PAK ImmigrationReport

WHO Global Code of Practice on International Recruitment of Health Personnel Implementation Strategy Report 2011 Pakistan

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IMPLEMENTATION STRATEGY REPORT 2011

WHO Global Code of Practice on International Recruitment of Health Personnel

PAKISTAN


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TABLE OF CONTENTS Foreword.......................................................................................................................................................................................... 5 INTRODUCTION ............................................................................................................................................................................. 6 WHO Global Code of Practice Basic Concept .................................................................................................................... 6 Overseas Migration of Healthcare Personnel ...................................................................................................................... 6 INTERNATIONAL PERSPECTIVE .................................................................................................................................................. 6 LOCAL CONTEXT ........................................................................................................................................................................... 7 Bureau of Emigration & Overseas Employment ............................................................................................................ 8 Migration Trends ...................................................................................................................................................................... 8 Emigration Statistics................................................................................................................................................................ 9 Foreign Remittances ................................................................................................................................................................. 10 Minimum Data Sets (MDS) ...................................................................................................................................................... 11 WHO GLOBAL CODE OF PRACTICE WHA63.16 ............................................................................................................ 11 An Overview ................................................................................................................................................................................. 11 OBJECTIVES OF THE WHO GLOBAL CODE OF PRACTICE ................................................................................................... 12 NATURE AND SCOPE OF THE WHO GLOBAL CODE OF PRACTICE ..................................................................................... 12 GUIDING PRINCIPLES OF THE WHO GLOBAL CODE OF PRACTICE ................................................................................... 12 RESPONSIBILITIES, RIGHTS AND RECRUITMENT PRACTICES AS PER THE WHO GLOBAL CODE OF PRACTICE ........ 13 HEALTH WORKFORCE DEVELOPMENT AND HEALTH SYSTEMS SUSTAINABILITY .......................................................... 14 DATA GATHERING AND RESEARCH ........................................................................................................................................ 15 INFORMATION EXCHANGE ....................................................................................................................................................... 16 IMPLEMENTATION OF THE CODE ............................................................................................................................................ 17 MONITORING AND INSTITUTIONAL ARRANGEMENTS ......................................................................................................... 17 PARTNERSHIPS, TECHNICAL COLLABORATION AND FINANCIAL SUPPORT...................................................................... 18 Support Requested from the Director-General ................................................................................................................ 18 HEALTHCARE IN PAKISTAN .................................................................................................................................................. 19 An Overview ................................................................................................................................................................................. 19 HISTORICAL PERSPECTIVE....................................................................................................................................................... 19 EVOLVING STRUCTURE OF HEALTH & THE PRESENT SCENARIO ...................................................................................... 19 HEALTH INDICATORS ................................................................................................................................................................ 20 PRIVATE AND INFORMAL SECTORS ........................................................................................................................................ 20 MILLENNIUM DEVELOPMENT GOALS ..................................................................................................................................... 20 HEALTH CARE UNDER DEVOLUTION ...................................................................................................................................... 21 MEDICAL AND DENTAL PROFESSION IN PAKISTAN .................................................................................................... 21 Pakistan Medical and Dental Council................................................................................................................................... 21 CURRENT COMPOSITION OF THE COUNCIL ........................................................................................................................... 22 CURRENT OFFICE APPOINTMENTS AT THE COUNCIL .......................................................................................................... 22


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MEDICAL EDUCATION INSTITUTIONS COUNTRY PROFILE .............................................................................................. 22 UNIVERSITIES/INSTITUTIONS IN PAKISTAN OFFERING DEGREES IN THE FIELD OF MEDICINE/ DENTISTRY ........... 22 MEDICAL COLLEGES PROVINCIAL BREAKUP ..................................................................................................................... 23 RECOGNIZED MEDICAL COLLEGES IN PAKISTAN ................................................................................................................ 23 DENTAL COLLEGES PROVINCIAL BREAKUP ....................................................................................................................... 25 RECOGNIZED DENTAL COLLEGES IN PAKISTAN .................................................................................................................. 25 TOTAL NUMBER OF DOCTORS/DENTAL SURGEONS (GP'S WITH BACHELORS DEGREE ONLY) ................................... 27 TOTAL NUMBER OF DOCTORS/DENTAL SURGEONS (SPECIALISTS) ................................................................................ 27 College of Physicians and Surgeons, Pakistan .................................................................................................................. 27 CURRENT PROGRAMS ............................................................................................................................................................... 28 NURSING PROFESSION IN PAKISTAN ................................................................................................................................. 29 An Overview ................................................................................................................................................................................. 29 NURSE MIGRATION ................................................................................................................................................................... 29 Nursing Institutions in Pakistan............................................................................................................................................ 30 RECOGNIZED (ACCREDITED) SCHOOLS & COLLEGES OF NURSING IN PAKISTAN .......................................................... 30 NURSING EDUCATIONAL INSTITUTIONS IN THE COUNTRY-PROVINCIAL BREAKUP ...................................................... 31 TOTAL NUMBER OF NURSES/ MIDWIVES/ LHV/LHW IN THE COUNTRY ..................................................................... 31 TOTAL NUMBER OF REGISTERED NURSES IN THE COUNTRY ............................................................................................ 31 NUMBER OF CURRENTLY WORKING REGISTERED NURSING PROFESSIONALS ................................................................ 32 HOMOEOPATHIC EDUCATION IN PAKISTAN ................................................................................................................... 32 TOTAL NUMBER OF REGISTERED QUALIFIED HOMOEOPATHIC DOCTORS IN THE COUNTRY .......................................... 32 PHARMACY IN PAKISTAN ....................................................................................................................................................... 32 HEALTH HUMAN RESOURCE SHORTAGE IN PAKISTAN .............................................................................................. 32 An Overview ................................................................................................................................................................................. 32 HUMAN RESOURCE FOR HEALTH STANDARDS & SHORTFALL ...................................................................................... 33 Migration of Health Personnel ............................................................................................................................................... 33 STAKEHOLDERS CONSULTATIVE MEETING .................................................................................................................... 35 The Way Forward....................................................................................................................................................................... 40 Three tiers of Implementation Strategy......................................................................................................................... 40 At the Global Level ............................................................................................................................................................ 40 At the Regional Level ....................................................................................................................................................... 41 At the Country Level......................................................................................................................................................... 41 Broad Stakeholder Consultations ................................................................................................................................ 42 ANNEX ............................................................................................................................................................................................ 43


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FOREWORD The global shortage of health workforce is the biggest constraint undermining the progress of the countries including Pakistan towards achieving the Millennium Development Goals (MDGs). The performance of the health systems is negatively impacted by the inequitable, inaccessible and severe shortage of skilled and motivated health personnel. The Global Health Workforce Alliance (the Alliance) since its inception is convening partnerships to catalyse action on health workforce issues through engagement of related stakeholders. WHO is also continuously supporting the Human Resource for Health being one of the most important pillars of the health system. The WHO Global Code of Practice on the International Recruitment of Health Personnel was developed as a global response to the challenges imposed by health personnel migration and for strengthening integrated and effective health systems. The code is introduced to safeguards the health systems in all countries by establishing guidelines that supports international recruitment in an ethical manner. Pakistan is one of 57 countries that are facing an HRH shortage below the threshold level defined by WHO for delivering the essential health interventions that are required to reach the (MDGs) by 2015. In addition to HRH planning, the Alliance and WHO are supporting the implementation of the Global Code of Conduct for International Recruitment in Pakistan with the hope that it would guide policies for strengthening the health systems in the country; diminish the negative impacts and maximize the positive effects of health workforce migration on its health systems; and safeguard the rights of its health personnel. For developing this report, we acknowledge the contribution of Dr Zulfiqar Khan, Dr Asad Hafeez, Rana Matloob Ahmed, and Dr Shbanam Sarfraz; whereas, value inputs by various partner organizations and stakeholders is highly appreciated. It is hoped that this initiative will help strengthen the building blocks of health system in Pakistan. Dr Mubashar Sheikh Executive Director Global Health Workforce Alliance, Geneva Dr Guido Sabatinelli Country Representative WHO Country Office, Pakistan


