WHO 2010 Code Fails to Improve Physician Supply in Shortage Countries

Study finds voluntary code reduced doctor migration initially but did not boost physician density in lower-income nations

Feb. 6, 2026 at 9:31pm

Got story updates? Submit your updates here. ›

A new study led by the Harvard Pilgrim Health Care Institute evaluates the impact of the WHO's 2010 Global Code of Practice, a voluntary agreement intended to improve ethical recruitment of physicians from countries with healthcare worker shortages. While the Code initially reduced physician migration from these countries, the research finds it did not improve their overall physician supply, highlighting the need for broader investments to strengthen global health systems.

Why it matters

Global health workforce shortages are intensified when doctors from lower-to-middle income countries (LMICs) migrate to high-income countries (HICs). The WHO Code was an attempt to address this issue, but the new findings suggest more comprehensive solutions are needed to sustainably build up the physician workforce in shortage countries and promote global health equity.

The details

Researchers analyzed physician migration to OECD countries from 2000-2021, comparing 56 WHO-designated shortage countries to 116 non-shortage countries. They found the Code was associated with about 2,600 fewer physicians leaving shortage countries each year, or roughly 17,000 during the first five years - a nearly 30% annual reduction in emigration. However, this effect diminished over time, and physician density in shortage countries did not improve across the full study period.

  • The WHO Global Code of Practice was unanimously signed by all member states in 2010.
  • The study analyzed data from 2000 to 2021.

The players

Harvard Pilgrim Health Care Institute

The research institute that led the study evaluating the impact of the WHO's 2010 Global Code of Practice.

World Health Organization (WHO)

The United Nations agency that established the voluntary Global Code of Practice in 2010 to address the issue of physician migration from countries with healthcare worker shortages.

Organization for Economic Co-operation and Development (OECD)

The group of mostly high-income countries that was the focus of the analysis on physician migration patterns.

Hao Yu

Harvard Medical School associate professor of population medicine at the Harvard Pilgrim Health Care Institute and senior author of the study.

Tarun Ramesh

Research fellow at the Harvard Pilgrim Health Care Institute and lead author of the study.

Got photos? Submit your photos here. ›

What they’re saying

“We saw a clear short-term drop in physicians leaving shortage countries after the WHO Code, but the effect faded over time.”

— Hao Yu, Harvard Medical School associate professor of population medicine

“Improving working conditions and training capacity is critical if countries want to sustainably invest in their physician workforce. Reducing migration alone won't move the needle in the quest for global health equity.”

— Tarun Ramesh, Research fellow

What’s next

The authors note that in addition to the Code, high-income countries and international agencies need to help lower-to-middle income countries build support systems, improve working conditions, and provide career support for physicians in order to sustainably invest in their healthcare workforce.

The takeaway

While the WHO's 2010 Global Code of Practice initially reduced physician migration from shortage countries, it did not lead to improvements in their overall physician supply. This highlights the need for more comprehensive solutions, including investments to strengthen health systems and working conditions in lower-income nations, in order to achieve global health equity.