The impact of international health worker migration and recruitment on health systems in source countries: Stakeholder perspectives from Colombia, Indonesia, and Jordan.

INTRODUCTION: To address domestic shortages, high-income countries are increasingly recruiting health workers from low- and middle-income countries. This practice is much debated. Proponents underline benefits of return migration and remittances. Critics point in particular to the risk of brain drain. Empirical evidence supporting either position is yet rare. This study contributes to filling this gap in knowledge by reporting high-level stakeholders' perspectives on health system impacts of international migration in general, and active recruitment of health workers in specific, in Colombia, Indonesia, and Jordan. METHOD: We used a multiple case study methodology, based on qualitative methods integrated with information available in the published literature. RESULTS: All respondents decried a lack of robust and detailed data as a serious challenge in ascertaining their perspectives on impacts of health worker migration. Stakeholders described current emigration levels as not substantially aggravating existing health workforce availability challenges. This is due to the fact that all three countries are faced with health worker unemployment grounded in unwillingness to work in rural areas and/or overproduction of certain cadres. Respondents, however, pleaded against targeting very experienced and specialised individuals. While observing little harm of health worker migration at present, stakeholders also noted few benefits such as brain gain, describing how various barriers to skill enhancement, return, and reintegration into the health system hamper in practice what may be possible in theory. CONCLUSION: Improved availability of data on health worker migration, including their potential return and reintegration into their country of origin's health system, is urgently necessary to understand and continuously monitor costs and benefits in dynamic national and international health labour markets. Our results imply that potential benefits of migration do not come into being automatically, but need in-country supportive policy and programming, such as favourable reintegration policies or programs targeting engagement of the diaspora.

The Multilevel Dimension of Rules-Based Disease Surveillance beyond the State.

The timely availability of accurate information on disease outbreaks with a potential for cross-border spread is a global public good, allowing for a more effective preparedness and response. An ensuing question for national public health authorities is how such information is attained when it is gathered in territories beyond their jurisdiction. International and regional law norms emerge as an option for providing such a global public good. Therefore, the current article examines existing legal frameworks for ad hoc disease surveillance beyond the state at the international and regional levels, namely: the World Health Organization's International Health Regulations of 2005; Regulation (EC) No. 851/2004 and Decision No. 1082/2013/EU in the European Union; the Statute of the Africa Centres for Disease Control and Prevention within the African Union; and the Protocol from the Economic Community of West African States, which created the West African Health Organisation. The comparison offers broader insights on the role of rules as a vehicle for securing prompt and reliable information of new and re-emerging communicable diseases, such as Covid-19.

Counter-contestation in global health governance: The WHO and its member states in emergency settings.

Is the contestation of international institutions always a one-sided process that originates from nation-states? In research to date, there has been little discussion of the extent to which international institutions endure, or even form counter-reactions to national contestation strategies. This study examines the reasons for which WHO engages in counter-contestation vis-à-vis its member states. The paper analyzes the evolution of global health governance by relating a principal-agent approach and contestation considerations. The WHO (agent) wants to reshape the principal-agent relationship with the member states (principals) in order to maximize its autonomy and eventually ensure stronger independence. The WHO pursues its efforts to become more independent on the basis of its own logic of action: To achieve this autonomy from member states, WHO on the one hand uses a strategy we call counter-contestation. On the other hand the member states want their interests to be represented by the WHO and ensure this goal through the logic of action known as contestation. Four international health crises are used to show how different the logics of action are and what effects they have. This study explores how and to what extent WHO actively engages in the political exchange of diplomatic moves and manoeuvres, creating contestation as a mutual game between states and International Organizations.