International recruitment

International recruitment needs to be managed to avoid negative impact on the health systems of developing countries. However individual freedom and the right to emigrate will always keep a number of migrant nurses and doctors moving across borders. Consequently, issues concerning the welfare of immigrant health workers also need to be addressed.

Health workers are often found to be part of the refugee community in developed countries. In order to tackle the shortage of nurses and doctors in London, the Mayor of London Office in 2002 commissioned a study to identify skilled professional among the refugee population. The main finding of the study was that a number of refugee nurses and doctors were willing to be employed by the health system. The report calls for an ethical treatment of these professionals and recommend support for these workers to be able to enter the health workforce. See Missed opportunities.

Research has demonstrated the vulnerability of overseas staff in health systems. For example, overseas nurses recruited by private agencies or directly by nursing homes in the UK are exposed to exploitation during the recruitment process as well as during their professional practice.

The study, Researching equal opportunities for overseas-trained nurses and other healthcare professionals explores the experiences of overseas-trained nurses and other health professionals, public and private health services in the UK. The authors found that overseas trained nurses’ skills and experiences were generally not recognised, and that they face discrimination in the workplace.

Positive practice environments provides an overview of the influences of international policies and agreements on nurses experiences. It also explores the social and personal benefits and costs of migration for international nurses and outline framework to develop positive practice environments to support long-term integration and the retention.

Two third of the overseas nurses working in the UK are recruited with the support of specialised recruitment agencies. (See Should I stay or should I go?) Yet, the role of recruitment agencies in international migration has attracted limited attention in the research agenda. Susan Maybud and Christiane Wiskow in Merchants of labour explored how these agents not only facilitate recruitment but also instigate migration of highly needed health professionals from countries facing serious problems of shortages of HRH.

Source (countries from where migrants emigrate) and destination countries need to ensure that the movement of health professionals is guided by ethical rules. John Connell and Barbara Stilwell argue that source countries need to ensure adequate production and retention of their own staff. Destination countries need to improve their recruitment standards ensuring equitable standards and a return of losses incurred by source countries.

Codes of practice for international recruitment

Given that international recruitment has been blamed for nursing and doctor shortages in developing countries, some countries which are destinations for migrant health workers, such as the UK, have now introduced codes of practice for ethical recruitment of health personnel. But compliance is purely voluntary, and they do not regulate the private sector, which continues to recruit nurses from overseas. Ethical international recruitment of health professionals: will codes of practice protect developing country health systems? reviews the use of codes of practice (and similar instruments), as a means of managing the migration of health professionals from developing countries where staff are in short supply.

See also:

• Commonwealth Code of Practice for the International Recruitment of Health Workers
• UK Code of Practice for the international recruitment of healthcare professionals

Retention

Improving retention of health professionals within national health systems is one of the main challenges for HRH managers and policy makers. Interventions at this level require strategic packages rather than single approaches. Often these strategic elements fall under different sectors, increasing the complexity of the process.
Low retention of health professionals in sub-Saharan Africa results in the loss staff with the most experience going abroad for improved professional and economic development. This has left many health systems in the region on the verge of collapse. See Supporting the retention of human resources for health.

Retaining health workers in low-income countries needs to be addressed in a number of ways. For instance, increasing the production of health workers will have a limited impact if is not coordinated with good retention. Low-income countries have been adopting policies to improve retention of health workers in the last decade with different results. See Retention of health care workers in low-resource settings.

Further resources on retention

• A study identifying factors affecting retention of midwives in Malawi