Reflections on the ethics of recruiting foreign-trained human resources for health
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RESEARCH
Open Access
Reflections on the ethics of recruiting foreigntrained human resources for health Vivien Runnels1,2, Ronald Labonté1,2,3*, Corinne Packer1
Abstract Background: Developed countries’ gains in health human resources (HHR) from developing countries with significantly lower ratios of health workers have raised questions about the ethics or fairness of recruitment from such countries. By attracting and/or facilitating migration for foreign-trained HHR, notably those from poorer, less well-resourced nations, recruitment practices and policies may be compromising the ability of developing countries to meet the health care needs of their own populations. Little is known, however, about actual recruitment practices. In this study we focus on Canada (a country with a long reliance on internationally trained HHR) and recruiters working for Canadian health authorities. Methods: We conducted interviews with health human resources recruiters employed by Canadian health authorities to describe their recruitment practices and perspectives and to determine whether and how they reflect ethical considerations. Results and discussion: We describe the methods that recruiters used to recruit foreign-trained health professionals and the systemic challenges and policies that form the working context for recruiters and recruits. HHR recruiters’ reflections on the global flow of health workers from poorer to richer countries mirror much of the content of global-level discourse with regard to HHR recruitment. A predominant market discourse related to shortages of HHR outweighed discussions of human rights and ethical approaches to recruitment policy and action that consider global health impacts. Conclusions: We suggest that the concept of corporate social responsibility may provide a useful approach at the local organizational level for developing policies on ethical recruitment. Such local policies and subsequent practices may inform public debate on the health equity implications of the HHR flows from poorer to richer countries inherent in the global health worker labour market, which in turn could influence political choices at all government and health system levels.
Introduction Canada has a long history of formal policies that have encouraged immigration, and accepts “more immigrants and refugees for permanent settlement in proportion to its population than any other country in the world [1]”. For some decades this has included migration of foreign or internationally-trained health professionals, who often fill vacancies in rural and under-resourced regions of the country. Like several other developed countries (and particularly the Anglo-American nations), Canada has come to rely upon internationally-trained health human * Correspondence: [email protected] 1 Globalization and Health Equity Research Unit, Institute of Population Health, University of Ottawa, Canada Full list of author information is available at the end of the article
resources (HHR), particularly doctors and nurses, to meet its labour force
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