Ethical Planning

This technical report summarizes the presentations and discussions that took place during a policy dialogue on international health workforce mobility and recruitment challenges. These discussions provided a better understanding of the progress made and challenges in implementing the WHO Code of Practice on the International Recruitment of Health Personnel and provided further recognition of policy mechanisms that may be used to address the challenges and benefits associated with international migration and recruitment of health personnel. [from author]

This study compared the trends in new professional registrations in the UK from doctors qualifying overseas before and after the national ethical guidance on international recruitment to determine what, if any, effect these policies have had on ethical recruitment. [adapted from author]

This paper assesses what health workforce sustainability might mean for Australia and New Zealand, given the policy direction set out in the World Health Organization draft code on international recruitment of health workers. [from abstract]

The objective of this article is to argue that it is important for all stakeholders involved in rural recruitment and/or retention processes to consider their decisions and actions from an ethics perspective. [from abstract]

This presentation discusses the United States’ implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel, the challenges and next steps. [adapted from author]

This paper describes the history of development of a WHO code of practice as well as the legal nature and significance of this proposed international instrument. The paper then highlights some key substantive issues to consider when elaborating the text of a WHO code of practice, and presents the process for moving forward the development of a WHO code of practice. [adapted from introduction]

This code provides guidelines for an ethical approach to the international recruitment of health workers in a manner that takes into account the potential impact of such recruitment on health services in the source country and it seeks to safeguard the rights of recruits, and the conditions relating to their profession in the recruiting countries. [from author]

This study focuses on the recruitment practices of Canada (a country with a long reliance on internationally trained HHR) and recruiters working for Canadian health authorities. [adapted from abstract]

The aim of this policy is to promote high standards of practice in the recruitment and employment of health professionals who are not South African Citizens or permanent residents in the health sector in South Africa. It attempts to preclude the active recruitment of health professionals from developing countries without specific government agreements. [adapted from author]

This presentation offers the findings of a study assessing how policies in richer countries impact least-developed countries, specifically regarding skilled labour migration.

International recruitment of health professionals has been high on the policy debate agenda in recent years with increasing advocacy for the development of an international code of practice, notably the current draft for a WHO global code. This paper assesses the effect of the first national code, which has been in place in England since 2001 and as such has lessons for current initiatives in other countries and globally. [from introduction]

The International Council of Nurses expressed concerns regarding the aggressive international recruitment of nurses and maintained that internationally recruited nurses might be particularly at risk of exploitation or abuse. The purpose of this study was to explore and describe how recruitment agencies contributed to the emigration of South African nurses. [adapted from abstract]

The purpose of this guide is to explain why it is necessary to ground health workforce planning in human rights, and how to develop a plan that does just that. [from summary]

The Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Nurses to the United States reflects the mutual recognition of stakeholder interests relevant to the recruitment of foreign educated nurses. It is based on an acknowledgement of the rights of individuals to migrate, as well as an understanding that the legitimate interests and responsibilities of nurses, source countries, and employers in the destination country may conflict.

This report summarizes the results of the first year of the two-year project entitled International Recruitment of Nurses to the United States: Toward a Consensus on Ethical Standards of Practice. It examines the structure and basic practices of the U.S. based international nurse recruitment industry. The purpose of the project is to facilitate consensus among stakeholders on how to reduce the harm and increase the benefits of international nurse recruitment for source countries and for migrant nurses themselves. [from author]

This editorial describes the widespread recruitment of health workers from sub-Saharan Africa to developed nations by recruiting agencies. The authors describe international efforts to criminalize this practice and express concern at the continued practice of recruitment.

One major challenge for all countries is to establish workforce planning mechanisms that effectively meet the demands for health care and provide workforce stability. However, few nations have developed strategic plans for meeting nursing resource requirements that effectively address supply and demand. Instead, many developed countries choose to implement short term policy levers such as increased reliance on immigration, sometimes to the detriment of developing countries.

