Monitoring and managing workforce mobility in Montenegro

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Background

In May 2019, the Ministry of Health of Montenegro set up a database on the mobility of physicians, containing information on specialization, age and length of practice, and country/

institution in which they intend to work. For the time being all medical doctors who leave their institutions to work in some other health facility or the private sector (internal mobility), or in another country (external mobility), have been monitored.

The Ministry of Health requires all health institutions to submit data on the mobility of physicians and such data are already available on 55 physicians for the period May to mid-November 2019. Monitoring will be soon be extended to include other areas of the health workforce.

For the time being, the monitoring of physician mobility is mainly administered by the Ministry of Health, but it is envisaged that the Institute of Public Health and the Medical Chamber of Montenegro will be involved in this work in the near future. The Institute of Public Health has the main responsibility for the collection of health-related data,

including those on human resources working in health facilities and the health sector overall. It is anticipated that the Institute will collaborate with the Medical Chamber, the Ministry of Health and the Health Insurance Fund on including additional mobility-related data in this register, which will make for a comprehensive, sustainable monitoring system. Aside from providing the above-mentioned administrative sources, the Institute of Public Health has conducted a survey among physicians on their intentions to leave the country within the concept of EU accession and open borders.

One of the main challenges for Montenegro in employing health workers whose experience was gained primarily outside the country is that they are not familiar with the local health system. In addition, since it can be difficult to obtain information about these health workers from other countries, it is not easy to monitor them. Collaboration on data exchange and developing IT links between the key institutions (Ministry of Health, Institute of Public Health and Medical Chamber), as well as complying with the WHO Global Code of Practice on International Recruitment of Health Personnel (the Code) (1), would enhance the monitoring and management of health- workforce mobility in Montenegro.

Monitoring and

managing workforce mobility in Montenegro

Policy on retention of health professionals

In Montenegro, existing policies aimed at retaining health workers in the country have led to: a reduction in unemployment among new graduates; a significant number of medical doctors with residency status (which enables professional advancement); various possibilities of continuing medical education (since 2016, part of the national budget has been earmarked to this end); and the procurement of up-to-date medical equipment. Policies that might be effective in retaining health professionals relate, among others, to:

improving working conditions; increasing salaries (from the beginning of 2020); and addressing housing concerns related to career placement.

WHO Global Code of Practice on International Recruitment of Health Personnel

Although Montenegro has not yet adopted the Code (1), the Ministry of Health considers that it could be very useful in ensuring the ethical recruitment of health workers from source countries. Moreover, it could contribute to the sustainability of Montenegro’s health system and the retention of health professionals.

Data on monitoring and managing workforce mobility

Monitoring the mobility of physicians in Montenegro has made it possible to gather data on this category of health professional (age, gender, qualifications, internal and external mobility) since May 2019. The collection of data on other categories is reliant on several preconditions, such as, the establishment of a nursing chamber.

Initiatives

The Ministry of Health, the Institute of Public Health and the Medical Chamber are currently working to consolidate the various databases into a centralized system, which should provide a better insight into health-workforce mobility.

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Monitoring and managing workforce mobility in Montenegro

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).

The following 3 initiatives are also planned.

1. An investigation into health-system needs, according to physician preferences.

Small-country systems adopt a personalized approach to physicians entering the system, which results in the best- performing students and physicians having more work choices. Taking physician preferences into account is one way of supporting and motivating this part of the health workforce.

2. Adoption of the Code (1)

The aim is to achieve a better balance in the health system and assure the retention and ethical recruitment of health workers from source countries.

3. The establishment of a nursing chamber (by the Ministry of Health)

This will allow the collection of data on nurse mobility and help complete those on overall health-workforce mobility.

Cross-country collaboration

Cross-country collaboration could be valuable for sharing experiences and creating a common pool of the most sought after and rarest medical specialities, which could be mobilized in small countries according to need.

Advice to other countries on monitoring and management of workforce mobility

Because of their size, small countries have the advantage of being able to monitor health-workforce mobility at the central level. The increasing mobility of the health workforce affects small countries more than it does larger ones: even the departure of only one leading physician from the health system can be felt. For this reason, collaboration among small countries, including the exchange of experiences and good practice, could contribute to finding ways of resolving this issue.

WHO/EURO:2020- 1316-41066-55754