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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Please describe
Disclaimer
[disclaim]
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
Latvia
Full name of institution:
Roga
Name of designated national authority:
Ministry of Health Republic of Latvia
Title of designated national authority:
Ministry of Health Republic of Latvia
Telephone number: (E.g. +41227911530 .)
+ 371 67876000
Email: (Please enter one email address only.)
dace.roga@vm.gov.lv,hrhinfo@who.int
Implementation of the Code
[q1]
1. Has your country taken steps to implement the Code?
Yes
[q1x1x]
1.1 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.
Yes
[q1x1]
Action 1
In Latvia, the Ministry of Education and Science is the coordinating institution for the recognition of qualifications, including the health profession, in order to ensure equal and fair rights in the recognition of foreign qualifications. The Ministry of Health cooperates with the Ministry of Education and Science in this matter.
Action 2
The Ministry of Health also cooperates with medical institutions (mainly large hospitals), which, based on their experience in attracting foreign medical professionals, make proposals to improve the process and reduce barriers (administrative, time resources, costs) to the recognition of professions and specialties. This also applies to short-term professional recognition, where the institution of medical practice attracts a foreign specialist to provide one specific service.
Action 3
In turn, professional organizations in the health sector (Latvian Medical Association, Latvian Association of Professional Organizations of Medical Practitioners, Latvian Nurses' Association) and the Health Inspectorate are competent institutions that recognize foreign qualifications for health professions in accordance with the Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005 on the recognition of professional qualifications. An important aspect of cooperation with the competent authorities is to ensure that clear, comprehensible information on the recognition of regulated professions in the health sector is published in the database of regulated professions.
[q1x2x]
1.2 Measures have been taken or are being considered to introduce changes to laws or policies consistent with the recommendations of the Code.
Yes
[q1x2]
Measure 1
During the current pandemic, vaccination against Covid-19 is also provided to foreign specialists, including foreign medical students, especially those who participated in mitigating the effects of Covid-19 by participating in the treatment process within their competence.
Measure 2
According to the health policy and regulatory enactments developed by Latvia, only persons registered in the register have the right to engage in medical treatment in Latvia. As soon as a medical practitioner recognizes his or her qualification in Latvia, it is registered in the national register of medical practitioners. If a medical practitioner is registered in the register (regardless of nationality, country of origin, education obtained abroad or in Latvia) all legislation regulating employment relations (for example, salary, working hours, responsibilities, and duties, etc.), as well as conditions of professional activity are the same for all medical practitioners in the register (regardless of nationality, country of origin, education acquired abroad or in Latvia).
Measure 3
[q1x3x]
1.3 Records are maintained on all recruiters authorized by competent authorities to operate within their jurisdiction.
Yes
[q1x3]
Please describe:
Please see section 1.2. information provided. We confirm that in accordance with the regulatory enactments regulating the field of health, all medical practitioners are registered in the register of medical practitioners, including those who have received education abroad (both in the EU and third countries) and a qualification recognized in Latvia. If a medical treatment is performed by an unregistered medical practitioner, it is an unauthorized medical treatment that is criminally punishable and supervised by the Health Inspectorate (it is determined by Section 12 of the Medical Treatment Law: Ārstniecības likums (likumi.lv)).
[q1x4x]
1.4 Good practices, as called for by the Code, are encouraged and promoted among recruitment agencies.
No
[q1x5x]
1.5 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.
Yes
[q1x5]
Measure 1
Please see section 1.1. information provided.
When developing regulatory enactments, the Ministry of Health consults with the involved parties to ensure the availability of information on the recognition of professional qualifications, as well as to improve the requirements and procedures for the recognition of professional qualifications. However, Latvia is basically a donor country, so there is no active recruitment of foreign specialists. Latvia currently places more emphasis on the return of the diaspora, for example, it is a little easier to recognize the right to practice and financial compensation is offered if a person returns to work in the health sector in Latvia. This applies to all foreign doctors, but there are more chances to attract doctors of Latvian nationality who return to live in Latvia.
Measure 2
Measure 3
[q1x6x]
1.6 Other steps:
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:
[q2x1oth]
2.1.5 Other areas of support:
Support Area 1
To help other countries overcome the Covid-19 pandemic, Latvia donates Covid-19 vaccines to third countries.
