National Reporting Instrument 2021

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Background

Hide [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/).
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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/
I have read and understood the WHO policy on the use and sharing of data collected by WHO in Member States outside the context of public health emergencies
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Designated National Authority Contact Details

Hide [q01b] Contact information:
Country
Hungary
Full name of institution:
Hanna
Name of designated national authority:
National Directorate General for Hospitals
Title of designated national authority:
central office
Telephone number: (E.g. +41227911530 .)
+36-1-919-0343, +36-1-338-4891
Email: (Please enter one email address only.)
pava.hanna@okfo.gov.hu,hrhinfo@who.int
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Implementation of the Code

Hide [q1] 1. Has your country taken steps to implement the Code?
Yes
Hide [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
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Action 1
Hungary is committed to strengthen data and information exchange on the HRH-related knowledge and to facilitate policy dialogues across different types of stakeholders at international, national and sub-national level. At international level, Semmelweis University organized discussions at the SEPEN workshop in 2019, dedicated to health workforce mobility (http://healthworkforce.eu/technical_report/workshop-3-videos-and-presentations/ ).
Action 2
Information on the CoP, including its significance, potential use, and lessons on implementation so far is also shared with national and international audience alike at the undergraduate, BSc, MSc and postgraduate CPD training programmes, scientific conferences, and events that Semmelweis University as WHO Collaborating Center runs and/or participates (see for example the L-ead Summer School Programme: https://emk.semmelweis.hu/eithealth/).
Action 3
Hide [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.
No
Hide [q1x3x] 1.3 Records are maintained on all recruiters authorized by competent authorities to operate within their jurisdiction.
No
Hide [q1x4x] 1.4 Good practices, as called for by the Code, are encouraged and promoted among recruitment agencies.
No
Hide [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
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Measure 1
In the frames of the SEPEN Joint Tender, Semmelweis University organized several events dedicated to health professionals’ mobility and migration, for example a workshop in 2019 that gathered experts from all over Europe, or some webinars that focused also on the mobility and migration topics. See further details: http://healthworkforce.eu/findings/
Measure 2
Semmelweis University, as designated WHO CC joined the consortium to prepare the Human Resources for Health leadership and Management course (RFP-2018/HIS/HWF/HPS/004). The work on the prototype curriculum for a Master’s Programme on HRH Leadership and management were coordinated by the Hungarian team, and Semmelweis contributed to the work and all materials for the short training programmes on HRH Leadership and management.
Measure 3
Hide [q1x6x] 1.6 Other steps:
No
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Partnerships, Technical Collaboration and Financial Support 1/2

Hide [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:
Hide [q2x1oth] 2.1.5 Other areas of support:
Support Area 1
Technical support for developing health personnel was enabled in the framework of the EU tender entitled “Support for the health workforce planning and forecasting expert network”, where Semmelweis University, Hungary acted as consortium leader and lead the activities of the international network. In this partnership, we assured opportunities for professional consultancy and policy dialogues with the aims of arranging knowledge transfer, sharing information, building professional networks meanwhile also emphasizing the important linkage between the results and the evidence-based and informed health policy interventions. Targeted country level support and consultation were provided for Estonia, Lithuania and Latvia during the SEPEN Joint Tender in order to develop their national health workforce planning systems.
Support Area 2
Semmelweis University WHO Collaborating Centre on HRH Development is committed to represent the professional program of the WHO in the European Region and beyond, as well as supporting the professional research and educational tasks.
Support Area 3
Hide [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:
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Partnerships, Technical Collaboration and Financial Support 2/2

