International recruitment of health and social care personnel: code of practice - March 2023 (revised)

5. WHO Health Workforce Support and Safeguards List 2023

5.1 The country red list in Annex A is drawn from the WHO Health and Workforce Support and Safeguards List 2023. These countries face the most pressing health workforce challenges related to universal health coverage (UHC). Country identification follows the methodology contained in the 10-year review of relevance and effectiveness of the WHO Global Code of Practice on the International Recruitment of Health Personnel (A73/9). Consistent with the WHO global code of practice principles and articles and as explicitly called for by the WHO global code of practice 10-year review, the listed countries should be:

• prioritised for health personnel development and health system related support
• provided with safeguards that discourage active international recruitment of health personnel

5.2 Countries on the list should not be actively targeted for recruitment by health and social care employers, organisations recruitment organisations, agencies, collaborations or contracting bodies unless there is a government-to-government agreement in place to allow managed recruitment undertaken strictly in compliance with the terms of that agreement.

5.3 Countries on the list are graded red in the code. If a government-to-government agreement is put in place between a partner country, which restricts recruiting organisations to the terms of the agreement, the country is added to the amber list. If a country is not on the red or amber list, then it is green.

5.4 Green graded countries with government-to-government agreements in place are listed separately in Annex A Green countries are not published in the Code of Practice unless there is a government-to-government agreement in place for international health and social care workforce recruitment.

5.5 The agreement may set parameters, implemented by the country of origin, for how UK employers, contracting bodies and agencies recruit. Green countries with government-to-government agreements in place are listed separately in Annex B below.

5.6 The red and amber country list does not prevent individual health and social care personnel from resident in countries on the list making a direct application to health and social care employers for employment in the UK, of their own accord and without being targeted by a third party, such as a recruitment organisation, agency or recruitment collaboration.

5.7 Workforce flows from countries on the red and amber list will be monitored and where trends indicate an increased level of recruitment activity, DHSC will work in partnership with the FCDO to understand the cause(s) and impact of this activity and consider taking appropriate actions to provide health system and health workforce related support.

5.8 The informal and formal escalation stages of investigation followed when it transpires that recruitment activity contravenes the code of practice is set out at Annex B.

5.9 The country list replaces the list of developing countries that should not be actively recruited from referred to in the previous (pre-2021) code of practice.

Red, amber and green grading of countries

5.10 Whether active recruitment is permitted from a country is determined by its red, amber or green grading as follows:

a) Red: No active recruitment permitted. Red countries are list in Annex A.

b) Amber: Managed recruitment permitted and undertaken strictly in compliance with the terms of the relevant government-to-government agreement approved by the Cross Whitehall International Recruitment for Health Steering Group. Active recruitment outside of the government to government agreement is not permitted. Amber countries are listed in Annex A.

c) Green: Active recruitment permitted. The UK government has several government-to-government agreements with green graded countries to set parameters for how UK employers, recruitment organisations , agencies, collaborations and contracting bodies recruit. Organisations are encouraged to recruit on the terms of the government-to-government agreement. Green graded countries that have government-to-government agreements with the UK are listing in Annex A.

Criteria for determining red list countries

5.11 In 2021, The WHO Secretariat produced the WHO Health Workforce Support and Safeguard list which comprises of 55 countries. The countries listed have a UHC service coverage index that is lower than 55 and a density of doctors, nurses and midwives that is below the global median (49 per 10,000 population). The WHO Health Workforce Support and Safeguard List is due to be reviewed in every three years (next update is expected to be published in 2026).

Review of the List

5.12 The WHO Health Workforce Support and Safeguards List will be updated alongside the regular progress reports to the World Health Assembly on WHO Global Code of Practice implementation.

5.13 The code of practice red and amber country list may be updated on an ad hoc basis – for example, in response to new government-to-government agreements being signed. All agreements will take WHO guidance on the development of bilateral agreements into account.

Changes in a country's RAG grading – red or green to amber

5.14 A red country can become amber if a government-to-government agreement is put in place to allow recruitment of health and social care personnel.

5.15 The government of any red graded country may approach DHSC, FCDO Health Education England (HEE) or another system partner with a proposal for a workforce partnership. All agreements are negotiated by the DHSC on behalf of the UK Government. It is not appropriate for recruitment organisations agencies and collaborations to be involved in any part of this process.

5.16 If the agreement is approved and implemented, the country will remain on the list as amber and managed recruitment of health and social care personnel is undertaken in compliance with the terms of that agreement.

5.17 Active recruitment is permitted from green countries. Green countries are any country not included on the WHO Health Workforce Support and Safeguard List 2020.

5.18 There are a small number of green graded countries where an increase in international recruitment may exacerbate existing health and social care workforce shortages. Where this is the case, the same process outlined above can be followed to change the grading of a green country to amber. This means , any international recruitment to the UK is managed strictly in compliance with the terms of a the government-to-government government agreement.

Review of the list

5.19 The WHO Health Workforce Support and Safeguard list will be updated alongside scheduled progress reports on WHO Global Code of practice implementation and reported to the World Health Assembly every 3 years.

5.20 The UK code of practice country list may be updated on an ad hoc basis, for example, in response to new government-to-government agreements being signed. All agreements will take WHO guidance on the development of bilateral agreements into account.