Support Area 2
Latvia is a member of the WHO and the International Red Cross and makes mandatory contributions accordingly.
Support Area 3
[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:
[q2x2oth]
2.2.5 Other areas of support:
Support Area 1
Support for the Health Workforce Planning and Forecasting Expert Network (SEPEN) provided support to Latvia, which resulted in the REPORT ON TAILORED ADVICE AND GUIDANCE FOR THE IMPROVEMENT OF THE LATVIAN HEALTH WORKFORCE PLANNING SYSTEM, June-August, 2020. SEPEN's joint bid was funded by the European Union Third health program with the service contract of the Executive Agency for Consumers, Health, Agriculture and Food No. 2016 73 01. It was chaired by the University of Zemmelweiss in Hungary, and the members of the consortium included the Standing Committee of European Physicians (CPME), the Catholic University of Leuven, the Italian Ministry of Health, and the Italian National Agency for Regional Health Services (AGENAS).
Support Area 2
Support Area 3
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)
There are medical education institutions in the regions, including one higher education institution that started the general care nurse education program in 2021, as well as educational institutions have structural units in the regions. Professional development programs are financed from the European Union funds and the conditions for the implementation of these programs are to ensure regional accessibility.
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)
When acquiring a doctor's specialty at the residency, there is a regional principle that a person can study in state-funded studies, but after completing studies and obtaining a doctor's specialist certificate, it is a condition to work in a state or municipal institution for three years.
4.3.3 Incentives (Financial and non-financial)
Regional residents (persons studying for a medical specialty) are entitled to a higher resident's salary by 30%; Also in Latvia, a project of European Union funds is being implemented, which provides compensation for starting work in regions outside the capital, as well as for starting work in the most critical professions in the sector (including the capital) - nurses and nursing assistants in hospitals, family doctors and medical assistants.
4.3.4 Support (Decent and safe living and working conditions; career advancement opportunities; social recognition measures; others)
[q4x4x]
4.4 Other relevant measures
Yes
[q4x4]
Please describe
Investments by European Union funds to improve the infrastructure of hospitals and GP practices, including in the outermost regions, which, among other things, provide decent working conditions for doctors.
[q5]
5. Are there specific policies and/or laws that guides international recruitment, migration and integration of foreign-trained health personnel in your country?
No
[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?
Yes
[q6x1]
6.1 Please provide further information in the box below:
There are competent bodies that ensure the recognition of qualifications. There is a Health Inspectorate that maintains a database of medical personnel, including foreigners. There is a Health Inspectorate, which monitors that the professional activities of a medical practitioner (including from abroad) comply with the law.
[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?
Yes
[q7x1x]
7.1.a Please provide further information in the box below.
Latvian e-Government portal to serve e-services to citizens - Latvijas valsts portāls, where information is also available in English
[q7x2x]
7.1.b Please upload any format of documentation that provides such information (e.g. pdf, excel, word)
Upload document:
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.
No additional information
[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
1 Addressing the issue of attracting human resources in the field of health care, the Ministry of Health has prepared amendments to several regulations of the Cabinet of Ministers, which were approved by the government on 18 August 2020. Significant changes - relaxed requirements for doctors in the diaspora who want to move to Latvia to be able to continue their professional work here. To provide an opportunity for physicians living in the diaspora to continue their professional activities when moving to Latvia, the procedure for registration in the Register of Medical Practitioners and Medical Support Persons has been facilitated. Namely, if a medical practitioner (with a diploma obtained in Latvia) has worked in a profession outside Latvia in a Member State of the European Economic Area or Switzerland for at least three years in the last five years and wants to continue working in Latvia, the person will have to submit certain certificates of professional activity abroad. A person will also be able to do it remotely, for example, while still outside Latvia, and if everything is correct, return to Latvia immediately to work. Until now, the so-called "registry exam" had to be taken, which made the process more difficult. As a result, it will be a positive impulse for Latvia to return highly qualified specialists in the field of health care.
Measure 2
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
The Health Inspectorate does not have statistical data on health care workers born and trained abroad in Latvia. But in accordance with Regulation no. 827 “Procedures for Recognition of Professional Qualifications for Permanent Professional Activity in the Republic of Latvia” (Paragraph 22), the institution that issues recognition certificates shall send copies of decisions on recognition of professional qualifications to the Academic Information Center (https://likumi.lv/ta/en/en/id/287586-procedures-for-the-recognition-of-a-professional-qualification-for-independent-professional-activity-in-the-republic-of-latvia).
