Realizing Rights: The WHO Global Code of Practice on the International Recruitment of Health Personnel Analysis with Nurses' Perspectives

The World Health Organization (WHO) acknowledged the scope of the issues that undermine the development of sustainable health workforces when it promulgated the WHO Global Code (Code) of Practice on the International Recruitment of Health Personnel in 2010. The Code supplies a template for policy solutions to the global health worker crisis. Its recommendations are based upon four principles: 1.) to recognize the right of all people to the highest attainable standard of health; 2.) to acknowledge the right of skilled health workers to legally migrate in search of life opportunity; 3.) to employ a global policy approach to address the root causes and effects of health personnel disparity, and; 4.) to give special consideration to the needs of developing health systems. These four references embody an international consensus framework for health workforce policy that links health personnel to realization of the right to health, and well resourced to developing health systems.;In this dissertation an analysis of the Code's literal and normative content is aligned with interview evidence obtained from internationally educated nurses (IENs) and health policy experts, to test its potential as a scaffold for nurse workforce policy that operationalizes its human rights framework. Guiding principles, offered by the Code, address the way society, governments and all stakeholders, should respond to the health system issues impacted by the unequally distributed shortage of skilled health workers. Its broad implementation direction does not, however, delineate the specific practices that respect, protect and fulfill the right to health. Nor does it supply a blueprint for policy that gives special consideration to the most needy. It acknowledges, but does not resolve, the policy tension of competing obligations to the freedom rights of nurses and the universal right to health.;The Code connects realization of the right to health, its central guiding principle, to the skilled health workforce. This supports the central argument of this thesis, that nurses are critical for fulfilling the right. Given this position, formal human rights governance obligations, directions and accountability mechanisms, derived from the International Covenant on Economic, Social and Cultural Rights (ICESCR) or domestic legislation apply to the responsibility to guarantee everyone access to nursing care.;The global nursing marketplace links wealthy and developing health systems. Vacancies in well resourced countries present opportunities that attract nurses, adding to the critical shortages seen in fragile systems and further threatening realization of the right to health. Health outcomes align with the concentration of health workers; invariably regions with fewer health workers manifest poorer health.;The Code echoes the ICESCR when it directs wealthy States to assist under resourced ones and to consider the effects of their health workforce policies on developing health systems. The right to health also imposes responsibilities toward the underserved. Although the Code explicitly cites the..."right to the highest attainable standard of...health", nothing in its text prescribes any compensatory remedy for right to health abuses that are exacerbated when nurses trained in poor countries deliver care in well resourced systems. Without correcting the long-standing wrongs that subsidize the nurse workforces of wealthy systems, at the expense of developing ones, it is unlikely that global solutions that realize the right to health for the underserved will be found. In addition to State duties, the Code directs that all stakeholders play a role in its implementation. Member States are left to, on their own or in collaboration, forge laws and develop policies that oversee the activities of stakeholders.;I propose a nurse workforce policy outline that uses the Code's guiding principles and objectives to operationalize human rights norms. The policy standards rest upon: 1) setting right to health as a core value: 2) accessing formal and informal accountability routes; 3.) using targeted incentives, specifically education and financial subsidy, to match the nurse workforce to health needs: and, 4.) sharing responsibility, research, resources, and best practices. Nurses and right to health are central to achieving the Code's purpose.