Hide [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
Hide [q3xTitle] Title of Agreement
Title Web-link to agreement Upload the full text of the agreement
Agreement 1 COOPERATION IN GRADUAL AND POSTGRAUDAL PATHOLOGY TRAINING PROGRAMS at SEMMELWEIS UNIVERSITY and KAROLINSKA INSTITUTET
Agreement 2
Agreement 3
Agreement 4
Agreement 5
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Hide [q3xTOA] If you cannot share the full text of the agreement please fill :
Type of Agreement Coverage
COOPERATION IN GRADUAL AND POSTGRAUDAL PATHOLOGY TRAINING PROGRAMS at SEMMELWEIS UNIVERSITY and KAROLINSKA INSTITUTET (SQ001) Bilateral (A1) National (A1)
(SQ002)
(SQ003)
(SQ004)
(SQ005)
Hide [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):
COOPERATION IN GRADUAL AND POSTGRAUDAL PATHOLOGY TRAINING PROGRAMS at SEMMELWEIS UNIVERSITY and KAROLINSKA INSTITUTET 1 1 1
Hide [q3xCHP] Categories of Health Personnel (check all that apply)
Doctors Nurses Midwives Dentists Pharmacists Other (include details as necessary) :
COOPERATION IN GRADUAL AND POSTGRAUDAL PATHOLOGY TRAINING PROGRAMS at SEMMELWEIS UNIVERSITY and KAROLINSKA INSTITUTET 1
Hide [q3xVP] Validity period
From: To:
COOPERATION IN GRADUAL AND POSTGRAUDAL PATHOLOGY TRAINING PROGRAMS at SEMMELWEIS UNIVERSITY and KAROLINSKA INSTITUTET (SQ001) 2012 (2012) 2021 (A30)
(SQ002)
(SQ003)
(SQ004)
(SQ005)
Hide [q3xCN] Countries that are involved
COOPERATION IN GRADUAL AND POSTGRAUDAL PATHOLOGY TRAINING PROGRAMS at SEMMELWEIS UNIVERSITY and KAROLINSKA INSTITUTET
Hungary, Sweden
Hide [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:
COOPERATION IN GRADUAL AND POSTGRAUDAL PATHOLOGY TRAINING PROGRAMS at SEMMELWEIS UNIVERSITY and KAROLINSKA INSTITUTET 1
Hide [q3xSYCOth] Signatory of the agreement from your country (Please specify:)
COOPERATION IN GRADUAL AND POSTGRAUDAL PATHOLOGY TRAINING PROGRAMS at SEMMELWEIS UNIVERSITY and KAROLINSKA INSTITUTET
Semmelweis University
Hide [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:
COOPERATION IN GRADUAL AND POSTGRAUDAL PATHOLOGY TRAINING PROGRAMS at SEMMELWEIS UNIVERSITY and KAROLINSKA INSTITUTET 1
Hide [q3xSPCOth] Signatory of the agreement from the partner country (ies) (Please specify:)
COOPERATION IN GRADUAL AND POSTGRAUDAL PATHOLOGY TRAINING PROGRAMS at SEMMELWEIS UNIVERSITY and KAROLINSKA INSTITUTET
Karolinska Institutet
Hide [q3xCOP] Does the agreement explicitly reference the Code?
COOPERATION IN GRADUAL AND POSTGRAUDAL PATHOLOGY TRAINING PROGRAMS at SEMMELWEIS UNIVERSITY and KAROLINSKA INSTITUTET
No
Hide [q3xPAP] Does the agreement reflect the code’s principles and practices?
COOPERATION IN GRADUAL AND POSTGRAUDAL PATHOLOGY TRAINING PROGRAMS at SEMMELWEIS UNIVERSITY and KAROLINSKA INSTITUTET
Yes
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Health Workforce Development and Health System Sustainability

Hide [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
Hide [q4x1x] 4.1 Measures taken to educate the health workforce
Yes
Hide [q4x1]
4.1.1 Manage production
4.1.2 Improve quality of education
4.1.3 Strengthen regulation
4.4 Others
Hide [q4x2x] 4.2 Measures taken to ensure the sustainability* of the health workforce
Yes
Hide [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
Different scholarship programmes for resident doctors (from 2011) and nurses (from 2017). The essence of these programmes is that the doctors or nurses participating in the program should work in the Hungarian public healthcare sector after the successful completion of the training as long as the benefit was granted. New regulation on the legal status of the health personnel in the public healthcare: In 2020 the Act on the legal relationship of the health service was approved, ensuring a major wage increase for physicians in the public healthcare sector from 2021. The new law grants a 120% salary increase to physicians in Hungary in three steps, reaching its maximum in January 2023.
Other
Hide [q4x3x] 4.3 Measures taken to address the geographical mal-distribution and retention of health workers*
Yes
Hide [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)
4.3.3 Incentives (Financial and non-financial)
From 2015: Geographically different scholarship amount for certain professions (where there is a shortage in the given profession based on the hospital needs).
4.3.4 Support (Decent and safe living and working conditions; career advancement opportunities; social recognition measures; others)
Hide [q4x4x] 4.4 Other relevant measures
Yes
Hide [q4x4] Please describe
Financial measures to retain the health workforce Salary increasement measures for the health professionals working in the public sector. (In Hungary 95% of the health professionals employed in this sector). After the salary increasement measures has been introduced between 2012 and 2015, another four-year long salary increasement programme started in 2016. As of the 1st of September 2016 – as the first part of this programme – the salary was increased in all health professional categories. In case of specialist doctors and allied health professionals the basic wage and the related mobile elements were increased by an average of 27%. In 2017 the average salary increasement was 23.5% for doctors and 12% for the allied health professionals, whose salary has increased by an additional 8% in 2018. The salary increasement for allied health professionals continues: in 2018 another four-year long programme was approved. By 1 November 2020 the basic wage and the related mobile elements increased by an average 42% compared to the year of 2018.
Hide [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
Hide [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
Hide [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
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Responsibilities, Rights and Recruitment Practices

