‘Caught between a rock and a hard place’ is the expression (and Stones song ) that comes to mind having visited Marrakesh recently. Until a few months before the adoption of the (now notorious) UN Global Compact for Safe, Orderly and Regular Migration, quiet diplomacy and technical discussions guided its development process. At the time of the first meeting of WHO’s International Platform on Health Worker Mobility in September 2018, the Global Compact for Migration was still largely uncontroversial. Then, however, things changed quickly (and for the worse), as the debate and framing were hijacked by right-wing populist parties in several countries. Suddenly the Compact, intended as a framework for guiding dialogue and cooperation between countries about ‘safe, orderly and regular migration’ was framed as the main gateway for migrants entering Europe and The United States of America. That was the international backdrop as we arrived in Morocco, a few days before the adoption of the Compact.

In Marrakesh, during one of the side-events organized by Public Services International (PSI), European Public Service Union (EPSU), WHO, the Friedrich Ebert Stiftung and the governments of Germany and the Philippines, we presented a discussion paper: Global Skills Partnerships & Health Workforce Mobility: Pursuing a race to the bottom? As many of you may know, Michael Clemens, from the Centre for Global Development, has been the driving force behind this Global Skills Partnerships (GSP) concept . By now, the concept has become part of the Compact under objective 18. GSP have the aim to “Invest in skills development and facilitate mutual recognition of skills, qualifications and competence.” PSI commissioned research to us as to critically assess the skills partnership concept, its drivers and discourses, as GSP might have an impact on health equity and health systems development in both source and destination countries.

Unlike the treatment the average migrant gets at European borders nowadays, the world of ‘migration and development’ welcomed us at this UN Global Compact conference. Perhaps we were biased, but other pre-sessions seemed to indicate a big contribution (and interest) of the private sector in the economic potential of migration contributing to development. In line with mainstream economic thinking, migration was largely framed as a potential economic enabler, facilitating ‘win- win’ solutions. GSP clearly fits in this frame. By using a critical discourse lens it is evident that foremost an economic development approach and indirectly a trade and health objective are pursued through these public-private skills development partnerships facilitating health workforce mobility. The GSP seems to be a short-term cost-effective solution to address deficits in health care systems by sourcing skills transnationally. The investment case and economic benefits are projected to be sustainable and inclusive but both the literature review and interviews that we conducted failed to provide evidence of this. The GSP concept as it currently stands doesn’t adopt a human rights-based approach to health systems development nor does it give much attention to health care services as a global public good.

So, our stance versus GSP is somewhere stuck between a rock and a hard place, currently. The (GSP) picture could of course be improved, in the short-term, by assuring that trade unions and governments are strongly involved when pursuing bilateral labour agreements that include new skills partnerships; and in the longer-term by pursuing regional, and perhaps global governance and public finance model(s) to mitigate the benefits and externalities of health personnel migration.

This requires, however, in our opinion, strong public, multilateral engagement and shouldn’t be left to the market, philanthropy and the private sector. If government and trade union aren’t at the table to protect and promote the public interest, the other parties have ample space to jump in, with other interests. The risk for exactly that to happen is rather high, unfortunately, in the current international environment.

This is the political economy irony and dichotomy (of the rock and the hard place) of global labour migration and skills partnerships. They are being promoted as an efficient solution in places where care demands and financial gains are high. If there is no direct benefit [in the receiving countries] of different types of labour migration, things are, however, instantly framed as a ‘crisis’ that needs to be contained, surveilled and securitized. A more nuanced and fairer political narrative on labour migration in the health care sector (and other sectors) needs to be pursued.  And of course, in an ideal world, decent public investment in health care staff would just make GSP redundant. But we don’t live in an ideal world.

As an end-of-year thought, let us share a quote displayed in bright neon letters at the Irish emigration museum in Dublin: “We All Come From Somewhere”!