Monitoring and managing workforce mobility in Monaco

Background Due to Monaco’s small size, monitoring statistics related to health-care staff can be carried out easily and efficiently. The Directorate of Health and Social Action collects the data from the various health establishments and independent practitioners, the Monaco Statistics (IMSEE) compiles them and they are published in a number of media, such as the brochures, “Monaco in figures” and “Public policy barometers”, as well as on the IMSEE website (1). Recent advances in e-health (shared medical records and the interconnection of hospital, government and public insurance networks) have promoted the quality and availability of data. Current data show that the situation has been fairly stable in recent years in terms of the number of health professionals in practice. Furthermore, needs are covered for most specialities due to the contribution of foreign professionals and the return of most nationals to the country after graduation abroad. Policy on retention of health professionals For Monaco, encouraging the return of national graduates obliged to train abroad in the absence of a university health faculty in Monaco is an important issue and a range of measures have been taken to this end. Those wishing to work in private practice are given priority. The national Employment Office encourages applications from Monegasque nationals and presents them to employers as priority candidacies. Foreign nationals may practise if the numbers of Monegasque nationals are insufficient to cover the needs. The latter- mentioned benefit from assistance related to professional installation, access to housing and business stocks below current market prices, and exemption from social-security contributions linked to their practices for a period of 3 years. For foreign health personnel working in Monaco, working conditions, remuneration, promotion and social benefits are similar to those offered to national workers. They may also benefit from better working environments (such as, higher staff-to-patient ratio), as well as higher salaries, dedicated nurseries and better social security. These factors make it possible to attract and retain many foreign experts. Furthermore, physicians working in hospitals are also entitled to work in private practice 30% of the time. Monitoring and managing workforce mobility in Monaco WHO Global Code of Practice on International Recruitment of Health Personnel Monaco is aware of the WHO Global Code of Practice on International Recruitment of Health Personnel (the Code) (2) and actively applies it. Through the Directorate for International Cooperation, Monaco is very much involved in international cooperation with lower- to middle-income countries, providing technical and financial assistance to low- income countries (2). None of the current regulations on, or practices in, the international recruitment of health personnel conflict with the requirements of the Code (2). Given the specificities of the country (small size, lack of a university health faculty), all national health professionals are trained abroad. The mobility of health personnel due to the above-mentioned needs is of concern. Monaco recognizes university diplomas obtained in the European Union or the European Economic Area. There is a commission, comprising medical professors, lawyers and representatives of health authorities, which verifies degree equivalence and compliance with the national regulations. As mentioned above, foreign health personnel working in Monaco enjoy the same working conditions, remuneration, and criteria for promotion and social benefits as national workers. Data on monitoring and managing workforce mobility Monaco has fairly complete data on health personnel and their background (including nationality, age, sex, country of graduation, date of hiring in Monaco, internal mobility). Due to the small size of the country and its relatively low number of health workers, it is easier to obtain complete data in Monaco than in some larger countries. Data collection can be improved, however. Although they are available in the various health- care institutions, their transmission to the Directorate of Health and Social Action is neither automated nor regular. The development of e-health in the country should contribute to resolving this issue. © W H O Monitoring and managing workforce mobility in Monaco References 1. Monaco Statistics [website]. Monaco: Government of Monaco; 2020 (www.imsee.mc, accessed 17 February 2020)). 2. WHO Global Code of Practice on International Recruitment of Health Personnel. Geneva: WHO; 2018 (https://www.who.int/ hrh/migration/code/NRI2018FinalEN.pdf?ua=1, accessed 17 February 2020). 3. Coopération monégasque au développement [Monegasque development cooperation]. In: Gouvernement princier [website]. Monaco: Government of Monaco; 2020 (https://cooperation-monaco.gouv.mc/, accessed 17 February 2020). Initiatives Monaco is very active in international cooperation with low- income countries. A complete overview of action taken in this area is available on the Government’s website (3). Cross-country collaboration Regarding use of the Code (2), Monaco works actively with low-income countries on issues, such as malaria control and sickle cell anaemia, and has contributed to the establishment of 4 national reference centres (in Madagascar, Mali, Niger and Senegal). Monaco also helped create a specialized university degree in Bamako (Mali) and supports associations and research institutes in that country. The Government of Monaco, the Monegasque association, SHARE, the Foundation for Children, and various other associations and individuals collaborated on financing the construction of a cardiology intervention unit at the Mother and Child Hospital Le Luxembourg in Bamako (Mali). This unit carries out catheterization procedures to dilate or unclog arteries in the event of a cardiovascular attack. © World Health Organization 2020. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. WHO/EURO:2020-1314-41064-55748