5. WHO Health Workforce Support and Safeguard List 2020
5.1 The WHO Health Workforce Support and Safeguard List 2020 sets out the countries that should not be actively targeted for recruitment by health and social care organisations or recruitment agencies, unless there is a government-to-government agreement in place to allow managed recruitment undertaken strictly in compliance with the terms of that agreement.
5.2 The list is available at Annex A and replaces "the list of developing countries that should not be actively recruited from" referred to in the previous code of practice.
5.3 The list is based on the analysis set out in the "Report of the WHO Expert Advisory Group on the Relevance and Effectiveness of the WHO Global Code of Practice on the International Recruitment of Health Personnel" (a link can be found in the resources section at Annex C).
5.4 Recruitment activity from countries on the list will be monitored and where trends indicate an increased level of recruitment activity, DHSC will work with the country in question to understand the cause and whether it is related to active recruitment. 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.
Red, amber and green grading of countries
5.5 Whether active recruitment is permitted from a country is determined by its red, amber or green (RAG) grading as follows:
a) Red: No active recruitment permitted.
b) Amber: Managed recruitment permitted and undertaken strictly in compliance with the terms of the 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.
c) Green: Active recruitment permitted. In some countries, particularly middle income, this may be through a government to government agreement to set parameters for how UK agencies recruit.
Criteria for determining red countries
5.6 Red graded countries are countries which appear on the list. These countries have been determined by the WHO Expert Advisory Group using the following criteria:
a) UHC Service Coverage Index Score: This is the coverage index for essential health services and is presented on a scale of 0 to 100. 25% of countries considered by the WHO scored under the benchmark of 50 points.
b) Density of doctors, nurses and midwives per 10,000 population. The benchmark was set as the median workforce density for these three occupations, 46 doctors, nurses and midwives (healthcare workers) per 10,000 population.
5.7 Of the 180 WHO Member States included in the analysis, 43 countries scored less than 50 points on the UHC service coverage index and had a health workforce density below the median healthcare workers per 10,000 population.
Changes in a country's RAG grading – red to amber
5.8 A red country can become amber if a government-to-government partnership agreement is put in place to allow recruitment of health and social care personnel only on the terms of the agreement.
5.9 The government of any red graded country may approach DHSC, HEE or a system partner with a proposal for a workforce partnership. Proposals can also come from any relevant organisation, but should be agreed with the country concerned, via the FCDO office in post.
5.10 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 strictly in compliance with the terms of that agreement.
5.11 Active recruitment is permitted from green countries. Green countries are any country not included on the WHO Health Workforce Support and Safeguard List 2020.
5.12 Some green countries have a government to government agreement in place for international health and care workforce recruitment (Annex A). This may set parameters for how UK employers, contracting bodies and agencies recruit. Health and social care employers and recruitment agencies are encouraged to recruit on the terms of the government to government agreement.
5.13 The green country list will be updated on a regular basis, as new government to government agreements are signed. It is recommended employers, contracting bodies and recruitment agencies regularly check the list for updates and prior to embarking on any recruitment campaign. There are a small number of green listed 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 list country to amber, so that any international recruitment is managed strictly in compliance with the terms of a government-to-government agreement.
Review of the list
5.14 The methodology for the list will be reviewed every 3 years as part of the assessment of the WHO Code's relevance and effectiveness. The next review will follow the fifth round of national reporting in 2023–2024 and be presented to the Seventy-ninth World Health Assembly.