National Reporting Instrument 2021
Background
[iBG]
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 additionally mandated to report to the World Health Assembly every 3 years.
WHO Member States completed the 3rd round of national reporting in March 2019. The WHO Director General reported progress on implementation to the 72nd World Health Assembly in May 2019 (A 72/23). The 3rd Round of National Reporting additionally informed the Member-State led Review of the Code’s relevance and effectiveness, as presented to the 73rd WHA in 2020 (A 73/9).
The Review highlights that Code implementation, through targeted support and safeguards, is necessary to ensure that Health Emergency and Universal Health Coverage-related progress in Member States serves to reinforce rather than compromise similar achievement in others. In light of the considerations in the Report and decision WHA 73(30), the WHO Secretariat has additionally prepared the Health Workforce Support and Safeguards List, 2020.
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 4th Round of National Reporting are to be presented at the 75th World Health Assembly in May 2022. Given the ongoing COVID-19 pandemic, the NRI (2021) has been adapted to additionally capture information related to health personnel recruitment and migration in the context of the pandemic.
The deadline for submitting reports is 31 January 2022.
Should technical difficulties prevent national authorities from filling in the online questionnaire, it is also possible to download the NRI via the link: https://www.who.int/teams/health-workforce/migration/code-nri. Please complete the NRI and submit it, electronically or in hard copy, to the following address:
Health Workforce Department
Universal Health Coverage and Health Systems
World Health Organization
20 Avenue Appia, 1211 Geneva 27
Switzerland
hrhinfo@who.int
Disclaimer: The data and information collected through the National Reporting Instrument will be made publicly available via the WHO web-site following the proceedings of the 75th WHA in 2022. The quantitative data collected will be updated on and available through the National Health Workforce Accounts online platform. (http://www.who.int/hrh/statistics/nhwa/en/).
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 additionally mandated to report to the World Health Assembly every 3 years.
WHO Member States completed the 3rd round of national reporting in March 2019. The WHO Director General reported progress on implementation to the 72nd World Health Assembly in May 2019 (A 72/23). The 3rd Round of National Reporting additionally informed the Member-State led Review of the Code’s relevance and effectiveness, as presented to the 73rd WHA in 2020 (A 73/9).
The Review highlights that Code implementation, through targeted support and safeguards, is necessary to ensure that Health Emergency and Universal Health Coverage-related progress in Member States serves to reinforce rather than compromise similar achievement in others. In light of the considerations in the Report and decision WHA 73(30), the WHO Secretariat has additionally prepared the Health Workforce Support and Safeguards List, 2020.
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 4th Round of National Reporting are to be presented at the 75th World Health Assembly in May 2022. Given the ongoing COVID-19 pandemic, the NRI (2021) has been adapted to additionally capture information related to health personnel recruitment and migration in the context of the pandemic.
The deadline for submitting reports is 31 January 2022.
Should technical difficulties prevent national authorities from filling in the online questionnaire, it is also possible to download the NRI via the link: https://www.who.int/teams/health-workforce/migration/code-nri. Please complete the NRI and submit it, electronically or in hard copy, to the following address:
Health Workforce Department
Universal Health Coverage and Health Systems
World Health Organization
20 Avenue Appia, 1211 Geneva 27
Switzerland
hrhinfo@who.int
Disclaimer: The data and information collected through the National Reporting Instrument will be made publicly available via the WHO web-site following the proceedings of the 75th WHA in 2022. The quantitative data collected will be updated on and available through the National Health Workforce Accounts online platform. (http://www.who.int/hrh/statistics/nhwa/en/).
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Disclaimer
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For more information on WHO Data Policy kindly refer to http://www.who.int/publishing/datapolicy/en/
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
Designated National Authority Contact Details
[q01b]
Contact information:
Country
Malta
Full name of institution:
Andrew
Name of designated national authority:
Andrew Xuereb
Title of designated national authority:
Chief Nursing Manager
Telephone number: (E.g. +41227911530 .)
35622992283
Email: (Please enter one email address only.)
andrew.p.xuereb@gov.mt,hrhinfo@who.int
Implementation of the Code
[q1]
1. Has your country taken steps to implement the Code?
No
Partnerships, Technical Collaboration and Financial Support 1/2
[q2x1]
2.1. Has your country provided technical or financial assistance to one or more WHO Member States, particularly developing countries, or other stakeholders to support the implementation of the Code?
