2012年-世界发展银行全球_Towards_a_Regional_Strategy_to_Strengthen_the_Nurse_Workforce_of_the_English-speaking_CARICOM___International_Legal_Instruments_Agreements_and_Obligations_42页_338kb

Summary of Report No. 62282-LAC: Towards a Regional Strategy to Strengthen the Nurse Workforce of the English-speaking CARICOM

Core Content

This report, prepared by the World Bank and the O'Neill Institute for National and Global Health Law at Georgetown University, examines the international legal instruments and agreements that could support a regional strategy to strengthen the nurse workforce in the English-Speaking Caribbean Community (ES CARICOM). It highlights the need for a coordinated regional approach to address nurse shortages, improve training capacities, and manage migration.

Main Views

1. Nurse Shortages and Migration in ES CARICOM

• Nurse supply is insufficient to meet the growing demand, exacerbated by an aging population and significant human capital losses.
• Migration of nurses to countries like the US, UK, and Canada is a major concern.
• Current policies have not been effective in addressing these challenges, necessitating a more comprehensive strategy.

2. Types of International Legal Instruments

• There are two categories: legally binding and non-legally binding.
• Legally binding instruments include bilateral treaties, multilateral treaties, and framework conventions.
• Non-legally binding instruments include resolutions, codes of practice, and memorandums of understanding (MoUs).

3. Legally Binding Instruments

• These include:
  • GATS (General Agreement on Trade in Services): Governs trade in services, including health services.
  • CSME (Caribbean Single Market Economy): Facilitates free movement of nurses within the region.
  • ILO Migration Conventions: Outline labor rights and protections for migrant workers.
• These instruments do not restrict the use of policy tools for migration management and do not address nurse training and workforce monitoring.

4. Non-Legally Binding Instruments

• These include:
  • Regional Plan for Action for Human Resources for Health (2007–2015): A regional framework for health workforce development.
  • Commonwealth Code of Practice (2003): Provides ethical guidelines for international recruitment of health workers.
  • Global Code of Practice (2010): Sets global standards for managing migration of health professionals.
• These instruments offer a supportive framework for regional action in all priority areas and are more flexible than legally binding ones.

5. Pros and Cons of Binding vs. Non-Binding Instruments

• Legally Binding:
  • Pros: Clear legal obligations, enforceable under international law.
  • Cons: Difficult to negotiate, costly to amend, may lead to watered-down commitments.
• Non-Legally Binding:
  • Pros: More flexible, quicker to negotiate, can be adjusted as needed.
  • Cons: Lack of enforceability, may lead to poor compliance unless supported by incentives and monitoring.

Key Information

6. Preferred Instrument for a Regional Strategy

• A multi-lateral Memorandum of Understanding (MoU) is recommended as the most suitable instrument.
• It allows for quick negotiation and flexibility, which is essential for addressing the dynamic nature of nurse migration.
• MoUs can be expanded into a formal pact as more countries join, enhancing regional coordination and visibility.

7. Policy Recommendations from Phase 1

• Strengthen Workforce Monitoring: Identify data needs and develop systems to track nurse education and migration.
• Improve and Expand Training Capacities: Promote alternative training arrangements, including online programs, temporary recruitment from destination countries, and use of the diaspora.
• Manage Migration: Implement bonding schemes, ease push factors, leverage expatriates as volunteers, and establish mutual recognition agreements and recruitment agreements.

8. Challenges and Considerations

• Evidence base for policy action is growing but remains weak.
• Cross-country coordination in training and migration management is lacking.
• A regional legal agreement should include actions to monitor the workforce and evaluate policy initiatives to ensure effectiveness.

9. Regional Collaboration

• ES CARICOM countries need to collaborate closely to manage migration and expand training capacities.
• Joint engagement with destination countries is essential to establish sustainable migration flows and investment in nurse training.

Conclusion

A regional strategy to strengthen the nurse workforce in ES CARICOM should be based on a non-legally binding multi-lateral MoU, which offers the necessary flexibility and speed for implementation. This approach aligns with the political commitment of regional stakeholders and can be supported by international expectations and incentives, particularly through monitoring and evaluation mechanisms.

Key Tables and Boxes

Table 1: Types of Legally-Binding International Agreements

Table 2: Types of Non-Legally Binding International Agreements

Box 1: Policy Recommendations from Phase 1 Study

• Workforce Monitoring: Identify and track nurse education and migration data.
• Training Capacities: Promote alternative training methods and expand slots through tripartite financing.
• Migration Management: Create barriers to migration, ease push factors, and establish recruitment and recognition agreements.

Box 2: Benefits of a Regional Approach to Manage Nurse Migration

• Facilitates coordinated action across ES CARICOM.
• Enhances visibility and legitimacy of the initiative.
• Encourages mutual benefit and sustainable migration flows.

Annexes and Support

• The study was supported by extensive consultations with regional stakeholders, including Ministers of Health, nursing bodies, and international organizations.
• The findings are based on a critical review of international legal agreements and expert opinions.
• The report emphasizes the importance of a flexible and collaborative approach to address the complex challenges of nurse migration and workforce development.