Abstract. This paper assesses what health workforce 'sustainability' might mean for Australia and New Zealand, given the policy direction set out in the World Health Organization draft code on international recruitment of health workers. The governments in both countries have in the past made policy statements about the desirability of health workforce 'self-sufficiency', but OECD data show that both have a high level of dependence on internationally recruited health professionals relative to most other OECD countries. The paper argues that if a target of 'self-sufficiency' or sustainability were to be based on meeting health workforce requirements from home based training, both Australia and New Zealand fall far short of this measure, and continue to be active recruiters. The paper stresses that there is no common agreed definition of what health workforce 'self-sufficiency', or 'sustainability' is in practice, and that without an agreed definition it will be difficult for policy-makers to move the debate on to reaching agreement and possibly setting measurable targets or timelines for achievement. The paper concludes that any policy decisions related to health workforce sustainability will also have to taken in the context of a wider community debate on what is required of a health system and how is it to be funded.
In May 2010 the World Health Organization(WHO)Global Code on international recruitment of health professionals was approved by the World Health Assembly.1,2 The Code sets out a range of practical and 'ethical' aspects of international recruitment of health workers, including an emphasis on health workforce 'sustainability' (Articles 3.6 and 5.4). This places an emphasis on developed, 'recruiter' countries making more effort to meet their health workforce requirements from their own resources. The aim is both to reduce the potential negative effect of outmigration of skilled health workers from the developing world, and to encourage improvements in the efficiency of workforce planning at country level. As WHO had noted 'The concept focuses on strengthening national health worker education. More broadly, achieving self-sufficiency or sustainability in the health workforce is about effective retention and deployment of available workers'.3
International migration of health workers is a complex issue, not fully captured by simplistic 'brain drain' arguments, as many health professionals move on their own initiative, for career development, security, or to find a job.2 Active international recruitment of health workers can be a relatively low cost compared to meeting the expense of domestic training in Australia or New Zealand, it can be a flexible quick fix to national health-worker shortages, and has been an attractive policy for governments in many countries. Australia and New Zealand have both been highly reliant on international recruitment to meet their health workforce requirements. Both countries cast their recruitment net widely, but have a pronounced effect on the Pacific islands.4 New Zealand is also a major 'source' country of international recruits - mainly for Australia - emphasising the point that some countries are both major 'sources' and 'destinations' for migrant health professionals.
The governments in both countries have also in the past made policy statements about the desirability of health workforce sustainability or self-sufficiency, a concept that could now take on a greater resonance and prominence with the adoption of the WHO Code. This paper assesses what health workforce 'sustainability' might mean for Australia andNewZealand, given the policy direction set out in the WHO Code, and within the broader context of health labour market dynamics and government policy in the two countries.
Australia and New Zealand have a high level of dependence on internationally recruited health professionals relative to most other OECD countries. …