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/).
[hidLabels]
//hidden: Please not delete.
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
Trinidad and Tobago
Full name of institution:
Jennifer
Name of designated national authority:
Jennifer C. Andall
Title of designated national authority:
Manager - Health Sector Human Resource Planning and Development
Telephone number: (E.g. +41227911530 .)
18686270012
Email: (Please enter one email address only.)
jennifer.andall@health.gov.tt,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 Code has been shared with the Regional Health Authorities and the Ministry of Health Human Resource Divisions.
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
Measures are being taken to include the principles of the Code in the Recruitment Policies of the Regional Health Authorities in the country.
Measure 2
Measure 3
[q1x3x]
1.3 Records are maintained on all recruiters authorized by competent authorities to operate within their jurisdiction.
Yes
[q1x3]
Please describe:
Currently, the Ministry of Health does not work with any private local or foreign recruitment agency. Recruitment by the Ministry of Health is done via bi-lateral agreements.
[q1x4x]
1.4 Good practices, as called for by the Code, are encouraged and promoted among recruitment agencies.
Yes
[q1x4]
Please describe:
1.4.1 Promotion of the Code among private recruitment agencies.
1.4.2 Domestic legislation or policy requiring ethical practice of private recruitment agencies, as consistent with the principles and articles of the Code.
1.4.3 Public or private certification of ethical practice for private recruitment agencies.
1.4.4 Others
Local recruitment agencies and the Ministry of Health are required to adhere to sound industrial relations practices and the applicable legislation and policies for recruitment of non-nationals. These practices are definitely promoted by the Government.
[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
Before the recruitment of health personnel from abroad, the Ministry of Health consults with the Regional Health Authorities and internal stakeholders on their HRH needs and seeks Cabinet approval before engaging in regional or international recruitment. The Ministry of Health also liaises with the source country focal person in the recruitment process.
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:
[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?
Yes
[q3xTitle]
Title of Agreement
| Title | Web-link to agreement | Upload the full text of the agreement | |
|---|---|---|---|
| Agreement 1 | Technical Cooperation Agreement for Cuba | ||
| Agreement 2 | |||
| Agreement 3 | |||
| Agreement 4 | |||
| Agreement 5 |
[q3xUploadx1]
[q3xUploadx2]
[q3xUploadx3]
[q3xUploadx4]
[q3xUploadx5]
[q3xTOA]
If you cannot share the full text of the agreement please fill :
| Type of Agreement | Coverage | |
|---|---|---|
| Technical Cooperation Agreement for Cuba (SQ001) | Bilateral (A1) | National (A1) |
| (SQ002) | ||
| (SQ003) | ||
| (SQ004) | ||
| (SQ005) |
[q3xMCA]
Main content of agreement
(check all that apply)
| Education and training | Institutional capacity building | Promotion of circular migration | Retention strategies | Recognition of health personnel | Recruitment of health personnel | Twinning of health care facilities | Other mechanism (include details if possible): | |
|---|---|---|---|---|---|---|---|---|
| Technical Cooperation Agreement for Cuba | 1 | 1 | 1 | 1 | 1 | 1 | ||
[q3xCHP]
Categories of Health Personnel (check all that apply)
| Doctors | Nurses | Midwives | Dentists | Pharmacists | Other (include details as necessary) : | |
|---|---|---|---|---|---|---|
| Technical Cooperation Agreement for Cuba | 1 | 1 | 1 | 1 | ||
[q3xVP]
Validity period
| From: | To: | |
|---|---|---|
| Technical Cooperation Agreement for Cuba (SQ001) | 2018 (2018) | 2023 (A28) |
| (SQ002) | ||
| (SQ003) | ||
| (SQ004) | ||
| (SQ005) |
[q3xCN]
Countries that are involved
Technical Cooperation Agreement for Cuba
Cuba
[q3xSYC]
Signatory of the agreement from your country
| Ministry of Foreign Affairs | Ministry of Health | Ministry of Education | Ministry of Trade | Ministry of Labour | Ministry of Immigration /Home Affairs | Other: | |
|---|---|---|---|---|---|---|---|
| Technical Cooperation Agreement for Cuba | 1 | ||||||
[q3xSPC]
Signatory of the agreement from the partner country (ies)
| Ministry of Foreign Affairs | Ministry of Health | Ministry of Education | Ministry of Trade | Ministry of Labour | Ministry of Immigration /Home Affairs | Other: | |
|---|---|---|---|---|---|---|---|
| Technical Cooperation Agreement for Cuba | 1 | ||||||
[q3xSPCOth]
Signatory of the agreement from the partner country (ies) (Please specify:)
Technical Cooperation Agreement for Cuba
Vice President of the Council of State of Cuba
[q3xCOP]
Does the agreement explicitly reference the Code?
