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
Belgium
Full name of institution:
Tom
Name of designated national authority:
Tom Auwers
Title of designated national authority:
Secretary-general FPS Health
Telephone number: (E.g. +41227911530 .)
003225249083
Email: (Please enter one email address only.)
ibri@health.fgov.be,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
The content of the Code has been communicated to the public authorities and the various advisory councils that help determine Belgian public policy on the migration of health professionals.
Action 2
Action 3
[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
The policy on the migration of health professionals is integrated into the policy on the planning and quota of health professionals in Belgium.
Measure 2
This policy is subject to continuous re-evaluation and, within this framework, any modification takes into account the recommendations of the Code.
Measure 3
[q1x3x]
1.3 Records are maintained on all recruiters authorized by competent authorities to operate within their jurisdiction.
No
[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
Any public policy on the planning and allocation of professionals is subject to the prior opinion of consultative bodies where the various stakeholders can express themselves.
Link documents of the planning committee: https://organesdeconcertation.sante.belgique.be/fr/organe-d'avis-et-de-concertation/commission-de-planification-offre-medicale
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
See 2.1.5
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
Annual support of BE Voluntary Core Funding with focus on WHO HSS for developing countries à 1.7 mn EUR per year
Support Area 2
Specific support of 4 mn EUR for WHO to strengthen fragile health systems in 2020 – focus on Palestina
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:
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
The training system for health professionals aims to be a system of a high quality, in terms of practical and theoretical training. For physicians and dentists there is a regulation on the level of the determinations of quota by federal and regional government.
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
The number of health professionals is monitored on an ongoing basis, in order to be able to redirect the flow towards professions in shortage or sectors in demand.
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)
The Belgian health care system aims to ensure the best working environment (quality of the working environment, remuneration, work-life balance, ...) for health care professionals. The number of health professionals is monitored on an ongoing basis, in order to redirect the flow to professions in shortage or sectors in demand. Measures are also taken, mainly in general medicine, to address regional disparities.
4.3.3 Incentives (Financial and non-financial)
There are financial incentives in place for the installation of General Practitioners in underserved geographic areas
4.3.4 Support (Decent and safe living and working conditions; career advancement opportunities; social recognition measures; others)
[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
Belgium has regulations governing the flow of migrant health professionals in terms of public health protection (recognition of qualifications), training and monitoring of flows.
Law/policy 2
As Belgium is a member of the EU, there is a difference between EU and non-EU professionals.
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?
Yes
[q6x1]
6.1 Please provide further information in the box below:
Protection of public health (recognition of qualifications), supervision of training and monitoring of flows.
[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.
Data on migrant health professionals are integrated into the planning and allocation of health professionals and are subject to continuous monitoring.
Migration at three levels has been taken into account in our work: start of studies, start of internship period and start of career in the labor market. This is also integrated in the projection model of the workforce, used in the development of future scenarios, where foreign inflow is included at these levels.
More information regarding international mobility can be found in the following reports for physicians and dentists:
- Physicians: https://organesdeconcertation.sante.belgique.be/fr/documents/hwf-note-mobilite-internationale-des-medecins-2020
- Dentists: https://organesdeconcertation.sante.belgique.be/fr/documents/hwf-note-mobilite-internationale-des-dentistes-2020
Examples of future scenarios:
- Basic scenario physicians:
https://organesdeconcertation.sante.belgique.be/fr/documents/hwf-scenarios-de-base-de-levolution-de-la-force-de-travail-medecins-2016-2036
- Alternative scenarios physiotherapists:
https://organesdeconcertation.sante.belgique.be/fr/documents/hwf-scenarios-alternatifs-de-levolution-de-la-force-de-travail-kinesitherapeutes-2016-2041
[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.
[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
no information available
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
At the level of the service health care professions and professional practice from the DG Health Care at Federal Public Service Health, Food Chain Safety and Environment there is a federal database of health professions installed, named ECAD, as an operational application with information on, among other things, visa data to get permission to practice the profession in question in Belgium.
The main data from this database are visualized annually in a report "STATAN". The most recent version can be found here: https://organesdeconcertation.sante.belgique.be/fr/documents/hwf-statan-2020
[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 | see uploaded document | |||||||||
| Nurses | see uploaded document | |||||||||
| Midwives | see uploaded document | |||||||||
| Dentists | see uploaded document | |||||||||
| Pharmacists | see uploaded document |
[q12x1x3]
Upload any format of documentation that provides such information (e.g. pdf, excel, word).
Question 12
No comment
Question 12
No comment
[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 | |||||
| Country 1: Top country of training | |||||
| Country 1: No. of foreign trained health personnel | |||||
| Country 2: Top country of training | |||||
| Country 2: No. of foreign trained health personnel | |||||
| Country 3: Top country of training | |||||
| Country 3: No. of foreign trained health personnel | |||||
| 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) | |||||
| Year of data | |||||
| Additional Comments |
[q13x2x3]
Upload any format of documentation that provides such information (e.g. pdf, excel, word).
Please upload file
Question 12
No comment
Question 12
No comment
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
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 |
Joint Questionnair (or data used for joint questionnaire) | Joint Questionnair (or data used for joint questionnaire) | Joint Questionnair (or data used for joint questionnaire) | Joint Questionnair (or data used for joint questionnaire) | Joint Questionnair (or data used for joint questionnaire) | Please keep the order of professions (here midwives are at the end while pharmacists is usually the last profession within the table |
| 2020 | 920 | 1329 | 265 | 166 | 235 | |
| 2019 | 802 | 1813 | 261 | 173 | 206 |
[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 |
Please keep the order of professions (here midwives are at the end while pharmacists is usually the last profession within the table - no idea: see part I/ regulated professions database (European Commission) | |||||
| 2020 | Please keep the order of professions (here midwives are at the end while pharmacists is usually the last profession within the table - no idea: see part I/ regulated professions database (European Commission) | |||||
| 2019 | Please keep the order of professions (here midwives are at the end while pharmacists is usually the last profession within the table - no idea: see part I/ regulated professions database (European Commission) |
[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
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 | |
|---|---|---|
| The recruitment of migrant health professionals is left to private operators | Disseminate more widely (via a dedicated portal, for example) the information useful to migrant candidate professionals | |
| Flows of migrant professionals can unbalance the planning systems in place at the national level | Fully introduce migrant flows into the quota system | |
| Migrant professionals coming to train in Belgium on a temporarry basis tend to circumvent the norms in order to reamin on the Belgian market, which could jeapordizee the agreements made |
[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’.