2.1.1 Specific support for implementation of the Code
2.1.2 Support for health system strengthening
2.1.3 Support for health personnel development
2.1.4 No support provided
2.1.5 Other areas of support:
[q2x2]
2.2. Has your country received technical or financial assistance from one or more WHO Member States, the WHO secretariat, or other stakeholders to support the implementation of the Code?
2.2.1 Specific support for implementation of the Code
2.2.2 Support for health system strengthening
2.2.3 Support for health personnel development
2.2.4 No support received
2.2.5 Other areas of support:
Partnerships, Technical Collaboration and Financial Support 2/2
[q3]
3. Has your country or its sub-national governments entered into bilateral, multilateral, or regional agreements and/or arrangements with respect to the international recruitment and migration of health personnel?
No
[q3xUploadx1]
[q3xUploadx2]
[q3xUploadx3]
Health Workforce Development and Health System Sustainability
[q4]
4. Does your country strive to meet its health personnel needs with its domestically trained health personnel, including measures to educate, retain and sustain a health workforce that is appropriate for the specific conditions of your country, including areas of greatest need?
Yes
[q4x1x]
4.1 Measures taken to educate the health workforce
Yes
[q4x1]
4.1.1 Manage production
4.1.2 Improve quality of education
4.1.3 Strengthen regulation
4.4 Others
[q4x2x]
4.2 Measures taken to ensure the sustainability* of the health workforce
Yes
[q4x2]
4.2.1 Workforce planning/forecasting
4.2.2 Increasing domestic production and education opportunities
4.2.3 Increasing employment opportunities
4.2.4 Manage recruitment of international health personnel
Other
[q4x3x]
4.3 Measures taken to address the geographical mal-distribution and retention of health workers*
Yes
[q4x3]
4.3.1 Education (Education institutions in underserved areas; students from under-served areas; relevant topics in education/professional development programmes; others)
4.3.2 Regulation (Mandatory service agreements; scholarships and education subsidies with return of service agreements; enhanced scope of practice; task shifting; skill-mix; others)
Exercises to ensure adequate and safe skill mix between nurses and carers; Revision of job descriptions etc.
4.3.3 Incentives (Financial and non-financial)
Work opportunities for nurses to work post-retirement; Nursing & Midwifery staff allowances increase by age. Continuous Professional Allowance to all HCP.
4.3.4 Support (Decent and safe living and working conditions; career advancement opportunities; social recognition measures; others)
Improved work conditions, through agreement with the Unions representing the health care professionals (sectoral agreement). Family friendly measures as per Government Collective Agreement and also the Public Service Management Code. Advancement in the career, both in the clinical and management stream as per sectoral agreement. Sponsorships for Medical Staff to study abroad in specific areas
[q4x4x]
4.4 Other relevant measures
No
[q5]
5. Are there specific policies and/or laws that guides international recruitment, migration and integration of foreign-trained health personnel in your country?
Yes
[q5x1]
5.1 Please provide further information in the box below:
Law/policy 1
Work Permits for health care professionals coming from Non Eu Countries. Law not specifically for Health Care Professionals.
Law/policy 2
Law/policy 3
[q6x]
6. Recognizing the role of other government entities, does the Ministry of Health have processes (e.g. policies, mechanisms, unit) to monitor and coordinate across sectors on issues related to the international recruitment and migration of health personnel?
No
[q7x]
7. 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
Responsibilities, Rights and Recruitment Practices
[q8x]
8. Which legal safeguards and/or other mechanisms are in place to ensure that migrant health personnel enjoy the same legal rights and responsibilities as the domestically trained health workforce? Please tick all options that apply from the list below:
8.1 Migrant health personnel are recruited internationally using mechanisms that allow them to assess the benefits and risk associated with employment positions and to make timely and informed decisions regarding them
8.2 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
8.3 Migrant health personnel enjoy the same opportunities as the domestically trained health workforce to strengthen their professional education, qualifications and career progression
8.4 Other mechanisms, please provide details below if possible:
[q9x]
9. Please submit any other comments or information you wish to provide regarding legal, administrative and other measures that have been taken or are planned in your country to ensure fair recruitment and employment practices of foreign-trained and/or immigrant health personnel.
KINDLY NOTE THAT THIS APPLIES TO RECRUITMENT IN THE PUBLIC SECTOR/SERVICE ONLY . INFORMATION WITH REGARDS TO PRIVATE SECTOR IS NOT AVAILABLE.
All foreign Health Care Professionals are obliged to obtain a Pass in the "Basic Maltese for Health Care Professionals" course, within 1 year of employment.
Induction course is performed in each entity upon employment.