Technical Cooperation Agreement for Cuba
No
[q3xPAP]
Does the agreement reflect the code’s principles and practices?
Technical Cooperation Agreement for Cuba
Yes
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 Ministry of Health works closely with tertiary level institutions that educate health personnel and highlights the skill needs for the country. There is at least one formal Cabinet approved committee that has been established with the local university medical school, and the human resource sub-committee meets at least once per month to address needs and support systems to facilitate training and education.
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 Ministry of Health is in the process of implementing and updating where necessary its 10-year Manpower Plan. In addition to identifying human resource needs and training areas for the health for the health sector over the coming years, it also addresses strategies to improve efficiency, productivity and working conditions, as well as, training and education.
Other
[q4x3x]
4.3 Measures taken to address the geographical mal-distribution and retention of health workers*
No
[q4x4x]
4.4 Other relevant measures
Yes
[q4x4]
Please describe
One of the major initiatives to be undertaken is a full human resource audit of health workers. The work has already begun with nursing staff. The audit will facilitate greater alignment with the primary health care thrust of the Ministry of Health.
[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
Human resource policies on recruitment are utilized to guide international recruitment of staff.
Law/policy 2
The Regulatory Bodies for the various health professions have their guidelines to facilitate persons who were trained abroad but wish to practice in Trinidad and Tobago.
Law/policy 3
Only general labour laws exist, nothing specific to international recruitment, migration and integration of foreign trained health personnel.
[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:
Coordination with the Ministry of Foreign Affairs on bi-lateral and other international agreements related to health, including the recruitment of health workers; and the Ministry of National Security for the provision of work permits to internationally recruited health workers. Additionally, these health workers have to be registered with the respective regulatory board or council in order to practice locally. These bodies have their own guidelines for recognizing foreign qualifications and what is required by the individual to be licensed to practice in Trinidad and Tobago.
The Ministry of Health is beginning the process of working with stakeholders to capture data on in and out-flow of health workers.
[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.
[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
There is need for greater collaboration with the private health sector in the country to gain a better understanding of their recruitment practices, especially with regards to foreign health workers/emigrants.
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 regulatory bodies are the main authorities for the collection of such data, but this is not currently done on a consistent and easily retrievable manner.
[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 | 5205 | 4035 | 1156 | Medical Board of Trinidad and Tobago | 2021 | 1 | The nationality of 14 doctors is unknown from the database | |||
| Nurses | Nursing Council of Trinidad and Tobago | Have not been able to obtain data from the Nursing Council for several years | ||||||||
| Midwives | Nursing Council of Trinidad and Tobago | Have not been able to obtain data from the Nursing Council for several years | ||||||||
| Dentists | 475 | 457 | 15 | Dental Council of Trinidad and Tobago | 2021 | 1 | The country of birth for 3 dentists is unknown from the database | |||
| Pharmacists | 928 | Pharmacy Board of Trinidad and Tobago | 2018 | 2 | This is an approximate number as the Board is in the process of updating its information. The data is not disaggregated. |
[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:
[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
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 |
International Cooperation Desk, Ministry of Health | International Cooperation Desk, Ministry of Health | International Cooperation Desk, Ministry of Health | International Cooperation Desk, Ministry of Health | International Cooperation Desk, Ministry of Health | |
| 2020 | 0 | 11 | 0 | 0 | 0 | These figures represent the inflow of health personnel through the Technical Cooperation Agreement for Cuba only. |
| 2019 | 34 | 45 | 0 | 11 | 0 | These figures represent the inflow of health personnel through the Technical Cooperation Agreement for Cuba only |
[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 | |
|---|---|---|
| Ensuring implementation and compliance with the code | 1. Cross-sectional stakeholder involvement in developing plans needs to be undertaken and obtaining Cabinet approval for formalization and to have resources assigned for implementation and monitoring. 2. Availability of funding. | |
| Flights and border closure due to Covid restrictions (March 2020 to Aug 2021) | ||
[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’.