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INTRODUCTION The increasing demand for skilled health human resource, better remunerations in the developed countries coupled, together with the poor work environment and low remunerations in the developing countries militate against the retention of skilled healthcare professionals in the developing countries. Emigration of healthcare professionals is illustrative of the fact that that there is both, a national as well as an international perspective of the socio-political and economic context in a country. Recruitment policies and Emigration laws and regulations in developed countries influence whether there is a demand for health professionals in these countries. On the contrary, living conditions in a low income country determine whether health staff is de-motivated and intends to leave their country of residence. There is a vital need for addressing the migration issue primarily because it puts a strain on the already deprived health resources of the low income countries and in turn affects how health care service delivery impacts the health related outcomes. It is fundamental to understand the importance of addressing the pull and the push factors simultaneously; pull factors of migration to high-income countries and push factors in low-income countries. Unless and until these are not dealt with concurrently, any investments in strengthening the health systems are likely to be unproductive. International migration has become an area of great concern and many international organizations including the UN General Assembly, ILO, WHO, UNAIDS, UNDP, IOM, SAARC, ASEAN and group of G77 are working towards evolving a mechanism that addresses the concerns of the stakeholders and is beneficial for countries of origin, countries of destination, and most importantly, for migrant workers including the healthcare professionals themselves. The adoption of the WHO Global Code of Practice on the International Recruitment by the 193 member states, at the 63rd World Health Assembly, is a major mile stone achieved in this context and is expected to have a major impact on making the international migration of health personnel, transparent and sustainable. In Pakistan, the initial assignment in this context was sponsored by the GHWA, through the GIZ funds, in 2011. WHO also provided vital support and guidance towards the formulation of and implementation of the strategy report. WHO GLOBAL CODE OF PRACTICE BASIC CONCEPT The code was introduced to establish guidelines that promote international recruitment in an ethical manner, safeguarding the health systems in all countries. It is expected to serve as a framework that facilitates consultations amongst the stakeholders. The WHO Member States are required to disseminate a national report, through the WHO Secretariat, every three years, on matters pertaining to health personnel and health systems, and on the strategy adopted and activities related to implementing the guidelines and practices as recommended by the Code. Guidelines on Monitoring the Implementation of the WHO Global Code have been developed by the WHO Secretariat and are expected to facilitate the reporting process. They define the requirements for Minimum Data Sets; provide recommendations regarding information and materials that may be useful to include in the Regular National Reports; reporting formats and outlines the process of submitting information gathered by other stakeholders. It is expected that the implementation of these guidelines will help in monitoring the process; encourage periodic reporting; evaluate progress; and highlight areas which require rethinking. OVERSEAS MIGRATION OF HEALTHCARE PERSONNEL INTERNATIONAL PERSPECTIVE Migration of healthcare personnel has been widely reviewed in the literature and its pros and cons debated especially over the last few years. For the developing countries, migration has become a matter of grave concern as loss of clinical staff from low and middle-income countries is crippling already fragile


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health care systems.1 Demand for skilled and experienced health workers from the developed world leaves behind a health workforce which is novice affecting the overall efficiency of the healthcare system with a negative impact on healthcare service delivery. African countries need at least 1 million additional workers in order to offer basic services consistent with the MDGs. Instead, these countries are affected by health worker loss crippling already fragile health care systems. 2 International migration is widely blamed for this widely emerging crises and it is certainly the case that significant numbers are moving to developed countries.3 Lack of opportunities matching the skill and competence of health personnel is a push factor for their migration. Targeted recruitment drives for health workers from resource-poor countries have become a common solution to filling vacancies in richer countries4. Without proper strategic plans for human resource, absorption and deployment of skilled workforce in developing countries is usually found not matching with the production of health human resource. In such scenarios they are often found looking for opportunities in developed countries and are attracted by better remuneration packages and attractive training opportunities. Despite having developed this critical resource, this leaves the poorest countries with all drain and no gain5. Absence of strategic planning and effective absorption, of the trained health human resource, results in increasing number of health personnel migrating, for better prospects. The developing counties must not spend their scarce resources to train health manpower for the rich countries of the world without meeting their national needs first. In Kenya US$65,997 is spent on educating a single medical doctor from primary school to university level, and for every doctor who emigrates, US$517,931 returns in investment are lost6. Although migration of health personnel compromises health system capacity to deliver adequate care especially in resource deficient countries, it has been encouraged by some countries who intentionally export health workers in exchange for financial remittance. Philippines is actively exporting Filipino nurses and it is estimated that the country receives over USD 800 million annually7. LOCAL CONTEXT The inclination of healthcare personnel in Pakistan to migrate abroad is influenced by a consortium of issues: income factors, close relatives already living abroad, gaining international training & experience and working in much superior conditions. While economic gain is a crucial reason, it would be wrong to assume that this is the one and only motivation for emigrating. Movement of healthcare personnel is also an indication of deteriorating health systems in the Pakistan where wages are low, working conditions compromised and there are a few perks gained from the job. Surplus production of health personnel and the resultant unemployment due to adequate absorption, stagnation and limited opportunities for career advancement, coupled with lack of infrastructure act as push factors for the health personnel to migrate. In Pakistan for the attainment of the health related Millennium Development Goals, the following three factors are found impeding the progress: 1 Mischa Willis-Shattuck, Posy Bidwell, Steve Thomas, Laura Wyness, Duane Blaauw and Prudence Ditlopo, Motivation and retention of health workers in developing countries: a systematic review, BMC Health Services Research 2008, 8:247 2 Chen L, Boufford JI: Fatal Flows Doctors on the Move. The New England Journal of Medicine 2005, 353:1850-1852. 3 Hongoro C, Normand C: Building and Motivating the Workforce. In Disease Control Priorities in Developing Countries Second edition. Edited by: Jamison D, Breman J, Measham A, Alleyne G, Claeson M, Evans D, Jha P, Mills A, Musgrove P. Oxford: Oxford University Press; 2006. 4 Kingma M: Nursing migration: global treasure hunt or disaster in the making. Nursing Inquiry 2001, 8:205-212. 5 Eastwood JB, Conroy RE, Naicker S, West PA, Tutt RC, Plange-Rhule J: Loss of health professionals from sub-Saharan Africa: the pivotal role of the UK. The Lancet 2005, 365:1893-1900. 6 Kirigia J, Gbary A, Muthuri L, Nyoni J, Seddoh A: The cost of health professionals' brain drain in Kenya. BMC Health Services Research 2006, 6(1):89. 7 Lindquist B: Migration networks: a case study in the Philippines. Asian Pacific Migration Journal 1993, 2(1):75-104.


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1. Delay in seeking professional care 2. Inadequate logistics of providing equitable care especially in rural areas 3. Lack of adequate human resources and trained personnel available for health care service delivery The Health Department in Pakistan is found facing three major challenges related to the health workforce: 1. Filling vacancies in the public health sector; 2. Meeting increasing demand as per the requirements of the Minimum Service Delivery Stabdards; 3. Creating sanctioned posts in order to absorb the output from training institutes in the country. BUREAU OF EMIGRATION & OVERSEAS EMPLOYMENT The Bureau was set up in October, 1971 under the directive of the President of Pakistan by amalgamating the following: 1. National Employment Bureau, 2. Protectorate of Emigrants and 3. Directorate of Seamens Welfare. The Bureau has a central function and is presently working under the administrative control of newly established Ministry of Human Resource Development (HRD)

Scope of work:

Registering and processing of export demand for Pakistani manpower by overseas countries. Facilitating Pakistani Professionals, intending to migrate, in sourcing appropriate overseas placements, both in the Public and Private Sectors of the destination countries, through the licensed Overseas Employment Promoters. MIGRATION TRENDS Due to lack of favourable opportunities available nationally and overall increase in demand of healthcare personnel in the international sphere, their retention within the country has become a major concern. Motivation to migrate stems from the desire for professional development and for a better quality of life. Pakistan has been an attractive labour supply market for foreign manpower deficient countries. Prior to the 1970s the efflux of Pakistani workers was primarily towards the West i.e Europe, USA and Canada. In the early 70s, however, an upsurge was noticed in the oil rich countries of Gulf and Middle East which was related to their growing economies. These countries fulfilled their healthcare manpower requirements by sourcing them from the South East Asian Countries, which included Pakistan. Pakistan labour production was much more than its absorptive capacity, so despite local need, it captured these labour markets by formulating favourable policies for exporting its surplus labour. It is interesting to note that females constituted a negligible proportion of the overall labour that was exported. Their migration was restricted due to social, religious and cultural factors. The emigration of domestic workers is further restricted by an age imposition not allowing under 35 years to emigrate. This is in contrast to India, Sri-Lanka and Philippines, where female migrant workers are contributing significantly towards their national economies.


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EMIGRATION STATISTICS From 1971 to Sep 20118:

A total of 5.75 million Pakistanis immigrated to varied overseas destinations for employment purposes. 5.69 million of them have emigrated through the Bureau of Emigration & Overseas Employment, whereas nearly 0.13 million went via the Overseas Employment Corporation. Country of destination for 94% of the Pakistanis was the GCC countries especially Saudi Arabia, UAE, Oman, Qatar, Kuwait & Bahrain. 6% proceeded to Libya, South Korea, Malaysia, countries in the EU and few other developed countries of the world. Out of the total, only 0.12% females were found to immigrate for overseas employment.