Significant numbers of African-trained health workers migrate every year to developed countries including Canada. They leave severely crippled health systems in a region where life expectancy is only 50 years of age, 16 per cent of children die before their fifth birthday and the HIV/AIDS crisis continues to burgeon. The population of Sub-Saharan Africa totals over 660 million, with a ratio of fewer than 13 physicians per 100,000. [from introduction]

This guidance sets out some of the key issues faced by IRNs, and suggests good practice for managers in overcoming these problems to create a new workforce whose wellbeing and professional status is at the forefront of recruitement policies. [from introduction]

This paper assesses the reasons for recent growth in recruitment of registered nurses from other countries to the United Kingdom (UK). It aims to examine trends in inward recruitment of nurses to the UK, assess the impact of free mobility of registered nurses in the European Union from a UK perspective, examine the impact of the introduction of ethical guidelines on international recruitment of nurses to the UK, and explore the reasons why registered nurses are internationally mobile. [from introduction]

This report calls for provincial governments to take a closer look at the way they hire doctors, nurses and other health professionals from developing countries. Canada has always relied on newcomers to help deal with shortages in this field, but increasingly these professionals are coming from developing countries, especially from Africa and Asia, which have staffing shortages and critical health problems of their own.

The Royal College of Nursing commissioned this report into the employment policy and practice implications of the rapid growth in the number of internationally recruited nurses working in the UK. [from summary]

This document highlights the potential advantages and perils of career moves and migration for nurses, describes some of the main nurse migration trends and establishes a list of critical questions as an ethical framework for nurse recruitment. [adapted from author]

This paper focuses on nurses who have migrated and are registered/licensed/authorized to practice, post-adaptation/orientation, and are working as a nurse in a given country. The term international nurse is used for nurses who have been educated abroad and have either been recruited or have chosen to migrate.

London is more reliant than other parts of England on the international recruitment of health professionals. This raises several questions. How can employers support and develop such a diverse workforce? How can they retain hard-won international health care staff in the face of increasing international competition? And is it ethical to recruit workers from developing countries experiencing their own shortages? This research summary profiles the capital’s international health care workforce for the first time, with case studies detailing the experiences of three London NHS trusts.

Past attempts to estimate the cost of migration were limited to education costs only and did not include the lost returns from investment. The objectives of this study were: (i) to estimate the financial cost of emigration of Kenyan doctors to the United Kingdom (UK) and the United States of America (USA); (ii) to estimate the financial cost of emigration of nurses to seven OECD countries (Canada, Denmark, Finland, Ireland, Portugal, UK, USA); and (iii) to describe other losses from brain drain. [author’s description]

Canada is a major recipient of foreign-trained health professionals, notably physicians from South Africa and other sub-Saharan African countries. Nurse migration from these countries, while comparatively small, is rising. African countries, meanwhile, have a critical shortage of professionals and a disproportionate burden of disease. What policy options could Canada pursue that balanced the right to health of Africans losing their health workers with the right of these workers to seek migration to countries such as Canada? [author’s description]

This publication provides an overview of some of the key challenges for policy-makers in addressing the linkages between migration, health and human rights.The first section explains why we are addressing the issue of migration and health and what is meant by doing this through a human rights framework. It then explores some of the terminology used. The second section links the reasons why people migrate with the health and human rights implications of moving on the populations left behind. The third section considers the health implications for those on the move both in the context of public health as well as in relation to the health of the individual.

A human rights framework provides a formal and explicit way to examine the different social, political and economic problems that both give rise to, and result from, international migration, in particular inequality. It also allows clear and explicit articulation of where the obligation to do something about these human rights impacts lies under international human rights law, together with migration of health workers; and ensures that any improvements in the right to health are achieved without any express limitation of any other rights, including freedom of movement and rights in work.

An honest and critical examination of the role of Health Care Professionals (HCPs) during communicable disease outbreaks is needed in order to provide guidelines regarding professional rights and responsibilities, as well as ethical duties and obligations. With this paper, we hope to open the social dialogue and advance the public debate on this increasingly urgent issue. [summary]