Monitoring and managing workforce mobility in San Marino

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Background

San Marino has information on all professional health workers.

At present, the country faces the challenge of finding medical doctors willing to work in San Marino to replace retiree physicians. The replacement of nurses is also an emerging problem. The development of a structured digital platform is currently underway and should provide continuous information about the health workforce.

Other challenges for San Marino relate to planning the health workforce (for example, understanding numbers, specialization, workforce age). There is a problem in securing enough university training spots for San Marino’s citizens in other countries. High-school graduates in San Marino wishing to enter faculties of medicine and surgery can apply to the many Italian universities that reserve a fixed number of places for foreign students.

Policy on retention of health professionals

San Marino is trying to gain an understanding of why medical doctors are leaving the country (which may also be the case for nurses in the near future) and to find ways of averting this situation. Establishing professional and economic benefits for health professionals (permanent contracts, higher salaries) could help. Since the small size of the population means that the number of clinical cases is limited, it is important that health professionals in San Marino can take advantage of continuing-education opportunities in larger hospitals outside the country to remain competitive. In addition, digital networking among San Marino’s health professionals and at the community level, as well as an exchange of information with other countries, could contribute to resolving retention issues in San Marino.

Setting up agreements between the University of San Marino and large hospitals outside the country, such as, the Gemelli University Policlinic in Rome and the University of Modena and Reggio Emilia, Italy, could also help retain health professionals in San Marino.

Monitoring and

managing workforce mobility in San Marino

WHO Global Code of Practice on International Recruitment of Health Personnel

San Marino is aware of the importance of the WHO Global Code of Practice on International Recruitment of Health Personnel (1), but it is not currently being implemented. To do so would require increasing the number of personnel in the country’s Human Resources Department.

Initiatives

In November 2018, San Marino introduced a new law relating to medical doctors. In brief, it aims to:

• attract the best professionals (both in San Marino or from other countries) to work with the Social Security Institute;

• encourage internal mobility between different roles and functions to make the best use of skills available;

• enhance individual resources through continuous learning and knowledge development;

• promote the increase of skills to ensure the safety and quality of the medical services provided;

• motivate staff, according to their expectations (for example, by recognizing performance);

• achieve equity in remuneration, according to the criteria of meritocracy;

• ensure maximum clarity and transparency in the evaluation of professional and managerial skills and the growth potential of individuals;

• ensure the protection and safety of all health workers.

Data on monitoring and managing workforce mobility

Although San Marino has data on health workers (age, numbers, postgraduate training received, and salary), not all of them have been computerized. It would also be possible to collect data on the competences and skills of health professionals working in clinical settings, including links to activities being carried out. Data on the specific skills and competences of all health workers would be desirable.

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Monitoring and managing workforce mobility in San Marino

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).

Cross-country collaboration

Due to scarce human resources, collaboration with other countries is a challenge but, as even a few extra medical doctors can make the difference in a small country, San Marino recognizes the need to become more appealing to foreign health workers. Periodically, newly qualified or specialized doctors from the Gemelli University Polyclinic in Rome and the University of Modena and Reggio Emilia spend time working in the intensive care and internal medicine units of San Marino Hospital.

San Marino would like to reinforce networking with Italian and other universities regarding health professionals.

Advice to other countries on monitoring and management of workforce mobility

Digital platforms can help improve the monitoring and management of workforce mobility, making it possible to collect data on the training pathways that each health facility or health unit has to offer (courses available, requirements for entry, duration of internships). Strengthening the health-administration workforce would also lead to more efficiency and less bureaucracy on the ground. San Marino has agreements with Italian hospitals, which provide the opportunity to exchange services and medical doctors. In the future, San Marino would like to enhance these measures in a systematic way by developing structured pathways and a clinical network and setting up agreements on the provision of second opinions, all of which could be implemented through a digital platform.

San Marino is also working on institutional accreditation, which is a useful tool for improving the quality and safety of services and promoting more efficiency and effectiveness. The aim would be international certification or recognition, including that of the European Union (EU). In fact, San Marino, together with Andorra and Monaco, is trying to set up an agreement with the EU, which would facilitate collaboration with Italy and other countries, or private companies, on increasing the number of cases treated in San Marino hospitals. International certification or accreditation would render San Marino more attractive to foreign health professionals or other institutions.

San Marino would suggest creating a network on human resources for health in small countries that includes larger countries. This would facilitate finding ways of resolving problems arising in small countries due to limited numbers of clinical cases and the resulting departure of health professionals to other countries to maintain their competences.

WHO/EURO:2020-1315-41065-55751