Hide [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:
Hide [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.
Additional regulations ensuring the fair employment of foreign trained health personnel: - System of personnel conditions in the Section 110 of the Act CLIV of 1997 on Health, - EU blue card - Salary regulation in the public healthcare sector.
Hide [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
.
Measure 2
Measure 3
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Data on International Health Personnel Recruitment & Migration

Hide [iq11] Improving the availability and international comparability of data is essential to understanding and addressing the global dynamic of health worker migration.
Hide [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
Hide [q11x1] Please describe
In accordance with the Hungarian Act on Health, all persons possessing healthcare qualifications obtained at an accredited educational institution within Hungary, or obtained in another country and recognised or nostrificated in Hungary, shall be entered in the Basic Registry (a public register) after procurement of the degree or certificate.
Hide [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.
Hide [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:
Option A: Completion of the table below
Hide [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 31033 28486 2547 0 26564 4469 Operational Registry 2020 1 .
Nurses 65642 64586 1056 0 62562 3080 Operational Registry 2020 1 .
Midwives 3594 3537 57 0 3394 200 Operastional Registry 2020 1 .
Dentists 6539 5877 662 0 5159 1380 Operational Registry 2020 1 .
Pharmacists 7737 7444 293 0 6969 768 Operational Registry 2020 1 .
Hide [q12x1x3] Upload any format of documentation that provides such information (e.g. pdf, excel, word).
Hide [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:
Hide [q13x2x3] Upload any format of documentation that provides such information (e.g. pdf, excel, word).
Please upload file
Top 10 countries of training for foreign trained-health personnel_2020_Hungary
No comment
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COVID-19 and Health personnel mobility

Hide [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
In addition to the general travel restrictions, a ban on termination of employment in the public healthcare sector was introduced in November 2020, in order to retain the health workforce during the public health emergency caused by the COVID-19 pandemic.
13.4 Others
Hide [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
Hide [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
Basic Register (public healthcare qualifications' register) Basic Register (public healthcare qualifications' register) Basic Register (public healthcare qualifications' register) Basic Register (public healthcare qualifications' register) Basic Register (public healthcare qualifications' register) The mechanism used is not COVID-specific, the number of foreign-trained healthcare personnel with recognised healthcare qualifications is considered as an indicator of the inflow of the health personnel in general.
2020 92 71 35 22 1
2019 123 46 57 60 0
Hide [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
Register for certificates issued for the recognition of healthcare qualifications abroad. Register for certificates issued for the recognition of healthcare qualifications abroad. Register for certificates issued for the recognition of healthcare qualifications abroad. Register for certificates issued for the recognition of healthcare qualifications abroad. Register for certificates issued for the recognition of healthcare qualifications abroad. The mechanism used is not COVID-specific, the number of healthcare personnel applied for certificates for the recognition of the healthcare qualification abroad (e.g. certificate of good standing) is considered as the indicator of the intention to work abroad only, therefore it has limited applicability to indicate the outflow.
2020 680 216 174 46 34
2019 718 238 197 54 22
Hide [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)
1st Challenge
2nd Challenge
3rd Challenge
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Constraints, Solutions, and Complementary Comments

Hide [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 automatic data exchange of MS Facilitating data exchange
Hide [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:
Hide [q18] 18. Submit any other complementary comments or material you may wish to provide regarding the international recruitment and migration of health personnel, as related to implementation of the Code.
Semmelweis University significantly contributed to the international data and information collection regarding HRH data and policies. A mapping study was published abut health workforce planning and policies in the EU Member States: http://healthworkforce.eu/countrysheets/
Hide [q18x1] Please upload any supporting files
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Thank You

Hide [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’.