8 Bureau of Emigration & Overseas Employment, Ministry of HRD, 17.10.2011

S.#. CATEGORIES 1971-2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Total 1 Engineer 19565 861 821 880 951 1355 2171 3295 2352 2408 2219 368782 Doctor 5085 506 402 431 534 509 463 516 589 819 1184 110383 Nurse 4378 406 350 342 310 128 99 119 219 78 96 65254 Teacher 4856 254 255 289 166 421 558 413 458 537 408 86155 Accountant 11840 341 443 613 694 961 1238 2325 1248 1381 1392 224766 Manager 6868 656 798 1078 1392 2462 2802 3164 2145 1936 1679 249807 Welder 32340 1545 3263 1770 1435 3098 4429 6069 5352 5120 4818 692398 Secr/Stenographer 2243 68 91 92 102 151 88 77 86 93 61 31529 Storekper 5342 309 475 287 329 774 485 792 454 504 654 10405

10 Agricul 100876 5096 9536 7453 7728 10780 12809 17584 11420 9155 8171 20060811 Clerk/Typist 52434 627 1160 1095 1090 1676 1639 3047 2086 2661 2753 7026812 For/Supervisor 32412 1147 1964 1544 1522 1871 2896 3755 2773 1962 3074 5492013 Mason 229312 11312 16415 13645 9685 9700 16213 36254 38085 30612 26765 43799814 Carpenter 158416 9954 13355 11231 8027 8861 12787 26673 22555 18544 18666 30906915 Electrician 102341 6570 8614 6024 4201 5688 8560 15455 15731 14515 13131 20083016 Cook 60123 2236 3240 3153 2314 2787 2526 3330 4245 4034 2893 9088117 Plumber 44479 3517 4760 2944 1581 2877 4510 8703 8301 7677 6950 9629918 Waiter/Bearer 19562 1000 1361 687 361 588 717 879 1727 1147 1334 2936319 Steel Fixer 89460 6273 8760 6680 4935 6318 9860 17904 16781 14403 13126 19450020 Painter 61359 3146 4995 3233 2516 3307 4978 6471 7747 6505 5646 10990321 Labourer 1145427 46726 73318 66650 54735 75098 130890 187844 168519 144111 138539 223185722 Technician 101798 9366 12719 10250 8651 8301 11055 16928 17483 19718 13740 23000923 Mechanic 84989 4142 6358 4406 3705 4304 6771 9645 9978 11874 10641 15681324 Cable Jointer 2967 96 50 70 78 131 73 179 705 1072 280 570125 Driver 285545 17984 21182 14830 11626 14114 26501 27417 33501 34905 32699 52030426 Operator 34470 2433 3707 1829 3709 3846 5006 9533 8113 8273 7485 8840427 Tailor 149999 3860 4334 3917 2293 2748 4067 4527 5264 4050 3362 18842128 Surveyor 5932 183 237 185 128 288 501 897 686 553 531 1012129 Fitter 14621 974 1475 1141 1547 2926 3764 7644 6371 4441 4154 4905830 Denter 21185 1185 2199 1110 441 613 906 1047 2192 1633 1617 3412831 Comp/Analyst 2106 404 354 371 443 672 934 940 624 598 509 795532 Designer 508 277 564 104 46 62 59 70 214 68 37 200933 Goldsmith 3502 240 408 234 135 321 147 76 90 40 73 526634 Pharmacist 397 19 32 68 16 31 12 21 18 59 35 70835 Rigger 1421 74 97 156 118 718 1048 556 468 129 534 531936 Salesman 33125 3103 4824 4195 3969 4115 4893 5655 4401 6647 5841 8076837 Draftsman 953 62 594 113 63 115 111 226 138 133 165 267338 Blacksmith 679 63 114 129 98 176 267 156 260 430 467 283939 Photographer 321 26 24 51 18 11 14 10 45 16 9 54540 Artist 900 381 391 544 443 289 186 118 104 63 32 345141 Others. 75810 0 0 0 0 0 0 0 0 0 0 75810

3009946 147422 214039 173824 142135 183191 287033 430314 403528 362904 335770 5690106TOTAL:-

WORKERS REGISTERED FOR OVERSEAS EMPLOYMENT BY BUREAU OF EMIGRATION & OVERSEAS EMPLOYMENT

DURING THE PERIOD 1971-2011 (Upto September)CATEGORY WISE


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FOREIGN REMITTANCES USD103 Billion worth of foreign remittances were received, by Pakistan from the overseas Pakistanis, during the financial period 1972-1973 to 2010-2011. Where migrating workforce has a positive impact

S.#Countries 1971-2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Total

1 U.A.E. 626705 18421 34113 61329 65786 73642 100207 139405 221765 140889 113312 114012 17095862 Algeria. 708 8 5 0 4 0 1 5 37 73 37 7 8853 Angola. 66 2 2 0 0 0 10 70 68 379 4 6 6074 Bahrain. 65987 1173 1022 809 855 1612 1630 2615 5932 7087 5877 8171 1027705 Brunei. 192 174 41 78 107 71 77 56 66 74 62 68 10666 Gabon. 287 2 0 2 0 0 6 1 0 1 0 1 3007 Gen-Island. 195 0 0 0 0 0 0 0 0 0 0 0 1958 Greece. 428 0 2 8 6 30 36 6 12 14 0 0 5429 Guinea. 60 1 0 17 30 2 12 5 5 2 10 12 156

10 Hong Kong. 97 10 7 13 6 12 16 16 22 20 33 21 27311 Iran. 12544 2 1 5 12 6 3 3 3 3 4 14 1260012 Iraq. 68132 1 0 0 0 0 0 0 0 1 1 0 6813513 Jordan. 4367 189 39 61 140 102 43 67 106 55 172 144 548514 Kenya 33 0 0 2 7 1 7 0 7 6 4 8 7515 Kuwait. 106307 440 3204 12087 18498 7185 10545 14544 6250 1542 153 138 18089316 Libya. 63701 713 781 1374 375 261 67 450 940 1293 2157 487 7259917 Lebanon. 359 1 0 1 0 4 4 8 18 16 21 29 46118 Malaysia. 1993 64 59 114 65 7690 4757 1190 1756 2435 3287 1581 2499119 Nigeria. 2019 16 21 66 14 25 55 57 105 125 162 121 278620 Oman. 212131 3802 95 6911 8982 8019 12614 32474 37441 34089 37878 39054 43349021 Qatar. 50481 1633 480 367 2383 2175 2247 5006 10171 4061 3039 3615 8565822 Saudi Arabia. 1648279 97262 104783 126397 70896 35177 45594 84587 138283 201816 189888 164332 290729423 Sierra Leone 124 0 0 0 0 0 7 3 4 0 0 0 13824 Sudan. 668 37 128 27 93 360 140 128 60 109 324 200 227425 Singapore. 113 9 14 5 3 6 8 11 16 39 58 47 32926 Somalia. 59 1 3 0 2 1 1 4 2 4 8 2 8727 Spain. 159 362 389 202 254 290 183 176 85 16 6 3 212528 Tanzania. 342 8 3 45 53 65 39 41 65 75 76 45 85729 Tunisia. 25 0 0 0 0 0 0 3 7 0 0 0 3530 Uganda. 303 0 0 0 1 1 0 0 12 4 5 7 33331 U.K. 1059 800 703 858 1419 1611 1741 1111 756 556 430 252 1129632 U.S.A. 802 788 310 140 130 238 202 297 232 184 196 133 365233 Yemen. 3796 25 73 85 157 81 127 163 151 241 170 45 511434 West Africa. 307 0 0 0 0 0 0 0 0 0 1 1 30935 South Africa. 24 3 8 59 7 38 65 45 93 314 184 107 94736 Zambia. 834 5 2 1 0 5 1 4 11 30 15 10 91837 Japan. 91 24 10 12 12 22 53 33 45 48 30 36 41638 South Korea. 3634 271 564 2144 2474 1970 1082 434 1534 985 251 9 1535239 Croatia. 44 0 0 0 0 0 0 0 0 0 0 1 4540 Turkmenistan. 493 216 4 214 16 109 10 5 97 20 28 0 121241 Cyprus. 140 17 31 22 40 32 111 206 129 144 50 41 96342 Turkey. 149 3 3 1 0 0 2 7 3 2 33 10 21343 China. 137 4 8 1 3 154 435 300 172 312 191 137 185444 Cameroon. 41 1 2 0 0 0 0 1 0 0 3 15 6345 Morocco.. 38 0 0 0 0 0 0 4 1 1 0 0 4446 Italy. 405 824 48 128 581 551 431 2765 2876 5416 3738 1774 1953747 Sweden. 46 2 0 0 8 15 3 3 8 21 28 59 19348 Switzerland 18 8 3 5 4 2 4 9 15 15 17 16 11649 Syria 217 20 2 6 5 4 80 1 3 7 1 0 34650 Germany 77 23 5 42 8 2 8 5 6 9 2 7 19451 Azerbaijan 3 1 0 5 7 2 4 3 10 10 6 0 5152 Others 2798 563 454 396 381 562 523 706 934 985 952 992 10246