[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 B: Download the Excel template with existing data and Upload with the updated data
WHO_foreign_trained_pers_Latvia
No comment
[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 B: Download the Excel template with existing data and Upload with the updated data
[q13x2x2]
Option B: Completion of the template in Excel
Download and Upload
Download and Upload
Please upload file (Maximum file size: 5MB)
WHO_foreign_trained_pers_Latvia
No comment
[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
In the Covid -19 situation, although there is a general shortage of doctors, hospitals restructured existing facilities and attracted additional staff - medical students, people with medical training but not working in the sector - their return was encouraged.
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
[q14x1]
14.1 How many foreign-trained or foreign-born health personnel were newly (inflow) active (temporarily and/or permanently) in your country in 2019 and 2020?
| Doctors | Nurses | Midwives | Dentists | Pharmacists | Comments | |
|---|---|---|---|---|---|---|
|
Data Source (e.g. Regulatory authority, immigration records, work permits, etc.) Please ensure data source consistency for each category of personnel for the two years |
Desicions of the recognitions of profesional qualifications in Latvia | Desicions of the recognitions of profesional qualifications in Latvia | Desicions of the recognitions of profesional qualifications in Latvia | Desicions of the recognitions of profesional qualifications in Latvia | Desicions of the recognitions of profesional qualifications in Latvia | |
| 2020 | 8 | 2 | 0 | 1 | 2 | |
| 2019 | 5 | 3 | 0 | 1 | 2 | Including 1 European Professional Card issued to pharmacists, information from the Internal Market Information System (IMI) |
[q14x2]
14.2 How many domestically-trained health personnel left (outflow) your country in 2019 and 2020 (for temporary or permanent migration)?
| Doctors | Nurses | Midwives | Dentists | Pharmacists | Comments | |
|---|---|---|---|---|---|---|
|
Data Source (e.g. letters of good standing, emigration records, G-G agreements etc.) Please ensure data source consistency for each category of personnel for the two years |
Professional qualifications of certificates issued by the Latvian Medical Association recognition abroad. | Notifications of recognition of professional qualifications abroad + information from the Internal Market Information System (European Professional Card) | Professional qualifications of certificates issued by the Latvian Medical Association recognition abroad. | Notices on the recognition of professional qualifications abroad + information from the Internal Market Information System (European Professional Card - EPC) | Notifications of recognition of professional qualifications abroad + information from the Internal Market Information System (European Professional Card) | |
| 2020 | 212 | 36 | 0 | 37 | 3 | 212 doctors (of them 66 inhabitants of Latvia, 146 - foreigners who have graduated from Latvia);1-biomedical laboratory assistant; 1-medical assistant; 5-physiotherapist; 1-optometrists; 1-nutrition specialist; 2-dental hygienist 2- farmaceiti; 1-farmaceita asistents; |
| 2019 | 241 | 44 | 0 | 42 | 3 | 2019 - 241 doctors (of them - 86 inhabitants of Latvia, 155 - foreigners who have graduated from Latvia) and 42 dentists (6 of them) Latvian residents, 36 - foreigners who have graduated from Latvia).;4-medical assistant; 4-physiotherapist; 1- nursing assistant; 3-ergotherapist; 1-masseuse; 2- radiographer; 1-dental assistant; 3-dental technician. 2 – farmaceiti; 1-farmaceits (EPK) |
[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
Language barrier - in order to work in Latvia, a medical practitioner must know the Latvian language.
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 | |
|---|---|---|
| There are insufficient resources in the public sector for the development, implementation and improvement of long-term and comprehensive health workforce policies for attraction and retention, but there are some successful measures. | to develop the capacity of public administration on these issues | |
| Implementation and monitoring of human resources strategy in medical institutions (especially for recruitment and retention of labor force). | involvement of employers, administration of medical institutions in the development of the national health human resources strategy. | |
| Availability and quality of data, compatibility for monitoring of human resources, including recruitment | Modernization of the register of medical practitioners - which has already started. |
[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.
[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’.