Monitoring and managing workforce mobility in Slovenia

Background In Slovenia, the number of nursing staff increased from 16 083 in 2008 to 21 245 in 2018 (Table 1). In the same time frame, the number of doctors rose from 5015 to 6722 (Table 2). Despite the growing number of heath-care workers in the health and social-care system, representative chambers and associations are pointing out the influences of an ageing workforce, the lack of staff, departure from health professions and the migration of health-care resources to work abroad. Monitoring and managing workforce mobility in Slovenia Table 1. Number of nursing staff, by professional group, Slovenia, 2008 and 2018 Professional group Number in 2008 Number in 2018 Nurses (graduate) 4 054 7 194 Nurse assistants 12 092 14 051 Carers (including health workers) Data not systematically collecteda aAround 3000 health-care personnel are employed in the health and social- care sector. Source: National institute of Public Health (1). Table 2. Number of doctors, Slovenia, 2008 and 2018 Year Number of doctors 2008 5 015 2018 6 722 Source: National institute of Public Health (2). The outflow of health-care workers to other countries is not monitored. The Nurses and Midwives Association of Slovenia issues certificates of good standing, which are required by most employers abroad. However, since a request for such a certificate does not necessarily equate with the wish to work abroad, recording their issuance is not useful in terms of monitoring the exit of nursing staff from the country for this purpose. According to the Nursing and Midwives Association of Slovenia, the following numbers of certificates of good standing were issued in 2016–2019: • 158 in 2016 • 189 in 2017 • 218 in 2018 • 205 in 2019 (145 to nurse assistants and 60 to graduate nurses). The Medical Chamber of Slovenia does not have reliable data about the migration of doctors to work abroad. According to the Medical Chamber, the following numbers of certificates of good standing were issued in 2016–2019: • 236 in 2016 • 231 in 2017 • 287 in 2018 • 287 in 2019. Certificates are also issued for educational purposes, proof of professional status, etc. Statistics on these certificates are not kept. Lack of data and inefficient cooperation among the different stakeholders are the main barriers to monitoring and management of the workforce. Limited financial resources also place restrictions on what can be done. Policy on retention of health professionals At present, Slovenia does not have any policies on or systematic measures for retaining health workers. In 2019, the Ministry of Health set up working groups to revise staffing standards, based on how many health professionals were needed in the different working environments. In the same year, a publication on the professional competences and activities of nursing staff was issued. The Act on Amending the Health Services (2017) made it possible to recognize the input of nurse assistants who, for 12 years or more, had carried out activities requiring the competences of graduated nurses during 50% or more of their working time. Accordingly, nurse assistants who fulfil the competence requirements of the law can be employed under the same conditions as graduate nurses and thus receive equal pay for equal work. Remuneration for health workers was raised both in 2018 and 2019. In Slovenia, several measures have been introduced with the aim of reducing administrative burden in the health services, one of the latest being the electronic certificate of sick leave. It is expected that these measures will have a positive effect on the retention of health professionals. © W H O Monitoring and managing workforce mobility in Slovenia References1 1. Data portal [database]. Ljubljana: National Institute of Public Health; 2019 (https://podatki.nijz.si/pxweb/sl/NIJZ%20podatkovni%20portal?px_language=sl&px_ db=NIJZ+podatkovni+portal&rxid=4a4a219f-2528-4a69-ae61-310de076dbcd). 2. Zaposleni po poklicnih skupinah in statističnih regijah, Slovenija, letno [Persons in paid employment by occupation groups and statistical regions, Slovenia, annually]. In: Data portal [database]. Ljubljana: National Institute of Public Health; 2019. (https://podatki.nijz.si/Selection.aspx?px_path=NIJZ%20podatkovni%20 portal__5%20Viri%20v%20zdravstvu__1%20Izvajalci%20zdravstvene%20dejavnosti&px_tableid=BPI_TB01.px&px_language=sl&px_db=NIJZ%20 podatkovni%20portal&rxid=dcbf684b-39ab-4b23-a400-7abae81a028b). 3. 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). 4. Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005 on the recognition of professional qualifications. O.J.E.U. 2005, L 255:22–142 (https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=celex%3A32005L0036). 5. Directive 2013/55/EU of the European Parliament and of the Council of 20 November 2013 amending Directive 2005/36/EC on the recognition of professional qualifications and Regulation (EU) No 1024/2012 on administrative cooperation through the Internal Market Information System (“the IMI Regulation”). O.J.E.U. 2013, L 354:132–170 (https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=celex%3A32013L0055). 6. The law on employment, self-employment and work of foreigners (ZZSDT). In: PIS Legal Information System [website]. Ljubljana: The Government Office for Legislation; 2017 (http://pisrs.si/Pis.web/pregledPredpisa?id=ZAKO6655). 1 All URLs accessed 3 March 2010. WHO Global Code of Practice on International Recruitment of Health Personnel The Slovenian Ministry of Health is familiar with the WHO Global Code of Practice on International Recruitment of Health Personnel (the Code) (3). The authorities are aware of the impact of revised treatment methods and demographic change on health-care needs. The importance of collecting quality data is also recognized and Slovenia is preparing new legislation in this regard. Slovenia follows the principles of the Code (3), for example, in drafting policy documents, preparing national strategies, revising professional standards, and planning policy measures. The education of health professionals (graduate nurses, doctors, etc.) is in line with European Union Directives 2005/36/EU and 2013/55/EU (4,5). In Slovenia, the involvement of stakeholders (for example, health- and social- care providers, health-care professionals, various associations, chambers, users of services, and educators) in the process of preparing strategy papers, action plans and educational programmes, among others, is considered important. The Employment, Self-employment and Work of Foreigners Act (6) allows the employment of foreign workers if they fulfil certain conditions, such as, having the appropriate education and adequate knowledge of the Slovene language (equivalent to levels B2 or C1 of the Common European Framework for Languages). According to the Statistical office of the Republic of Slovenia, at the end of 2018, only 2.3 % of the health workforce, including health and non-health workers, were from outside Slovenia. Data on monitoring and managing health workforce mobility Data are available on: • number of health workers (profession, region, type of employer (primary sector, hospitals, providers of health-care services in nursing homes, etc.), gender, age, specialization, number of services provided, and private or public sector); • number of certificates of good standing issued; • number of licences to practice issued; • health professionals (including demographic data); • enrolment of health workers in educational programmes. With additional effort, it would also be possible to collect information on the departure of health professionals from the profession. Slovenia would find it useful to have data on: • departure of health workers to work abroad and from their professions • actual staff workload (mental and physical) • number of public-sector employees also working in the private sector. Cross-country collaboration Health-worker migration can reduce a country’s ability to provide safe, quality health services. For this reason, Slovenia is open to receiving information about good practice in other countries. Advice to other countries on monitoring and management of workforce mobility Slovenia would benefit from the following measures: • establishment of a system for monitoring the movement of health workers (departure from the profession or transfer abroad); • positive promotion of the health-care professions; • assessment of mental and physical workload and adaption of human resources to operational requirements; • development of quality management in health care (for example, through leadership training); • enhancement of the quality and safety of working conditions; • establishment of quality mentoring during schooling and at the start of the working career; • reduction in administrative burden; • introduction of compulsory training in human-resource management for managers working in the health-care system. © World Health Organization 2020. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. WHO/EURO:2020-1317-41067-55755