Issuance of a Working Permit for Non-Eu HCP, and a long term residence permit to those who fit the criteria.
Provision of Multi-faith rooms in certain entities.
Difficulties;
1. Bureaucratic procedure for work Permits to be issued to Non-EU HCP.
2. High rental fees
[q10x]
10. Regarding domestically trained/ emigrant health personnel (diaspora) working outside your country, please submit any comments or information on measures that have been taken or are planned in your country to ensure their fair recruitment and employment practices, as well as difficulties encountered
Measure 1
All Health care professionals are given the same opportunities as per HCP working in Malta.
Measure 2
Locally Health Care Professionals are trained in Institutions which are accredited. Qualifications achieved are as per EU Directives and therefore are registrable in any other EU country and therefore employment is easier.
Measure 3
Data on International Health Personnel Recruitment & Migration
[iq11]
Improving the availability and international comparability of data is essential to understanding and addressing the global dynamic of health worker migration.
[q11]
11. Does your country have any mechanism(s) or entity(ies) to maintain statistical records of foreign-born and foreign-trained health personnel?
Yes
[q11x1]
Please describe
Data is kept by the respective Regulatory bodies. The Medical Council currently does not have a mechanism to distinguish between Foreign-born and Foreign trained health personnel, although those foreign born have trained in their country of origin.
[iQ12]
12. Data on the active stock of health personnel, disaggregated by country of training and birth
Previous data shared with WHO is available here. Please liaise with your NHWA focal point and update as relevant.
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 workforce1), disaggregated by the country of training (foreign-trained) and the country of birth (foreign-born). Please consult with your NHWA focal point, if available, to ensure that data reported below is consistent with NHWA reporting.
Previous data shared with WHO is available here. Please liaise with your NHWA focal point and update as relevant.
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 workforce1), disaggregated by the country of training (foreign-trained) and the country of birth (foreign-born). Please consult with your NHWA focal point, if available, to ensure that data reported below is consistent with NHWA reporting.
[q12x0]
12.1 Consolidated stock of active health personnel
This information can be provided by one of the following three options. Please choose your preferred mode of data entry:
This information can be provided by one of the following three options. Please choose your preferred mode of data entry:
Option A: Completion of the table below
[q12x1x1]
Option A: Please complete the table below
Please fill red highlighted cells.
| Total | Domestically Trained | Foreign Trained | Unknown Place of Training | National Born | Foreign Born | Source* | Year | Does the data represent active stock? | Remarks | |
|---|---|---|---|---|---|---|---|---|---|---|
| Medical Doctors | 2889 | 2247 | 622 | 0 | 2247 | 622 | Medical Council | 2021 | 2 | There is no mechanism to establish who are practicing or otherwise. The medical council could not confirm that foreign born HCW are foreign trained, but gave an indication that this is the case. |
| Nurses | 7007 | 5089 | 1918 | 0 | 5089 | 1918 | Malta Nurses & Midwifery Council database | 2020 | 2 | There is no mechanism to establish whether nurses are in practice or not |
| Midwives | 417 | 386 | 31 | 0 | 380 | 37 | Malta Nurses & Midwifery Council database | 2020 | 2 | There is no mechanism to establish whether midwives are in practice or not |
| Dentists | 348 | 242 | 106 | 0 | 242 | 106 | Medical Council | 2021 | 2 | There is no mechanism to establish whose practicing or otherwise. Furthermore the council does not have a mechanism to determine whether the foreign born are all foreign trained. |
| Pharmacists | 1342 | 1238 | 105 | 0 | 1223 | 120 | Pharmacy Council register | 2021 | 2 | National Born Data is an estimate |
[q12x1x3]
Upload any format of documentation that provides such information (e.g. pdf, excel, word).
