Canada contributed 3.6 billion dollars in assistance to developing countries in 2005-2006. But we and other rich countries practice what has been called by some “foreign aid in reverse”: The recruitment of foreign health professionals from the developing world, a potential obstacle to the deployment of our initiatives in poorer countries. The WHO estimates that 57 nations are now facing a critical shortage of health professionals, 36 being located in sub-Saharan Africa, a region facing huge challenges with HIV/AIDS, as well as drug resistant tuberculosis and malaria. The total need for these countries is estimated at 2.4 million physicians, nurses and midwives.
At the same time, there are more Malawian physicians in Manchester than in Malawi, and more Ethiopian doctors in Chicago than Ethiopia. Canada is among the most active recruiters of healthcare professionals in the developing world. Data from CIHI (2011) shows that across Canada, 24% of practicing physicians are international medical graduates (IMGs). At the same time, the proportion of Canada’s IMGs trained in developing nations has increased steadily, from 52% in 1981-1990 to 76% in the last decade – so we are poaching doctors from developing nations at an ever-increasing rate. The same CIHI report shows that in Saskatchewan, fully 47% of the medical workforce is composed of IMGs, and 96% of its new IMGs graduated from medical schools in the developing world.
It is difficult to define what constitutes a fair balance between the principle of free movement of individuals and a collective responsibility to support (or at least not hinder) the sustainable improvement of public health and living conditions in the developing world. The good news is that during the last decade this issue has been exposed, debated and some action is being taken. In Canada, however, we are still putting much more emphasis on our own needs for health care professionals than on the unintended consequences of our appetite for foreign trained physicians and nurses.
In 2003, the Commonwealth countries adopted a Code of Practice for the International Recruitment of Health Workers. Unfortunately, not all member states ratified the document: Canada and a few others expressed only general support. In 2010, the WHO published a global code of practice for healthcare worker migration and similar initiatives have taken place in the Pacific region and the Caribbean countries. The UK, initially singled out as one of the main culprits, signed a bilateral agreement with South Africa in 2003, which focuses on reciprocal educational exchange of personnel. Under this agreement, South African doctors and nurses will have the opportunity to work in the UK National Health Service on various projects, while National Health Service staff will be encouraged to take on assignments in South Africa. The UK has also introduced a code of conduct for ethical cross-border recruitment and retention of healthcare workers.
The principles contained in these documents revolve around the concepts of transparency, fairness and mutual benefits. Their aim is not to build obstacles to the recruitment of foreign health professionals or limit the free movement of individuals. Rather, they seek to combine recruitment efforts with a sustained commitment to support training in the affected countries and fair treatment of these workers once they integrate into our health care systems.
Our federal, provincial and territorial ministers should take a step back from their disputes over financing and jurisdiction to address this important issue. It would have a profound positive impact both and home and abroad. In global health, we must stop being part of the problem.