities aligned with population health needs
Managing international recruitment of health personnel
Improving management of health personnel
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 [Q2x2x1x1] 2.2.1.1 Education Measure
Education institutions based in rural/underserved areas
Student intake from rural/underserved areas and communities
Scholarships and subsidies for education
Relevant topics/curricula in education and/or professional development programmes
(Re)orientation of education programmes towards primary health care
Others
Hide [Q2x2x3x1] 2.2.3.1 Incentives Measure
Additional financial reimbursement
Education opportunities
Opportunities for career advancement or professional growth
Professional recognition
Social recognition
Opportunity for pathways to permanent residency and/or citizenship for international health personnel
Others
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?
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?
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.
Amendments and change (especially in 2023) on Act on the Regulated Professions and on the Recognition of Foreign Professional Qualifications (Official Gazette no. 82/15, 70/19, 47/20, 123/23). https://www.hlk.hr/EasyEdit/UserFiles/propisi/2023/zakon-o-reguliranim-profesijama-i-priznavanju-inozemnih-strucnih-kvalifikacija-82-15-80-19-47-20-123-23.pdf
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.
Conference on Human Resource Planning in Healthcare with representative from Minstry of Health, Health Chambers, Croatian parliament, Medical Schools, Croatian Health Employers Association. https://hrh.mef.hr/en/english/
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.
Cooperation between Ministry of Labour and Ministry of Heralth on Regulated professions and professional qualifications https://mrosp.gov.hr/highlights-7158/your-europe/labour-market-and-employment/regulated-professions-and-professional-qualifications/12080 Introducing The service “Recognition of Foreign Professional Qualifications” is available on the e-Citizens portal https://gov.hr/en/the-service-recognition-of-foreign-professional-qualifications-is-available-on-the-e-citizens-portal/2527
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 Agreement on cross-border health cooperation between the Republic of Croatia and the Republic of Slovenia 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
Agreement on cross-border health cooperation between the Republic of Croatia and the Republic of Slovenia
HRV,SVN
Hide [Q6x1xAx2] d. Coverage
Agreement on cross-border health cooperation between the Republic of Croatia and the Republic of Slovenia
Sub-national
Hide [Q6x1xAx2x] Please enter the names of the subnational units (states, provinces, etc) which are involved in this agreement
Agreement on cross-border health cooperation between the Republic of Croatia and the Republic of Slovenia
Northwestern Istria - Primorska region (Izola General Hospital)
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
Agreement on cross-border health cooperation between the Republic of Croatia and the Republic of Slovenia 1 1
Hide [Q6x1xAx4] f. Categories of Health Personnel (check all that apply)
Doctors Nurses Midwives Dentists Pharmacists Other occupations
Agreement on cross-border health cooperation between the Republic of Croatia and the Republic of Slovenia 1 1 1 1 1
Hide [Q6x1xAx5] g. Validity period
Start Year End Year
Agreement on cross-border health cooperation between the Republic of Croatia and the Republic of Slovenia 2023 2030
Hide [Q6x1xAx6] h. Signatory of the agreement from your country
Agreement on cross-border health cooperation between the Republic of Croatia and the Republic of Slovenia
Others:
Hide [Q6x1xAx6xoth] If other signatory of the agreement from your country(Please specify:)
Agreement on cross-border health cooperation between the Republic of Croatia and the Republic of Slovenia
Prime minister of Croatia
Hide [Q6x1xAx6x1] If Ministry of Health is not a signatory, did the Ministry of Health participate in the development of the agreement?
Agreement on cross-border health cooperation between the Republic of Croatia and the Republic of Slovenia
Yes
Hide [Q6x1xAx7] i. Signatory of the agreement from the partner country (ies)
Agreement on cross-border health cooperation between the Republic of Croatia and the Republic of Slovenia
Others:
Hide [Q6x1xAx7xoth] If other signatory of the agreement from your country(Please specify:)
Agreement on cross-border health cooperation between the Republic of Croatia and the Republic of Slovenia
Prime minister of Slovenia
Hide [Q6x1xAx7x1] If Ministry of Health is not a signatory, did the Ministry of Health participate in the development of the agreement?
Agreement on cross-border health cooperation between the Republic of Croatia and the Republic of Slovenia
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)?
Agreement on cross-border health cooperation between the Republic of Croatia and the Republic of Slovenia
No, does not contain
elements to benefit the health system of either country
Hide [Q6x1xAx8x2] j.ii. Does the agreement include elements on health worker rights and welfare?
Agreement on cross-border health cooperation between the Republic of Croatia and the Republic of Slovenia
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?
Agreement on cross-border health cooperation between the Republic of Croatia and the Republic of Slovenia