Total: 2882017 127929 147422 214039 173824 142135 183191 287033 430314 403528 362904 335770 5690106

STATEMENT SHOWING NUMBER OF PAKISTANIWORKERS REGISTERED FOR OVERSEAS EMPLOYMENT THROUGH BUREAU OF EMIGRATION & OVERSEAS EMPLOYMENT

DURING THE PERIOD 1971-2011 (Upto September)COUNTRY WISE


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on the economies of their countries of origin, they have a major contribution in enhancing the quality of health service delivery and strengthening the health systems in the counties of destination. However more than 214 million of the migrant workers worldwide are often found confronting issues that include undue exploitation from their overseas employers & related agencies, inadequate health facilities/insurance, ambiguous contractual obligations, reduced salary packages and non availability of promised fringe benefits and un safe living & working environment. The countries of origin, on the other hand are found facing the issue of brain drain where they lose their skilled and trained workforce to other countries. MINIMUM DATA SETS (MDS) On the recommendation of the WHO Secretariat, all Member States are required to collect essential information on health personnel migration that allows an in depth analysis. The objective behind improving the availability of migration data and health personnel statistics in an internationally comparable format, is to help member states in developing evidence-based policies. The compilation of a minimum data set (MDS) to effectively monitor international health workforce migration is a key element for monitoring the implementation of the WHO Global Code of Practice. The proposed framework to be adopted is based on a hierarchy of three levels of information needs i.e. level A, B and C, each level supplementing the information already available. This is in line with the proposed order of priorities. In Pakistan, at present the various Federal/Provincial Ministries, and other concerned departments are not maintaining the data on the format prescribed by the WHO Secretariat. It is therefore required that all concerned departments initiate the process of recording the core information in a manner that it fulfills the future requirements of the regular national reporting instrument. WHO GLOBAL CODE OF PRACTICE WHA63.16 AN OVERVIEW World Health Assembly passed Resolution WHA57.19 in which it requested the Director-General to develop a voluntary code of practice on the international recruitment of health personnel in consultation with all relevant partners. The Kampala Declaration adopted at the First Global Forum on Human Resources for Health (Kampala, 27 March 2008) and the G8 communiqus of 2008 and 2009 further encouraged the WHO, which stepped up the development and adoption of a code of practice. At the Sixty-third World Health Assembly, the revised draft global code of practice on the international recruitment of health personnel was presented before the member states of the World Health Organization. The WHO Global Code of Practice on the International Recruitment of Health Personnel was adopted in accordance with Article 23 of the Constitution. It was further decided that the first review of the relevance and effectiveness of the WHO Global Code of Practice on the International Recruitment of Health Personnel shall be made by the Sixty-eighth World Health Assembly. The WHO global code of practice on the international recruitment of health personnel is expected to be a core component of bilateral, national, regional and global strategies for addressing the issues related to health personnel migration and health systems strengthening.


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OBJECTIVES OF THE WHO GLOBAL CODE OF PRACTICE 9 1. To establish and promote voluntary principles and practices for the ethical international recruitment of health personnel, taking into account the rights, obligations and expectations of source countries, destination countries and migrant health personnel; 2. To serve as a reference for member states in establishing or improving the legal and institutional framework required for the international recruitment of health personnel; 3. To provide guidance that may be used where appropriate in the formulation and implementation of bilateral agreements and other international legal instruments; 4. To facilitate and promote international discussion and advance cooperation on matters related to the ethical international recruitment of health personnel as part of strengthening health systems, with a particular focus on the situation of developing countries. NATURE AND SCOPE OF THE WHO GLOBAL CODE OF PRACTICE 10

The Code is voluntary. Member States and other stakeholders are strongly encouraged to use the Code. The Code is global in scope and is intended as a guide for Member States, working together with stakeholders such as health personnel, recruiters, employers, health-professional organizations, relevant sub-regional, regional and global organizations, whether public or private sector, including nongovernmental, and all persons concerned with the international recruitment of health personnel. The Code provides ethical principles applicable to the international recruitment of health personnel in a manner that strengthens the health systems of developing countries, countries with economies in transition and small island states. GUIDING PRINCIPLES OF THE WHO GLOBAL CODE OF PRACTICE 11 The health of all people is fundamental to the attainment of peace and security and is dependent upon the fullest cooperation of individuals and states. Governments have a responsibility for the health of their people, which can be fulfilled only by the provision of adequate health and social measures. Member States should take the Code into account when developing their national health policies and cooperating with each other, as appropriate. Addressing present and expected shortages in the health workforce is crucial to protecting global health. International migration of health personnel can make a sound contribution to the development and strengthening of health systems, if recruitment is properly managed. However, the setting of voluntary international principles and the coordination of national policies on international health personnel recruitment are desirable in order to advance frameworks to equitably strengthen health systems worldwide, to mitigate the negative effects of health

9 WHO Global Code of Practice on the International Recruitment of Health Personnel, WHA63.16, Article 1 10 WHO Global Code of Practice on the International Recruitment of Health Personnel, WHA63.16, Article 2 11 WHO Global Code of Practice on the International Recruitment of Health Personnel, WHA63.16, Article 3


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personnel migration on the health systems of developing countries and to safeguard the rights of health personnel.

The specific needs and special circumstances of countries, especially those developing countries and countries with economies in transition that are particularly vulnerable to health workforce shortages and/or have limited capacity to implement the recommendations of this Code, should be considered. Developed countries should, to the extent possible, provide technical and financial assistance to developing countries and countries with economies in transition aimed at strengthening health systems, including health personnel development. Member States should take into account the right to the highest attainable standard of health of the populations of source countries, individual rights of health personnel to leave any country in accordance with applicable laws, in order to mitigate the negative effects and maximize the positive effects of migration on the health systems of the source countries. However, nothing in this Code should be interpreted as limiting the freedom of health personnel, in accordance with applicable laws, to migrate to countries that wish to admit and employ them. International recruitment of health personnel should be conducted in accordance with the principles of transparency, fairness and promotion of sustainability of health systems in developing countries. Member States, in conformity with national legislation and applicable international legal instruments to which they are a party, should promote and respect fair labour practices for all health personnel. All aspects of the employment and treatment of migrant health personnel should be without unlawful distinction of any kind. Member States should strive, to the extent possible, to create a sustainable health workforce and work towards establishing effective health workforce planning, education and training, and retention strategies that will reduce their need to recruit migrant health personnel. Policies and measures to strengthen the health workforce should be appropriate for the specific conditions of each country and should be integrated within national development programmes. Effective gathering of national and international data, research and sharing of information on international recruitment of health personnel are needed to achieve the objectives of this Code. Member States should facilitate circular migration of health personnel, so that skills and knowledge can be achieved to the benefit of both source and destination countries. RESPONSIBILITIES, RIGHTS AND RECRUITMENT PRACTICES AS PER THE WHO GLOBAL CODE OF PRACTICE 12 Health personnel, health professional organizations, professional councils and recruiters should seek to cooperate fully with regulators, national and local authorities in the interests of patients, health systems, and of society in general. Recruiters and employers should, to the extent possible, be aware of and consider the outstanding legal responsibility of health personnel to the health system of their own country

12 WHO Global Code of Practice on the International Recruitment of Health Personnel, WHA63.16, Article 4


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such as a fair and reasonable contract of service and not seek to recruit them. Health personnel should be open and transparent about any contractual obligations they may have.

