Monitoring and managing workforce mobility in Andorra

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Background

There is no shortage of health professionals in Andorra at present. Some specialties, such as geriatric physicians, nurses and nurse assistants specialized in care of the elderly are, however, difficult to find. Furthermore, it will soon be a challenge for Andorra to cover the needs for general practitioners since most are nearing retirement age. An assessment of real needs with respect to all categories of health professional and the development of a national plan for the recruitment of health professionals are called for.

Policy on retention of health professionals

In Andorra, the recruitment and retention of foreign health personnel are facilitated by the possibility of earning good salaries (due to low tax rates) in comparison to those in neighbouring countries. Andorra’s excellent health system is also an incentive in itself. There is a first-class education system with programmes in Andorran, French and Spanish, all of which are free of charge up to university level. After high school, students have the choice of entering universities in Andorra, France or Spain. Degrees attained in France or Spain are automatically recognized in Andorra. External factors also play a role in retaining health professionals in the country. Quality of life is high and people have the possibility of participating in an abundance of leisure activities and cultural events.

Furthermore, the natural landscape is beautiful and there is a high level of security.

Medical professionals of any kind who graduate in Andorra can return and work in the country after having been employed abroad. For degrees obtained abroad, there is a degree- validation mechanism in place. Those who graduate abroad require a residence and employment permit issued by the Immigration Department of the Ministry of Home Affairs. If they wish to enter into a working agreement covered by the Social Security Fund, there are other requirements to be met.

Monitoring and

managing workforce mobility in Andorra

WHO Global Code of Practice on International Recruitment of Health Personnel

Andorra is familiar with the WHO Global Code of Practice on International Recruitment of Health Personnel (the Code) (1) but does not apply it. Information about employment vacancies is usually also disseminated to medical colleges in France and Spain. Andorra has bilateral agreements with these countries, involving workers’ freedom of movement. At present, Andorra has no means of deterring health personnel living and working in Andorra from moving to other countries.

Data on monitoring and managing workforce mobility

In Andorra, information on monitoring and managing health workforce mobility is recorded in the National Registry of Health Professionals and Health Care Facilities (in tabular and graphic form). Data on all health professionals must be recorded in the Register. The challenge is to keep track of health-workforce movements in and outside the country.

To deal with this, the Ministry of Health has requested that health-care facilities and health workers communicate any such changes voluntarily.

With additional effort, it would be possible to obtain more data from the registries of health professionals and health-care facilities, which are updated on a weekly or monthly basis. The same applies to data on real current and future population health-care needs.

Andorra would like to have data illustrating the current and future needs of the health-care system in the light of the health-care needs of the population.

Initiatives

Andorra is working to update the National Register of Health Professionals.

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Monitoring and managing workforce mobility in Andorra

Cross-country collaboration

At present, Andorra has agreements with neighbouring countries on the provision of health services, which the current system cannot offer due to the small size of the country. For example, in 2019, a specialist in trauma surgery returned to a Catalan hospital (a previous employer) because the number of cases in Andorra was not enough to allow the maintenance of medical skills. The Andorran Health Care System and the Social Security Fund were able to enter into an agreement with the surgeon and the hospital in question on allowing the surgeon to return to Andorra twice a month to carry out non-urgent surgical interventions and check on patients.

There are many examples of this kind of collaboration between the health-care facilities and health workers in Andorra and neighbouring countries.

References

1. Managing health workforce migration - the Global Code of Practice. In: Health workforce [website]. Geneva: WHO; 2020 (https://www.who.int/hrh/migration/code/practice/en/, accessed 15 February 2020).

Advice to other countries on monitoring and management of workforce mobility

For optimal monitoring and management of workforce mobility, it is important to:

1. gain an understanding of the real needs of the country’s health workers;

2. develop a plan, based on real population needs;

3. develop clinical guidelines and protocols on efficient care (Andorra employs a large number of physiotherapists, which translates into a high volume of treatments, many of which are possibly unnecessary);

4. build a database on health professionals that is easy to update, taking care to involve end users in its development from the start;

5. establish a strong health-information system (following all the required steps).

WHO/EURO:2020-1309-41059-55739