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

6. Health Workforce Development and Health Systems Sustainability

6.1 The WHO estimates 15 million health workers shortage in 2020, projected to decline to 10 million by 2030^[1] in low- and lower-middle income countries to achieve UHC. The WHO Expert Advisory Group urges all WHO Member States to mobilise the necessary investments in the education, recruitment and retention of health workers to effectively deliver UHC.

6.2 This Code of Practice sets out the Scottish Government's approach to safeguarding against active recruitment from countries with the greatest UHC related health workforce vulnerability, as well as supporting health workforce development and health systems sustainability. There are different mechanisms through which this support is provided in low income and lower middle-income countries.

Government-to-government Partnership Agreements with the UK

6.3 A government-to-government agreement is established through a Memorandum of Understanding signed by the DHSC on behalf of the UK government and the partner country's government. These types of agreements enable recruitment of health and care staff to be taken forward in a managed and mutually beneficial way.

6.4 Each individual agreement on health workforce will depend on the partner country's health workforce needs and context.

6.5 Government-to-government agreements provide opportunities for collaboration and mutual benefit. This can take the form of direct reimbursement, exchange of skills, knowledge and processes, support and investment in the training and education and investment in jobs in the country of origin.

6.6 Government-to-government agreements should ensure that migration to the UK does not exacerbate domestic workforce shortages^[2] The agreement should seek to strengthen health workforce development in the country of origin.

6.7 A government-to-government agreement can allow managed recruitment in red list countries. This may be particularly beneficial where there are high rates of individuals making direct applications, giving the sending government greater control and oversight of migration. The agreement can include provisions to strengthen the health or care workforce in the country of origin, whether through education, investment in jobs or other forms of support.

6.8 In agreeing these government-to-government agreements, the UK will engage with relevant stakeholders in partner countries. Government-to-government agreements will be based on the latest evidence including health labour market analysis. The UK will notify WHO of partnership agreements through the WHO global code of practice monitoring processes to support good practice.

Educating, training and developing the health workforce

6.9 In Scotland, NHS Boards and NHS staff also organise and participate in a number of training and exchange programmes which support healthcare services both in Scotland and in partner countries.

6.10 Examples of educational programmes which bring doctors and nurses to the UK to work, often with a view to returning to their countries of origin with improved clinical skills are provided in case studies 2 and 3.

Case study 1: UK-Philippines Memorandum of Understanding

The UK and the Philippines have a long-established bilateral relationship on healthcare workforce recruitment. In October 2021 a new UK-Philippines MoU was signed to reaffirm the ongoing partnership. The MoU formalises the relationship at Government level for Filipino nurses to work in the NHS, ensuring they are recruited ethically, supported to reach their full potential and that their mental and physical wellbeing is protected. The MoU also allows recruitment to the UK to be managed, minimising risks to the Philippine's health system.

Case Study 2 - Medical Training Initiative

The Medical Training Initiative is a successful programme aiming to improve the skills of the medical workforce in low- and middle- income countries. Funded by HEE and sponsored by the Academy of Medical Royal Colleges it provides 1500 places a year prioritised for doctors from low and lower middle-income countries to experience training and development in the NHS for up to two years. Doctors should return to their home countries where service users and colleagues benefit from the skills and experience they have obtained in the UK.

Case Study 3 - The Livingstone Fellowship

The aim of the Livingstone Fellowship is to enable doctors from Zambia and Malawi to come to Scotland for specialist medical training through NHS Scotland. The grant supports capacity strengthening of the medical profession in Zambia and Malawi and contributes to the Sustainable Development Goals of quality education by providing a means to specialist medical training and to the goal of good health and wellbeing by developing, recruiting and training health workers from Zambia and Malawi.

UK's Official Development Assistance for human resources for health

6.11 In eligible countries, the UK provides Official Development Assistance (ODA) to reduce poverty, tackle instability and create prosperity in developing countries. UK ODA investments in health systems, support low and lower-middle income countries to make progress towards UHC and wider health related sustainable development goals. This includes support for the development of the health workforce and support to the implementation of national health workforce strategies.

6.12 Channels of support include bilateral health programmes which directly support national governments or civil society partners with financing or technical collaboration in response to national health workforce challenges. This includes health workforce education and training, curriculum development, continuing professional development, qualification development, national workforce policy and/or strengthening related ministry of health policy and planning functions such as public financial management.

6.13 Human resources support is also provided through centrally managed, multi country programmes and through multilateral institutions such as the Global Fund, Gavi, the Vaccine Alliance, Global Financing Facility, World Bank, WHO and other UN agencies.

6.14 ODA-funded research programmes build understanding on how to invest in sustainable and resilient health workforces in different settings.