Member States and other stakeholders should recognize that ethical international recruitment practices provide health personnel with the opportunity to assess the benefits and risks associated with employment positions and to make timely and informed decisions. Member States should, to the extent possible, under applicable laws, ensure that recruiters and employers observe fair and just recruitment and contractual practices in the employment of migrant health personnel and those migrant health personnel are not subject to illegal or fraudulent conduct. Migrant health personnel should be hired, promoted and remunerated based on objective criteria, such as levels of qualification, years of experience and degrees of professional responsibility on the basis of equality of treatment with the domestically trained health workforce. Recruiters and employers should provide migrant health personnel with relevant and accurate information about all health personnel positions that they are offered. Member States should ensure that, subject to applicable laws, including relevant international legal instruments to which they are a party, migrant health personnel enjoy the same legal rights and responsibilities as the domestically trained health workforce in all terms of employment and conditions of work. Member States and other stakeholders should take measures to ensure that migrant health personnel enjoy opportunities and incentives to strengthen their professional education, qualifications and career progression, on the basis of equal treatment with the domestically trained health workforce subject to applicable laws. All migrant health personnel should be offered appropriate induction and orientation programmes that enable them to operate safely and effectively within the health system of the destination country. Recruiters and employers should understand that the Code applies equally to those recruited to work on a temporary or permanent basis. HEALTH WORKFORCE DEVELOPMENT AND HEALTH SYSTEMS SUSTAINABILITY 13 In accordance with the guiding principle as stated in Article 3 of this Code, the health systems of both source and destination countries should derive benefits from the international migration of health personnel. Destination countries are encouraged to collaborate with source countries to sustain and promote health human resource development and training as appropriate. Member States should discourage active recruitment of health personnel from developing countries facing critical shortages of health workers. Member States should use this Code as a guide when entering into bilateral, and/or regional and/or multilateral arrangements, to promote international cooperation and coordination on international recruitment of health personnel. Such arrangements should take into account the needs of developing countries and countries with economies in transition through the adoption of appropriate measures. Such measures may include the provision of effective and appropriate 13 WHO Global Code of Practice on the International Recruitment of Health Personnel, WHA63.16, Article 5


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technical assistance, support for health personnel retention, social and professional recognition of health personnel, support for training in source countries that is appropriate for the disease profile of such countries, twinning of health facilities, support for capacity building in the development of appropriate regulatory frameworks, access to specialized training, technology and skills transfers, and the support of return migration, whether temporary or permanent.

Member States should recognize the value both to their health systems and to health personnel themselves of professional exchanges between countries and of opportunities to work and train abroad. Member States in both source and destination countries should encourage and support health personnel to utilize work experience gained abroad for the benefit of their home country. As the health workforce is central to sustainable health systems, Member States should take effective measures to educate, retain and sustain a health workforce that is appropriate for the specific conditions of each country, including areas of greatest need, and is built upon an evidence-based health workforce plan. All Member States should strive to meet their health personnel needs with their own human resources for health, as far as possible. Member States should consider strengthening educational institutions to scale up the training of health personnel and developing innovative curricula to address current health needs. Member States should undertake steps to ensure that appropriate training takes place in the public and private sectors. Member States should consider adopting and implementing effective measures aimed at strengthening health systems, continuous monitoring of the health labour market and coordination among all stakeholders in order to develop and retain a sustainable health workforce responsive to their populations health needs. Member States should adopt a multi sectoral approach to addressing these issues in national health and development policies. Member States should consider adopting measures to address the geographical mal distribution of health workers and to support their retention in underserved areas, such as through the application of education measures, financial incentives, regulatory measures, social and professional support. DATA GATHERING AND RESEARCH 14 Member States should recognize that the formulation of effective policies and plans on the health workforce requires a sound evidence base. Taking into account characteristics of national health systems, Member States are encouraged to establish or strengthen and maintain, as appropriate, health personnel information systems, including health personnel migration, and its impact on health systems. Member States are encouraged to collect, analyse and translate data into effective health workforce policies and planning.



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Member States are encouraged to establish or strengthen research programmes in the field of health personnel migration and coordinate such research programmes through partnerships at the national, subnational, regional and international levels. WHO, in collaboration with relevant international organizations and Member States, is encouraged to ensure, as much as possible, that comparable and reliable data are generated and collected pursuant to paragraphs 6.2 and 6.3 for ongoing monitoring, analysis and policy formulation. INFORMATION EXCHANGE 15 Member States are encouraged to, as appropriate and subject to national law, promote the establishment or strengthening of information exchange on international health personnel migration and health systems, nationally and internationally, through public agencies, academic and research institutions, health professional organizations, and sub-regional, regional and international organizations, whether governmental or nongovernmental. In order to promote and facilitate the exchange of information that is relevant to this Code, each Member State should, to the extent possible:

o progressively establish and maintain an updated database of laws and regulations related to health personnel recruitment and migration and, as appropriate, information about their implementation; o progressively establish and maintain updated data from health personnel information systems in accordance with Article 6.2; and o provide data collected pursuant to subparagraphs (a) and (b) above to the WHO Secretariat every three years, beginning with an initial data report within two years after the adoption of the Code by the Health Assembly.

For purposes of international communication, each Member State should, as appropriate, designate a national authority responsible for the exchange of information regarding health personnel migration and the implementation of the Code. Member States so designating such an authority, should inform WHO. The designated national authority should be authorized to communicate directly or, as provided by national law or regulations, with designated national authorities of other Member States and with the WHO Secretariat and other regional and international organizations concerned, and to submit reports and other information to the WHO Secretariat pursuant to subparagraph 7.2(c) and Article 9.1. A register of designated national authorities pursuant to paragraph 7.3 above shall be established, maintained and published by WHO. 15 WHO Global Code of Practice on the International Recruitment of Health Personnel, WHA63.16, Article 7


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IMPLEMENTATION OF THE CODE 16

Member States are encouraged to publicize and implement the Code in collaboration with all stakeholders as stipulated in Article 2.2, in accordance with national and subnational responsibilities. Member States are encouraged to incorporate the Code into applicable laws and policies. Member States are encouraged to consult, as appropriate, with all stakeholders as stipulated in Article 2.2 in decision-making processes and involve them in other activities related to the international recruitment of health personnel. All stakeholders referred to in Article 2.2 should strive to work individually and collectively to achieve the objectives of this Code. All stakeholders should observe this Code, irrespective of the capacity of others to observe the Code. Recruiters and employers should cooperate fully in the observance of the Code and promote the guiding principles expressed by the Code, irrespective of a Member States ability to implement the Code. Member States should, to the extent possible, and according to legal responsibilities, working with relevant stakeholders, maintain a record, updated at regular intervals, of all recruiters authorized by competent authorities to operate within their jurisdiction. Member States should, to the extent possible, encourage and promote good practices among recruitment agencies by only using those agencies that comply with the guiding principles of the Code. Member States are encouraged to observe and assess the magnitude of active international recruitment of health personnel from countries facing critical shortage of health personnel, and assess the scope and impact of circular migration. MONITORING AND INSTITUTIONAL ARRANGEMENTS 17 Member States should periodically report the measures taken, results achieved, difficulties encountered and lessons learnt into a single report in conjunction with the provisions of Article 7.2(c). The Director-General shall keep under review the implementation of this Code, on the basis of periodic reports received from designated national authorities pursuant to Articles 7.3 and 9.1 and other competent sources, and periodically report to the World Health Assembly on the effectiveness of the Code in achieving its stated objectives and suggestions for its improvement. This report would be submitted in conjunction with Article 7.2(c). The Director-General shall: (a) support the information exchange system and the network of designated national authorities specified in Article 7; (b) develop guidelines and make recommendations on practices and procedures and such joint programmes and measures as specified by the Code; and 16 WHO Global Code of Practice on the International Recruitment of Health Personnel, WHA63.16, Article 8 17 WHO Global Code of Practice on the International Recruitment of Health Personnel, WHA63.16, Article 9


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(c) maintain liaison with the United Nations, the International Labour Organization, the International Organization for Migration, and other competent regional and international organizations as well as concerned nongovernmental organizations to support implementation of the Code.

WHO Secretariat may consider reports from stakeholders as stipulated in Article 2.2 on activities related to the implementation of the Code. The World Health Assembly should periodically review the relevance and effectiveness of the Code. The Code should be considered a dynamic text that should be brought up to date as required. PARTNERSHIPS, TECHNICAL COLLABORATION AND FINANCIAL SUPPORT 18 Member States and other stakeholders should collaborate directly or through competent international bodies to strengthen their capacity to implement the objectives of the Code. International organizations, international donor agencies, financial and development institutions, and other relevant organizations are encouraged to provide their technical and financial support to assist the implementation of this Code and support health system strengthening in developing countries and countries with economies in transition that are experiencing critical health workforce shortages and/or have limited capacity to implement the objectives of this Code. Such organizations and other entities should be encouraged to cooperate with countries facing critical shortages of health workers and undertake to ensure that funds provided for disease-specific interventions are used to strengthen health systems capacity, including health personnel development. Member States either on their own or via their engagement with national and regional organizations, donor organizations and other relevant bodies should be encouraged to provide technical assistance and financial support to developing countries or countries with economies in transition, aiming at strengthening health systems capacity, including health personnel development in those countries. SUPPORT REQUESTED FROM THE DIRECTOR-GENERAL At the Sixty-third World Health Assembly, on adoption of the WHO Global Code of Practice, the member states of the World Health Organization requested the Director-General for requisite assistance for its effective implementation. This encompassed provision of requisite support to Member States, as and when requested; facilitation of all stakeholders; urgent development of guidelines for minimum data sets, information exchange and reporting on the implementation of the WHO Global Code of Practice; and effective monitoring for any necessary amendments and strategies needed for its effective application.



