6. Health Workforce Development and Health Systems Sustainability
6.1 The WHO estimates 18 million more health workers are needed by 2030 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
6.3 A government-to-government partnership agreement is established through a Memorandum of Understanding signed by the UK government and the partner country's government. These types of agreements can be of value to all countries supplying health and social care personnel, including those not on the list, because they enable recruitment of health and care staff to be taken forward in a managed and mutually beneficial way.
6.4 Each individual partnership agreement on health workforce will be different and dependent on the partner country's health workforce needs. Partnerships provide opportunities for collaboration and mutual benefit, whether through direct reimbursement, exchange of skills, knowledge and processes, support in the development of training and education or/and the circular migration of staff (whereby healthcare staff move to the UK for a period of time to work and expand their skills and knowledge that they can apply to the health system of their home country on their return).
6.5 Agreements should ensure that migration to the UK does not exacerbate any existing domestic workforce shortages in that country, and that work is linked to strategies that support development of the health workforce and strengthen the health system there.
6.6 For countries not on the list, there is still value - in particular to middle-income countries - in developing government to government agreements to set parameters implemented by the country of origin for how UK employers and agencies recruit. An example of this is the long-standing agreement between the Government of the Philippines and the UK, whereby large-scale nurse recruitment takes place, within agreed parameters as set by the Government of the Philippines. The UK Government will continue to engage proactively with countries that are interested in this approach.
In agreeing these new partnerships, the UK will engage with relevant stakeholders in partner countries, including but not limited to, Ministries of Health, professional organisations, and civil society. Partnership agreements will refer to the evidence base including health labour market analysis.
6.7 HEE works with a number of countries, responding to requests for support on workforce development, creating placements for professional groups, matching NHS workforce need with international training requirements and seeking out new bilateral relationships to strengthen workforce development in the NHS and outside the UK.
6.8 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.
6.9 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 1 and 2.
Case Study 1 - 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 allows doctors to experience training and development in the NHS for up to two years. Doctors return to their home countries where service users and colleagues benefit from the skills and experience they have obtained in the UK.
Case Study 2 - 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.