Recruitment of nurses from global south branded
‘new form of colonialism’
African nurse leaders say poorer nations face severe
shortages despite rules intended to stop wealthy countries poaching staff
Kat Lay,
global health correspondent
Wed 27 Mar
2024 07.00 GMT
The UK and
other wealthy countries have been accused of adopting a “new form of
colonialism” in recruiting huge numbers of nurses from poorer nations to fill
their own staffing gaps.
International
nursing leaders said the trend was leading to worse patient care in developing
nations, which were not properly compensated for the loss of experienced
healthcare staff.
Howard
Catton, the chief executive of the International Council of Nurses, said there
was “real anger” among attenders at a meeting of nursing associations from
across Africa in Rwanda this month.
He said:
“The African nurse leaders said they were angry that high-income countries were
using their economic power to take the nursing workforce they needed from
poorer, more fragile countries.
“These
wealthier countries were effectively creating a new form of long-term
dependency that hinders the development of health systems in the source
countries.”
They
described it as “a new form of colonialism”, he said.
World
Health Organization rules are supposed to prevent the poaching of staff from
countries with vulnerable health systems. Recruitment from countries on the WHO
“red list” should not take place without formal agreements.
Catton
said, however, that even these often offered only a “veneer of ethical
responsibility” and there was often little evidence of mutual benefit. He has
previously called for a stronger global code of practice on international
recruitment.
Dr
Baboucarr Cham, the president of National Association of Gambia Nurses and
Midwives, said: “It is causing a lot of issues in the Gambia, because our
experienced nurses are leaving and going to Europe and America.
“Our main
teaching hospital has around 300 registered nurse positions. Last year 53
left.”
Cham said
the head of its midwifery unit told him she had lost 16 midwives, with staff
shortages so severe that she had to leave her oversight role and return to the
ward to deliver babies.
Recruiters
target experienced nurses, Cham said, requiring at least two years of
postgraduate experience in a large hospital.
The
remaining staff “are caring for more people and then obviously you will get
tired, you will get fatigued, and then patients will not receive quality care”.
In some
rural facilities there are no registered nurses or midwives at all, Cham said,
with severe consequences for local people: “They can lose their lives.”
He added:
“We are not saying international recruitment should not happen. Obviously it is
a fundamental human right to move to places where you can get better economic
opportunities. But those recruiting should also give back to the country. If
you recruit one nurse, you should [pay to] train two nurses.”
Remittances
sent back by nurses overseas made a huge contribution to the Gambia’s
development, he said, and some nurses do return with new skills and experience.
“But at the
end of the day our health systems are vulnerable, they are weak, and not
resilient, because we do not have enough manpower, and cannot retain the
experienced ones,” Cham said.
The years
since Covid have seen a notable increase in international healthcare
recruitment. High levels of burnout in domestic workforces have created
shortages just as more staff are needed to tackle post-pandemic backlogs.
Developed countries also have larger ageing populations requiring more care.
In its 2019
election manifesto, the Conservative government promised to boost nurse numbers
in England by 50,000 by 2024 – a target met only because of overseas
recruitment.
Germany
faces a shortfall of 150,000 nurses by 2025 and has launched overseas
recruitment campaigns in several countries. Canada, Australia and the US also
have hiring programmes, often carried out by regional authorities.
Recruiting
countries point out higher levels of nursing unemployment in some of the
countries they target but critics say this is generally because of a lack of
money in health systems to pay salaries, rather than a lack of need.
In the UK,
there are 9.2 nurses per 1,000 people, according to figures collated by the
World Bank. For Germany it is 12.3.
In the
Gambia, there are 0.9 nurses per 1,000 people.
Perpetual
Ofori-Ampofo, president of the Ghana Registered Nurses and Midwives
Association, said migration is “the right of the individual”.
She said:
“You cannot stop them from moving abroad in terms of seeking better
remuneration or of better conditions of service or aspiring for better or
decent lives for themselves.”
But she
said the fees associated with the official paperwork needed for a nurse to
prove their qualifications to overseas regulators had recently gone up 445.5%,
from 550 Ghanaian cedi (£33) to 3,000 (£180), suggesting government concern in
a country with 3.5 nurses per 1,000 people.
“We see it
as a way to curtail the movement of our nurses,” she said. The association says
it would be better “for Ghana’s government to put in systems that will attract
and retain nurses in Ghana, not to try to stop them”.
Overall
nursing figures for Ghana, which do not always distinguish between
degree-educated registered nurses and assistants with lower training levels,
could mask the scale of the problem, she said.
“If you
visit particular health facilities then you will see the reality of the
situation – unit by unit, or department by department, they are feeling the
pinch of their colleagues leaving and the burden of work that is left to those
that are at their post.”
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