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HEALTHCARE IN PAKISTAN AN OVERVIEW HISTORICAL PERSPECTIVE In 1947 Pakistan had just two medical colleges; in 2011 there are over 70 medical and dental colleges and 109 nursing schools, seven nursing colleges, twenty-six public health schools training LHVs and 141 midwifery training schools19 across the country. There are 32 medical schools in the public sector and 39 in the private sector. This has increased the number of doctors from 78 in 1947 to over 136648 in 2011 including around 25,807 specialists20 and an estimated 25,000 working overseas.21 Similarly the number of nurses has risen from less than 400 in 1947 to almost 54987 in 2011. Further, in 1947 Pakistan had just 292 hospitals providing almost 14,000 beds; today Pakistan has 920 public sector hospitals and around 800 in the private sector22 providing well over 100,000 hospital beds. Additionally, with the increased focus on Primary Health Care following the Declaration of Alma-Ata in 1978, Pakistan began to develop and expand health services and facilities in rural areas to meet the growing needs of a largely rural population and a commitment to primary health care. EVOLVING STRUCTURE OF HEALTH & THE PRESENT SCENARIO Health care in Pakistan has over the past thirty years, undergone many changes moving from a largely curative approach to one based more on primary health care following the signing of the Alma-Ata Declaration in 1978. This was followed by the significant expansion of the health infrastructure during the 1980s to include a Basic Health Unit in each union council covering an estimated population of 15,000 to 20,000 and a Rural Health Centre serving a cluster of four to five union councils23. Similarly Tehsil and District level hospitals were established to provide secondary level care with large hospitals providing more specialised care at tertiary level in all major cities. By the late 1980s a considerable health infrastructure had been developed across Pakistan including Basic Health Units in each union council and a Rural Health Centre covering four to five union councils. To date there are more than 550 RHCs and 4,870 BHUs with an additional 4,916 dispensaries, compared to around 700 dispensaries24 in 1947, and 1,138 MCH centres across Pakistan.25 In Punjab alone there are 19 teaching hospitals with 12,000 beds. This trend has significantly increased the need for trained health personnel at all levels, particularly doctors and nurses. In more recent years it has involved the establishment of new cadres, most notably Lady Health Workers and Community Midwives in order to provide basic health care to more people, especially rural women and children. This growth in itself has posed many challenges for the policy makers and in an effort to increase absolute numbers other key aspects of human resource planning, management and development have perhaps received less than the desirable attention. Pakistan has a health service environment that is challenged by the impact of poverty, a changing burden of disease, communicable, non-communicable, the lack of access to quality health services for its rural population and lifestyles. The situation is further complicated by increasing numbers of both the aged population and young age groups. 19 PNC, Jan 2011 20 PMDC Aug 2011 21 Scope of Medical Colleges in Private Sector; A.J.Khan 22 National Health Policy Zero draft 2009 23 Ministry of Health 24 Population Assoc. of Pakistan 25 Ministry of Health 2007


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More recently the focus has been on increased access, quality, equity and improved efficiency and productivity to meet the changing and increasing needs of the population. The Millennium Development Goals, with a particular emphasis on maternal and child health are being given priority. With the strong link between poverty and ill-health now well established there is also a need to provide pro-poor health care services. HEALTH INDICATORS The past few years have seen some improvement in economic growth however, the social indicators remain challenging and Pakistan is currently lagging behind if it is to achieve the Millennium Development Goals by 2015. The under-five mortality rate in Pakistan remains high at 94 per 1000 live births with diarrhoeal diseases and ARI as the main causes; infant mortality stands at 78 per 1000 live births and maternal mortality ratio at an estimated 276 per 100,000 live births26. PRIVATE AND INFORMAL SECTORS A further factor for consideration in Pakistan is that of the private and informal sector; this sector is so large that it cannot be ignored when considering health care. It is estimated that over 70 percent of the population access private health care and in rural areas the informal sector is often the first and preferred option for health care by the majority of the local community. Ironically in spite of having a much smaller share of the market both government and donors, almost without exception until very recently, have targeted only the public sector health systems. This has largely left the private and informal sectors to flourish without regulation. Studies have recently been undertaken for investigating the role of private sector and the impact of the Public Private Partnerships in the health and education sector. Also the newly established Health Care Commission has the mandate of working towards regulating the healthcare service delivery of both the private and public sector. MILLENNIUM DEVELOPMENT GOALS In the context of the Millennium Development Goals, commonly acknowledged to be a valid and a mutually reinforcing framework for measuring development progress, new challenges have arisen for health care professional and the policy makers. Three of the eight MDGs address health issues, in particular aiming to improve maternal health and reduce child mortality; combating HIV and AIDS and Malaria and Tuberculosis being the other key focus areas. Pakistan is a signatory to the Millennium Declaration and is committed to achieving the Millennium Development Goals set for 2015. The countrys targets for MDG-5 are to reduce the MMR to less than 140, and to increase skilled birth attendance to 90 percent by the year 201527 The MDGs constitute the main goals to be targeted in the medium term. The MDGs framework itself sets challenges in respect of human resources for health. Integrating the targets for achieving the MDGs into national planning is not straightforward and requires additional commitments and resource allocation in terms of funding and human resources. With the present medical, nursing, midwifery and health visiting workforce shortages, further complicated by the migrating health workforce, the likelihood that these goals become a reality has become a great challenge for the country. 26 WHO, 2007 27 Ministry of Health 2005


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HEALTH CARE UNDER DEVOLUTION The overall responsibility in terms of policy direction and planning for health services previously rested with the Federal Government through the Ministry of Health. Now after the 18th Amendment, the federal structure for health has devolved and this mandate has been awarded to the provinces. Challenges facing implementation of the WHO Global Code of Practice in the present scenario

1. Institutional Arrangement at National Level Lacking a coherent institutional structure at the national level for developing inter sectoral linkages essential for strategic planning and development in the health sector. Ill defined reporting relationships between provinces and organizations retained federally to serve national functions 2. Policy Frameworks Lacking capacity for development of a set of quality standards & guidelines that need to be articulated to the provinces & are essential for achieving the desired inter-provincial conformity and avoidance of unnecessary duplication. 3. Health Regulation Reorganization of existing regulatory institutions 4. Health Financing Establishing of health financing arrangements and mechanisms in view of the new service delivery arrangements that will evolve as a result of reform of existing institutions of service delivery 5. Human Resources for Health Reorganization of the human resource regulatory function and establishment of linkages and coordination between the Federation and the provinces for the required concurrence in terms of formulation and regulation of human resource policies and human resource decisions at the federal level. 6. Health information Building capacity both for collating as well as analyzing information for evidence based policy making. Reform of the health information institutions to bridge current weaknesses & create an overall apex mechanism MEDICAL AND DENTAL PROFESSION IN PAKISTAN PAKISTAN MEDICAL AND DENTAL COUNCIL The Pakistan Medical & Dental Council (PMDC) is a statutory Autonomous Organization constituted under the Pakistan Medical and Dental Council Ordinance, 1962. The objective is to establish uniform standard for the basic and the higher education of medicine & dentistry. PMDC lays down the minimum standards for the bachelors degrees, higher qualifications and postgraduate minor diplomas in Medicine & Dentistry; the essential qualifications and experience for the appointment of the various categories of teachers in the Medical/Dental Colleges in Pakistan; inspects the Medical/Dental Colleges periodically to ensures that the Regulations of the Council are followed by the various Medical/Dental Institutions in the Country; and prescribes the Code of Medical Ethics for the Registered Medical Practitioners to enforce ethical practice and prevent professional negligence.


