Monitoring the implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel: The Case of Indonesia

Authors
Ferry Efendi, Ching-Min Chen

Background
Indonesia has become one of the international nurse migration players supported the Code that was endorsed by World Health Assembly year 2010. In reference to the code, the Minister of Health (MoH) as designated national authority, issued the regulation on the management of Indonesian nurses’ migration [1]. This study aimed to monitor the implementation of the Code on state policy changing in facilitating nurse migration.
Methods
Qualitative and quantitative data were collected in order to understand the impact of the Code on Indonesian nurse migration. Triangulation approach was achieved through semi-structured interviews with key stakeholders, and records review of nurses’ migration in the last two years.
Results
Global Code of Practice contributed to shape the migration policy at the national level. This regulation provided a shift change of migration policy, which can be conducted by a country that had an agreement with Indonesia or a country that had a law on migrant protection. Acknowledging the importance of the Code, MoH translated the Code into Indonesian, and disseminate the material to multiple stakeholders. By the spirit of this Code, Indonesia received financial and technical cooperation agreement with Japan on the improvement of nursing capacity. The challenge faced by MoH was a need strong regulation which could accommodate the relevant players to coordinate on the national level, notably for MoH, National Board for The Placement and Protection of Indonesia Manpower, Ministry of Foreign Affair and private recruiters. Quantitative data showed that there were significant flows of nurse migration, especially on nurses’ movement before and after the code adopted. It was four folds increased on nurse migrate between 2010 (567 nurses) to 2012 (2512 nurses) compared to three years before the code adopted [2]. By this, Indonesia’s government should carefully assess the flow of migration as the country suffered of nurses’ shortages [3]. Lack of HRH information system and no integrated national HRH observatory hinder the policy maker to promote a strategic approach in nurse migration.
Conclusions
The Code has been utilized by Ministry of Health to manage the migration. This guideline at least giving direction that may be used where appropriate in the formulation and implementation of nurse migration. A stronger regulation which not only tied MoH, but also other stakeholder in health migrant placement needs to be established. Further, strengthening HRH information system and research on the impact of migration on Indonesia’s health system must be conducted soon.

References
1. MoH: Peraturan Menteri Kesehatan Republik Indonesia Nomor 47 Tahun 2012 Tentang Pendayagunaan Perawat Ke Luar Negeri [Minister of Health Decree of Republic Indonesia Number 27 Year 2012 About Utilization of Nurses to Foreign Country]. In. Jakarta: MoH; 2012.
2. Data Tenaga Kerja Indonesia [Data on Indonesian Migrant Workers] [www.bnp2tki.go.id]
3. MoH: Profil Kesehatan Indonesia 2012 [Indonesia Health Profile Year 2012]. In. Jakarta: Kemenkes; 2013.

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