WHO calls for ‘fair and ethical’ international nurse recruitment

The guidance, titled Bilateral Agreements on Health Worker Migration and Mobility, aims to promote a “new generation” of international recruitment agreements between nations which are more equitable to both parties involved.

“[Financial contributions] do not compensate for the loss of health personnel with several years’ experience”

WHO guidance

These bilateral agreements between two nations are usually put in place between the country of origin and the receiving host nation, prior to the recruitment of nurses, doctors and other healthcare.

They may, but do not always, include a promise from the host nation to contribute financially towards the country of origin, or other benefits, in exchange for the loss of the healthcare workers.

But international organisations, including the WHO and the International Council of Nurses, as well as UK nurse leaders, have criticised such agreements for not always being equitable.

The WHO’s new guidance states: “Bilateral agreements on health worker migration and mobility tend to be driven by  the health sector needs of the destination countries and, in some cases, with limited meaningful engagement by the ministries of health of the countries of origin.”

The guidance, which had contributions from the Organisation for Economic Co-operation and Development and the International Labour Organization, referred to an unbalanced “power dynamic” between often vastly more wealthy host countries and the countries of origin which are often subject to high levels of emigration.

As a result, the WHO said agreements currently often benefit the host countries far more and any monetary investment into the country of origin’s health system usually did not counterbalance the loss of experienced healthcare staff.

“While bilateral agreements have allowed countries of origin to limit the negative consequences of health worker migration and mobility to a certain extent, they have not yielded investments in health system strengthening,” the document said.

“Even if the destination country makes a financial contribution to the education in the country of origin, it does not compensate for the loss of health personnel with several years’ experience…,” it said.

“Some countries of origin could face an endless cycle of continued investment in enhancing the competencies of health workers who are then internationally recruited, leaving their population to be served largely by junior health workers,” it added.

The WHO recommended that, going forward, countries should create a “new generation” of bilateral agreements that are less geared towards benefitting the economies of highly developed nations.

These agreements, the WHO said, should be balanced in terms of the benefits to both nations, and prioritise improving health outcomes over economic benefit to the countries.

“This will require signatories to explicitly define the types and amounts of investments and support, as well as other essential safeguards, that will benefit the health system of the country of origin,” the guidance said.

It recommended that professional health organisations, unions, regulators, diaspora associations, employers, and government wings should be consulted on these agreements, and said data collection was crucial to inform new ones in the future.

The guidance was made public this week, tying into World Health Worker Week.

WHO director of health workforce James Campbell said the guidance would, going forward, support fairer bilateral agreements.

“We need a new generation of bilateral agreements that promote fair and ethical international health worker migration and mobility that brings proportional benefits to health systems of both source and destination countries,” he added.

Calls for guidance like this have been made repeatedly by leading nursing figures in the UK in recent years.

Chief nursing officer Dame Ruth May, in 2023, spoke of an “ethical” dilemma over international recruitment, warning of the harm it can cause to developing countries when unrestricted.