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CURRENT COMPOSITION OF THE COUNCIL 28

Representations from

PM&DC Ordinance 1962 Section3(1) Clause #

National assembly (a) 01 Nomination From Each Province (aa) 04 University (b) 26 Registered Medical Practitioners; (c) 04 Federal Government (d) 04 Registered Dentists (e) 02 Medical And Dental Colleges (f) 102 Legal Member (g) 01 Dg(H) (h) 01 Total 145 CURRENT OFFICE APPOINTMENTS AT THE COUNCIL

President: Dr. Sibtul Hasnian Vice president: Dr. Asim Hussain Registrar: Dr. Ahmed Nadeem Akbar MEDICAL EDUCATION INSTITUTIONS COUNTRY PROFILE29

Training Institution # Category Annual Approx Output

Medical Colleges 74 Doctors 9000 Dental Colleges 32 Dentists 2000 Institution for Pharmacy 28 B. Pharmacy 2,000

UNIVERSITIES/INSTITUTIONS IN PAKISTAN OFFERING DEGREES IN THE FIELD OF MEDICINE/ DENTISTRY30 S. No Name of the Universities 1. University of the Punjab, Lahore 2. Bahria University, Shangrilla Road, Sector E-8, Islamabad. 3. University of Health Sciences, Lahore. 4. Quaid-e-Azam University, Islamabd. 5. Gandhara University, 57-C, Gulmohar Lane, University Town, Peshawar. 6. Ziauddin Medical University, 4/B, Shara-e-Ghalib, Block-6, Clifton, Karachi-75600. 7. Dow University of Health Sciences, Baba-e-Urdu Road, Karachi-74200 8. Liaquat University of Medical & Health Sciences,Jamshoro 9. University of Sindh, Jamshoro.

28 Pakistan Medical and Dental Ordinance 1962, Clause 3 29 Ministry of Health June 2011 30 Pakistan Medical and Dental Council, www.pmdc.org.pk


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10. Isra University, Hala Road, P.O. Box 313, Hyderabad 11. The Aga Khan University, Stadium Road, P.O. Box-3500, Karachi-74800 12. Baqai Medical University, Super Highway, Gadap Road, P.O. Box No.2407, Karachi-74600. 13. University of Karachi, University Road, Karachi-75270. 14. Hamdard University, Madinat Al-Hikmah, Mohammad Bin Qasim Avenue, Karachi. 15. Khyber Medical University, Peshawar 16. Hazara University, Mansehra 17. University of Balochistan, Quetta. 18. Foundation University, Islamabad. 19. Riphah International University, Rawalpindi. 20. University of Peshawar Peshawar 21. National University of Science & Technology, Rawalpindi. 22. King Edward Medical University, Lahore. S. No Other Institutions 1. The College of Physicians and Surgeons Pakistan 2 Pakistan Institute of Engineering Applied Sciences MEDICAL COLLEGES PROVINCIAL BREAKUP31 Province Public Medical Colleges Private Medical Colleges Federal 0 3 Punjab 12 20 Sindh 8 12 Khyber Pakhtoon Khawa 8 8 Baluchistan 1 0 AJ&K 0 1 Total 30 44 Grand Total 74 RECOGNIZED MEDICAL COLLEGES IN PAKISTAN 32

Province of Punjab

Public Medical Colleges in Punjab 1. Allama Iqbal Medical College, Lahore 2. Army Medical College, Rawalpindi. 3. Fatima Jinnah Medical College for Women, Lahore 4. King Edward Medical College, Lahore 5. Nishtar Medical College, Multan Recognized. 6. Punjab Medical College, Faisalabad. 7. Quaid-e-Azam Medical College, Bahawalpur. 8. Rawalpindi Medical College, Rawalpindi. 9. Services Institute of Medical Sciences, Lahore. 31 Ministry of Health, June 2011 32 Pakistan Medical and Dental Council, www.pmdc.org.pk


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10. Sargodha Medical College, Sargodha. 11. Shaikh Zayed Medical College, Rahim Yar Khan. 12. Nawaz Shairf Medical College, Gujrat. 13. Sheikh Khalifa Bin Zayed Al-Nahyan Medical College Medical College , Lahore Private Medical Colleges in Punjab 1. FMH College of Medicine & Dentistry, Lahore 2. Foundation University Medical College, Rawalpindi 3. Islamic International Medical College, Rawalpindi 4. Lahore Medical & Dental College, Lahore. 5. Wah Medical College, Wah Cantt 6. University Medical College, Faisalabad 7. University College of Medicine & Dentistry, Lahore 8. CMH Lahore Medical College, Lahore 9. Independent Medical College, Faisalabad 10. Sharif Medical & Dental College, Lahore 11. Continental Medical College, Lahore 12. Akhtar Saeed Medical & Dental College, Lahore 13. Central Parks Medical College, Lahore. 14. Multan Medical & Dental College,Multan 15. Shalamar Medical & Dental College, Lahore 16. Avicenna Medical College, Lahore 17. Rashid Latif Mediacl College,Lahore 18. Islam Mediacl College,Sialkot 19. Amna Inayat Medical College,Sheikhupura

Province of Sind

Public Medical Colleges in Sind 1. Chandka Medical College, Larkana. 2. Dow University of Health Sciences, Karachi 3. Sindh Medical College, Karachi 4. Karachi Medical & Dental College, Karachi 5. Liaquat University of Medical & Health Sciences, Jamshoro. 6. Nawabshah Medical College for Girls, Nawabshah 7. Dow International Medical College, Karachi 8. Ghulam Mohammad Maher Medical College, Sukkur Private Medical Colleges in Sind 1. Aga Khan University Medical College, Karachi 2. Baqai Medical College, Karachi 3. Faculty of Medicine & Allied Medical Sciences Isra University, Hyderabad. 4. Hamdard College of Medicine & Dentistry Karachi. 5. Jinnah Medical & Dental College, Karachi 6. Sir Syed College of Medical Sciences for Girls, Karachi. 7. Ziauddin Medical College, Karachi 8. Muhammad Medical College, Mirpurkhas 9. Liaquat College of Medicine & Dentistry, Karachi 10. Liaquat National Medical College, Karachi. 11. Bahria University Medical & Dental College, Karachi. 12. Al-Tibri Medical College, Karachi.

Province of Baluchistan

1. Bolan Medical College, Quetta


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Province of Khyber Pakhtun Khawa

Public Medical Colleges in Khyber Pakhtun Khawa 1. Ayub Medical College, Abbottabad 2. Khyber Medical College, Peshawar 3. Gomal Medical College, Dera Ismail Khan 4. Saidu Medical College, Swat. 5. KUST Institute of Medical Sciences, Kohat 6. Khyber Girls Medical College, Peshawar 7. Badsha Khan Medical College, Peshawar Private Medical Colleges in Khyber Pakhtun Khawa 1. Frontier Medical College, Abbottabad 2. Kabir Medical College/GIMS, Peshawar 3. Women Medical College, Abbottabad 4. Peshawar Medical College, Peshawar 5. Abbottabad International Medical College, Abbottabad 6. Jinnah Medical College, Peshawar 7. Rehman Mediacl College, Peshawar 8. Pak International Medical College, Peshawar

Province of AJK

1. Mohiuddin Islamic Medical college, Mirpur

Federal-Islamabad

1. Shifa College of Medicine, Islamabad. 2. Islamabad Medical & Dental College, Islamabad 3. Yusra Medical & Dental College,Islamabad

DENTAL COLLEGES PROVINCIAL BREAKUP33 Province Public Medical Colleges Private Medical Colleges Islamabad 0 2 Punjab 3 8 Sindh 3 8 KPK 2 4 Baluchistan 1 0 Total 9 23 Grand Total 32

RECOGNIZED DENTAL COLLEGES IN PAKISTAN 34 Province of Punjab

Public Dental Colleges in Punjab 1. De'Montmorency College of Dentistry, Lahore 2. Dental Section, Nishtar Medical College, Multan 3. Dental Section, Army Medical College, Rawalpindi 33 Ministry of Health, June 2011 34 Pakistan Medical and Dental Council, www.pmdc.org.pk


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Private Dental Colleges in Punjab 1. Dental Section, FMH CM&D, Lahore 2. Dental Section, Lahore Medical & Dental College 3. Margalla College of Dentistry, Rawalpindi 4. Dental Section, UCM&D, Lahore 5. Sharif Medical & Dental College, Lahore 6. Dental Section, University Medical College, Faisalabad 7. Institute of Dentistry/CMH LMC, Lahore 8. Dental Section, Multan Medical & Dental College,Multan

Province of Sind

Public Dental Colleges in Sind 1. Dental Section, Karachi Medical & Dental College 2. Dental Section, Liaquat University of Medical & Health Sciences, Jamshoro 3. Dr.Ishratul Ebad Institute of Oral Health Sciences Karachi Private Dental Colleges in Sind 4. Baqai Dental College, Karachi 5. Fatima Jinnah Dental College, Karachi 6. Dental Section, Hamdard College of Medicine & Dentistry, Karachi 7. Dental Section Jinnah Medical & Dental College, karachi 8. Altamash Institute of Dental Medicine, Karachi 9. Dental Section, Liaquat College of Medicine & Dentistry, Karachi 10. Isra Dental College, Hyderabad 11. Ziauddin Dental College, Karachi 12. Dental Section Sir Syed College of Medical Sciences for Girls, Karachi

Province of Khyber Pakhtun Khawa

Public Dental Colleges in KPK 1. Dental Section, Ayub Medical College, Abbottabad 2. Khyber Medical College, Peshawar Private Dental Colleges in KPK 3. Sardar Begum Dental College, Peshawar 4. Dental Section, Frontier Medical College, Abbottabad 5. Peshawar Dental College,Peshawar 6. Dental Section,Women Medical College,Abbottabad

Province of Baluchistan

1. Dental Section, Bolan Medical College, Quetta

Federal - Islamabad

1. Islamic International Dental College, Islamabad 2. Dental Section, Islamabad Medical & Dental College, Islamabad


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TOTAL NUMBER OF DOCTORS/DENTAL SURGEONS (GP'S WITH BACHELORS DEGREE ONLY)35 Registered up to 31st August, 2011

M.B.B.S. B.D.S. L.S.M.F.