[q13x2]
12.2 Top 10 countries of training for foreign-trained health personnel
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:
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:
Option A: Completion of the table below
[q13x2x1]
Option A : Completion of the template below or in in Excel (Download the Excel template and Upload the complete form)
Please indicate data from the latest year available
Please indicate data from the latest year available
| Doctors | Nurses | Midwives | Dentists | Pharmacists | |
|---|---|---|---|---|---|
| Total foreign trained personnel | 622 | 1918 | 31 | 106 | 105 |
| Country 1: Top country of training | Italy | India | Italy | Italy | Italy |
| Country 1: No. of foreign trained health personnel | 106 | 912 | 13 | 30 | 29 |
| Country 2: Top country of training | United Kingdom | Pakistan | United Kingdom | United Kingdom | Spain |
| Country 2: No. of foreign trained health personnel | 86 | 238 | 8 | 17 | 16 |
| Country 3: Top country of training | Nigeria | Spain | Bulgaria | Romania | Philippines |
| Country 3: No. of foreign trained health personnel | 41 | 129 | 2 | 8 | 15 |
| Country 4: Top country of training | Poland | Phillippines | Germany | Polish | United Kingdom |
| Country 4: No. of foreign trained health personnel | 37 | 118 | 2 | 7 | 9 |
| Country 5: Top country of training | Serbia | UK | Austria | India | Hungary |
| Country 5: No. of foreign trained health personnel | 28 | 113 | 1 | 5 | 9 |
| Country 6: Top country of training | Bulgaria | Italy | Hungary | France | Poland |
| Country 6: No. of foreign trained health personnel | 26 | 96 | 1 | 3 | 4 |
| Country 7: Top country of training | Ukraine | Romania | Iran | Germany | Germany |
| Country 7: No. of foreign trained health personnel | 20 | 84 | 1 | 3 | 4 |
| Country 8: Top country of training | Germany | Bulgaria | Poland | Greece | Greece |
| Country 8: No. of foreign trained health personnel | 18 | 69 | 1 | 3 | 2 |
| Country 9: Top country of training | Ireland | Portugal | Spain | Kuwait | Bulargia |
| Country 9: No. of foreign trained health personnel | 18 | 16 | 1 | 3 | 2 |
| Country 10: Top country of training | America | Germany | Switzerland | Spain | South Africa |
| Country 10: No. of foreign trained health personnel | 16 | 15 | 1 | 3 | 2 |
| Source (e.g. professional register, census data, national survey, other) | Professional Register held by the Medical Council of Malta | Professional Register held by the Council for Nurses and Midwives Malta | Professional Register held by the Council for Nurses and Midwives Malta | Professional Register held at the Medical Council of Malta | Professional register held at the Pharmacy Council of Malta |
| Year of data | 2021 | 2021 | 2121 | 2121 | 2021 |
| Additional Comments | Assumption that foreign born are foreign trained since no accurate mechanism exists at the Council | Assumption that foreign born are foreign trained since no accurate mechanism exists at the Council |
[q13x2x3]
Upload any format of documentation that provides such information (e.g. pdf, excel, word).
Please upload file
COVID-19 and Health personnel mobility
[q13]
13. Were measures undertaken at national or sub-national level in response to the COVID-19 pandemic with respect to the temporary or permanent mobility of international health personnel?
13.1 No change in national or sub-national regulation, policy or processes related to the entry or exit of foreign-trained or foreign-born health personnel
Although the same protocols were kept, Government entity responsible for Residency/Work permits committed to process applications from HCP as a priority
13.2 National and/or sub-national regulation, policy or processes enacted to ease entry and integration of foreign-trained or foreign-born health personnel
13.3 National and/or sub-national regulation, policy or processes enacted to limit the exit of health personnel from country
13.4 Others
[q14]
14. Did you have a mechanism to monitor the inflow and outflow of health personnel to/from your country during the COVID-19 pandemic?
Inflow
Outflow
No
[q15]
15. Please list any challenges related to ethical international recruitment of health personnel during the COVID-19 pandemic
Please describe (e.g. active recruitment of ICU personnel)
Please describe (e.g. active recruitment of ICU personnel)
1st Challenge
Drainage of a number of nurses within the public service and being recruited by UK NHS. There were even adverts by Recruiting Agencies targeting specifically Nurses working in Malta
2nd Challenge
3rd Challenge
Constraints, Solutions, and Complementary Comments
[q16]
16. 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 solution /Recommendation | |
|---|---|---|
| Lack of Adequate data at national level | The introduction of a National Database including private sector | |
| Lack of National Setup to monitor and control | Setting up of a Competent body with the such fundions | |
| Lack of motivation and training across Private and Public | Training |
[q17]
17. Is there any specific support your country requires to strengthen implementation of the Code?
17.1 Support to strengthen data and information
17.2 Support for policy dialogue and development
17.3 Support for the development of bilateral/multi-lateral agreements
17.4 Other areas of support:
[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.
No specific designated persons in the field. An Expert from WHO to assist with the implementation of the Code is desirable.
[q18x1]
Please upload any supporting files
Thank You
[iThank]
You have reached the end of the National Reporting Instrument - 2021. You may go back to any question to update your answers or confirm your entry by clicking ‘Submit’.