Recruitment of nurses from the Global South has been called ‘new form of colonialism’

Britain and other wealthy countries have been accused of adopting a “new form of colonialism” by recruiting huge numbers of nurses from poorer countries to fill their own staff shortages.

International nurse leaders said the trend led to poorer patient care in developing countries, which were not properly compensated for the loss of skilled healthcare workers.

Howard Catton, the CEO of the International Council of Nursessaid there was “real anger” among those present a meeting from nursing associations from across Africa in Rwanda this month.

He said: “African nurse leaders said they were angry that high-income countries were using their economic power to take the nursing staff they needed from poorer, more vulnerable countries.

“These richer countries effectively created a new form of long-term dependency that hinders the development of health care systems in the source countries.”

They described it as “a new form of colonialism,” he said.

World Health Organization rules aim to prevent the poaching of staff from countries with fragile healthcare systems. Recruitment from countries on the WHO “red list” should not take place without formal agreements.

However, Catton said that even these often offered only a “veneer of ethical responsibility” and there was often little evidence of mutual benefit. He has before called for a stronger global code of practice for international recruitment.

Dr. Baboucarr Cham, chairman of the National Association of Gambia Nurses and Midwives, said: “It is causing a lot of problems in The Gambia because our experienced nurses are leaving and going to Europe and America.

“Our main teaching hospital has approximately 300 registered nursing posts. Last year 53 left.”

Cham said the head of the maternity department told him she had lost 16 midwives, with staff shortages so severe that she had to leave her supervisory role and return to the department to deliver babies.

Recruiters are focusing on experienced nurses, Cham said, which requires at least two years of post-doctoral experience in a major hospital.

The remaining staff “are taking care of more people and then obviously you’re going to get tired, you’re going to be fatigued, and then the patients aren’t going to get quality care.”

In some rural facilities there are no registered nurses or midwives at all, Cham said, with serious consequences for locals: “They could lose their lives.”

He added: “We are not saying that international recruitment should not take place. It is clearly a basic human right to move to places where you can get better economic opportunities. But those who recruit must also give something back to the country. If you recruit one nurse, you have to (pay) to train two nurses.”

The remittances sent back by nurses abroad have made a huge contribution to Gambia’s development, he said, and some nurses are returning with new skills and experience.

“But at the end of the day, our healthcare systems are fragile, weak and not resilient because we do not have enough manpower and cannot retain the experienced manpower,” Cham said.

The years since Covid have seen a notable increase in international healthcare recruitment. High levels of burnout among domestic workers have led to shortages just as more staff are needed to address post-pandemic backlogs. Developed countries also have larger aging populations that require more care.

In its 2019 election manifesto, the Conservative government pledged to increase the number of nurses in England by 50,000 by 2024 – a target only achieved thanks to recruitment abroad.

Germany faces a shortage of 150,000 nurses by 2025 and has started recruiting overseas campaigns in several countries. Canada, Australia and the US also have recruitment programs, often run by regional authorities.

Recruiting countries point to higher levels of unemployment among nurses in some of the countries they target, but critics say this is generally due to a lack of money in healthcare systems to pay salaries, rather than a lack of need .

There are in Great Britain 9.2 nurses per 1,000 inhabitantsThis is evident from figures from the World Bank. For Germany this is 12.3.

There are in Gambia 0.9 nurses per 1,000 inhabitants.

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 the sense of seeking better pay or better working conditions or seeking a better or decent life for themselves.”

But she said costs associated with the official paperwork a nurse needs to prove their qualifications to foreign regulators have recently increased by 445.5%, from 550 Ghanaian cedis (£33) to 3,000 (£180) , indicating government concern in a country with 3.5 nurses per 1,000 inhabitants.

“We see it as a way to restrict the movement of our nurses,” she said. The association says it would be better “if the Ghanaian government puts in place systems that attract and retain nurses in Ghana, and not try to hold them back.”

Overall nursing figures for Ghana, which do not always distinguish between registered nurses and assistants with lower levels of education, could mask the scale of the problem, she said.

“If you visit certain health facilities, you will see the reality of the situation – unit by unit, or department by department, they are feeling the pressure of the departure of their colleagues and the burden of the work being left to those in their posts are. .”