Province Male Female Total Male Female Total Male Female Total Punjab/Federal Area

27549 22362 49911 1895 2378 4273 511 54 565 Sindh 27872 24202 52074 1371 2350 3721 284 22 306 K.P.K 9402 4308 13710 833 787 1620 52 2 54 Baluchistan 2280 1426 3706 162 103 265 44 11 55 A.J.K. 1354 850 2204 129 94 223 3 1 4 Foreign Nationals

2340 741 3081 310 104 414 98 8 106 Total 70797 53889 124686 4700 5816 10516 992 98 1090 TOTAL=12486+10516+1090= 136292 TOTAL NUMBER OF DOCTORS/DENTAL SURGEONS (SPECIALISTS)36 Registered up to 31st August, 2011

M.B.B.S. B.D.S.

Province Male Female Total Male Female Total Punjab/Federal Area 9790 3164 12954 244 81 325 Sindh 5486 2115 7601 162 61 223 K.P.K 2715 624 3339 111 20 131 Balochistan 718 166 884 26 3 29 A.J.K. 435 101 536 18 4 22 Foreign Nationals 70 17 87 3 0 3 Total 19214 6187 25401 564 169 733 TOTAL=25401+733=26134 COLLEGE OF PHYSICIANS AND SURGEONS, PAKISTAN College of Physicians and Surgeons (CPSP) Pakistan, a post graduate training institute having regional centres across Pakistan, including five in Punjab, offers post graduate training in medical sciences in 53 specialties with sub-specialties in FCPS and Membership (MCPS) in 18 disciplines together with a two year college diploma, DCPS, which is being offered in 14 disciplines. The duration of the FCPS training varies from four to five years depending upon the specialties chosen. Competency based curricula have been developed for each discipline by the relevant faculties. More than 10,000 training seats have been awarded in 129 CPSP accredited medical institutions throughout the country. The College critically evaluates the standards and facilities available in these institutions to ensure quality training for its trainees. 35 Pakistan Medical and Dental Council, www.pmdc.org.pk 36 Pakistan Medical and Dental Council, www.pmdc.org.pk


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CURRENT PROGRAMS CPSP offers post-graduation Fellowship training in Medical Sciences in 64 specialties and sub-specialties for FCPS and Membership in 18 disciplines for MCPS and 2 for DCPS.

FCPS - (Postgraduate degree after 4-5 years of structured training) in 64 specialties MCPS (Postgraduate diploma with two years of structured training)in 18 Specialties DCPS in 2 Subjects

Fellowship Programs of the College of Physicians and Surgeons (FCPS) 1. Anaesthesiology 2. Anatomy 3. Biochemistry 4. Cardiac Surgery 5. Cardiology 6. Chemical Pathology 7. Clinical Haematology 8. Community Medicine 9. Dermatology 10. Diagnostic Radiology 11. Family Medicine 12. Forensic Medicine 13. Gastroenterology 14. General Surgery 15. Haematology 16. Histopathology 17. Immunology 18. Medical Oncology 19. Medicine 20. Microbiology 21. Nephrology 22. Neuro Surgery 23. Neurology 24. Nuclear Medicine 25. Obstetrics and Gynaecology 26. Operative Dentistry 27. Ophthalmology 28. Oral & Maxillo-Facial Surgery 29. Orthodontics 30. Orthopedic Surgery 31. OTO-RHINO-LARYNGOLOGY(ENT) 32. Paediatric Surgery 33. Paediatrics

34. Periodontology 35. Pharmacology 36. Physical Medicine & Rehabilitation 37. Physiology 38. Plastic Surgery 39. Prosthodontics 40. Psychiatry 41. Pulmonology 42. Radiotherapy 43. Thoracic Surgery 44. Urology 45. Virology 46. Cardio-Thoracic Anesthesiology 47. Clinical Cardiac Electrophysiology 48. Community and Preventive Paediatrics 49. Critical Care Medicine 50. Emergency Medicine 51. Endocrinology 52. Infectious Diseases 53. Interventional Cardiology 54. Neonatal Paediatrics 55. Paediatric Cardiology 56. Paediatric Gastroenterology - Hepatology & Nutrition 57. Paediatric Haematology Oncology 58. Paediatric Infectious Diseases 59. Paediatric Nephrology 60. Paediatric Neurology 61. Paediatric Ophthalmology 62. Rheumatology 63. Surgical Oncology 64. Vitreo Retinal Ophthalmology

Membership Programs of the College of Physicians and Surgeons (MCPS) 1. Anaesthesiology 2. Clinical Pathology 3. Community Medicine 4. Dermatology 5. Diagnostic Radiology 6. Family Dentistry 7. Family Medicine 8. Obstetrics & Gynaecology


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9. Operative Dentistry 10. Ophthalmology 11. Oral & Maxillo-Facial Surgery 12. Orthodontics 13. Otorhinolaryngology(ENT)

14. Paediatrics 15. Periodontology 16. Prosthodontics 17. Psychiatry 18. Pulmonology (Including T.B.) NURSING PROFESSION IN PAKISTAN AN OVERVIEW Health care services internationally are going through a period of profound change, particularly with the move from a focus on secondary and tertiary hospital based care to community based primary and public health initiatives. Key professions most impacted by this change are those involved in planning, administration and provision of health care services. The professions of Nursing, Health Visiting and Midwifery form a substantial part of this critical health workforce and need to be at the forefront of these changes. Pakistan is planning to be well prepared. At the time of inception of Pakistan, in 1947, majority of the nurses had migrated to the newly formed India, leaving Pakistan with a total number of 350 registered nurses that included retired nurses or those who were not in service. To resolve this acute shortage of nurses, a nursing school was established at Sir Gangaram Hospital, Lahore in December 1948 and in 1952, the first batch of trained nurses completed the general nursing program. In 1973, Pakistan Nursing Council was established which governed all nursing affairs, rules and regulation within the country. Today in Pakistan there are a total of 126 schools of nursing, 141 schools of midwifery, 30 school of public health, and 9 colleges of nursing. These include those established by the government, armed forces and private sector. In addition to these, there are colleges of nursing which offer specialized courses to the nursing diploma holders and nursing graduates. The total number of students in nursing schools is a very important indicator to determine the number of faculty and administrative staff required in these institutions, both currently, and in the future The primary purpose of nursing is the promotion and maintenance of an optimal level of wellness. The professional nurse participates in a multi-disciplinary approach to health in assessing, planning, implementing, and evaluating programs in regards to how they affect optimum wellness for patients. Being an important member of the healthcare professional team, it is important to retain nurses by better understanding the factors that contribute to their job satisfaction and elevates their motivation at work. In recent years, Pakistan has increased its Nursing, Health Visiting and Midwifery workforce production capability. In the past 10 years production of nurses has improved, the number of registered nurses has doubled and the ratio of nurses to population is now estimated to be one nurse to 3,626 people and one midwife to 53,882 population and one lady health visitor for 35,880 population. Theses figures indicate the need to increase the output of Nurse Professionals at a faster rate in order to keep up with the countrys growing population and health challenges NURSE MIGRATION The migration of nurse professionals from developing countries to the developed world has been a controversial problem for over three decades now, but the magnitude of the problem and its implications have changed due to the rapid pace of globalization. Countries of South Asia are victims of both internal migration (from rural, backward areas to the cities) as well as external migration (from country of origin to the Western countries in search of opportunities).


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The migration of nurses can be attributed to both external pull and internal push. The external pull comes from globalization and the free market economy. While opportunities for professional training, higher salaries, perks and better living conditions act as pull factors, surplus production of health personnel, resultant unemployment, l

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