Boston, MA—A groundbreaking study led by the Harvard Pilgrim Health Care Institute has evaluated the impact of the World Health Organization’s 2010 Global Code of Practice, a voluntary framework aimed at improving the ethical recruitment of physicians from countries designated as having critical shortages. The research, published on February 6 in the JAMA Health Forum, reveals that while the Code initially curtailed physician migration from these countries, it failed to enhance their physician supply, underscoring the necessity for more comprehensive investments in global health systems.
Global healthcare workforce shortages are exacerbated when physicians from lower-to-middle income countries (LMICs) migrate to high-income countries (HICs). In response, WHO member states unanimously adopted the Code in 2010 to mitigate this outflow and encourage investments in the physician workforce of LMICs. This study is the first to assess whether the Code’s implementation has led to tangible changes in doctor emigration from these shortage countries and improved their physician supply.
Initial Impact and Long-term Outcomes
Utilizing data spanning from 2000 to 2021, researchers analyzed physician migration patterns to Organization for Economic Co-operation and Development (OECD) countries, which predominantly comprise HICs. The study compared 56 WHO-designated shortage countries with 116 non-shortage countries to evaluate the Code’s effectiveness.
Initially, the Code appeared promising. “We saw a clear short-term drop in physicians leaving shortage countries after the WHO Code, but the effect faded over time,” stated Hao Yu, senior author and associate professor of population medicine at Harvard Medical School.
On average, the Code was associated with approximately 2,600 fewer physicians leaving shortage countries each year, or roughly 17,000 physicians during the first five years of its implementation, marking a nearly 30% annual reduction in physician emigration.
However, the effects of the Code diminished over time, and physician density, defined as the number of physicians per 10,000 people, in shortage countries did not improve throughout the full study period.
Broader Implications and Recommendations
The study’s authors emphasize that beyond the Code, HICs and international organizations must assist LMICs in building robust support systems, enhancing working conditions, and providing career development opportunities. “Improving working conditions and training capacity is critical if countries want to sustainably invest in their physician workforce,” noted Tarun Ramesh, the study’s lead author and research fellow at the Harvard Pilgrim Health Care Institute. “Reducing migration alone won’t move the needle in the quest for global health equity.”
Broadly, the study supports the WHO Code as a policy tool for reducing physician recruitment by HICs from LMICs and promoting global health equity. The findings underscore the significant role played by the WHO in advancing global health development. Withdrawal from the WHO could have detrimental effects on global health progress. Instead, countries should strengthen their commitment to this global health governance body, including its initiatives to address physician shortages in LMICs.
Looking Forward: Strengthening Global Health Systems
As the world continues to grapple with healthcare workforce challenges, the study highlights the importance of sustained international cooperation and investment in health systems, particularly in LMICs. Policymakers are urged to consider multifaceted approaches that not only address migration but also enhance the overall healthcare infrastructure in these regions.
The Harvard Pilgrim Health Care Institute’s Department of Population Medicine remains at the forefront of research aimed at understanding and addressing global health challenges. Their work continues to inform policies that strive for equitable healthcare access worldwide.