Yes
Hide [Q6x1xBx1x1]
Start year of implementation:
Agreement on cross-border health cooperation between the Republic of Croatia and the Republic of Slovenia 2023
Hide [Q6x1xBx2a] How many health personnel have left or entered your country through this agreement since its implementation?
Agreement: Agreement on cross-border health cooperation between the Republic of Croatia and the Republic of Slovenia
Number of personnel
Doctors In this case it is about solidarity and free movement of the population, patients.
Nurses In this case it is about solidarity and free movement of the population, patients.
Midwives In this case it is about solidarity and free movement of the population, patients.
Dentists In this case it is about solidarity and free movement of the population, patients.
Pharmacists In this case it is about solidarity and free movement of the population, patients.
Hide [Q6x1xBx6] Please provide any other relevant information on the agreement (e.g., context, positive elements, gaps and lessons learnt).
Agreement on cross-border health cooperation between the Republic of Croatia and the Republic of Slovenia
Agreement on cross-border health cooperation between the Republic of Croatia and the Republic of Slovenia, the Government has started the implementation of timely and high-quality treatment of urgent medical conditions of citizens and visitors of northwestern Istria in the Izola General Hospital. Until now, citizens and visitors of northwestern Istria used the services of more distant hospital centers in Pula and Rijeka. However, the cross-border health cooperation between the Republic of Croatia and the Republic of Slovenia enables faster and better treatment of emergency conditions, at times when hospital care time is extremely important. "It is particularly significant that the mentioned model of cross-border cooperation and border bridging in the implementation of national health policies serves as a representative example of good practice and a significant step forward in the implementation of the fundamental principles of the European Union (EU) - solidarity and free movement of the population, in this case patients, which is at the EU level is particularly challenging considering national competences in the field of healthcare.
Hide [Q6x1xBx7] Full text of the agreement and associated documents (implementation plan, progress report, implementation report, evaluation report, etc.)
Upload document(s)
Agreement on cross-border health cooperation between the Republic of Croatia and the Republic of Slovenia
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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.
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.
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)
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 0 0 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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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 0 1 1
Nurses 1 1 1 1
Midwives 1 0 1 1
Dentists 1 0 1 1
Pharmacists 1 0 1 1
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
Hide [Q12x1x1]
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) 15272 14545 727 47 680 Croatian Medical Chamber 2022 1
Nurses 40704 40221 483 Croatian Nursing Council 2022 2
Midwives
Dentists
Pharmacists
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
Hide [Q12x2x1]
Doctors Nurses Midwives Dentists Pharmacists
Total foreign trained personnel 727 483
Country 1: Top country of training BIH BIH
Country 1: No. of foreign trained health personnel 448 350
Country 2: Top country of training SRB SVN
Country 2: No. of foreign trained health personnel 144 49
Country 3: Top country of training MKD SRB
Country 3: No. of foreign trained health personnel 38 39
Country 4: Top country of training ITA DEU
Country 4: No. of foreign trained health personnel 15 15
Country 5: Top country of training RUS MKD
Country 5: No. of foreign trained health personnel 10 7
Country 6: Top country of training SVN CZE
Country 6: No. of foreign trained health personnel 9 5
Country 7: Top country of training CZE UKR
Country 7: No. of foreign trained health personnel 7 5
Country 8: Top country of training DEU ITA
Country 8: No. of foreign trained health personnel 7 4
Country 9: Top country of training UKR HUN
Country 9: No. of foreign trained health personnel 6 2
Country 10: Top country of training OTH NLD
Country 10: No. of foreign trained health personnel 5 2
Source (e.g. professional register, census data, national survey, other) Croatian Medical Chamber Croatian Nursing Council
Year of data (Please provide the data of the latest year available) 2022 2022
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
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.
Recognizing the importance of the topic and strengthening the cooperation of all stakeholders, and the need for multisectoral approach to addressing these issues in national health and development policies. Need for the strengthening of information exchange on international health personnel migration and health systems, nationally and internationally,
Hide [Q17x2] Do any articles of the Code need to be updated?

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

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)

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’.