Reflections on the ethics of recruiting foreign-trained human resources for health
Tóm tắt
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.
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.
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.
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.
Từ khóa
Tài liệu tham khảo
Knowles V: Forging our legacy: Canadian citizenship and immigration, 1900-1977. 2000, Ottawa: Public Works and Government Services Canada, (accessed 28 December 2010), [http://www.cic.gc.ca/english/resources/publications/legacy/index.asp]
Canadian Institute for Health Information: Regulated Nurses: Trends, 2003 to 2007. Ottawa. 2008
Canadian Institute for Health Information: International Medical Graduates in Canada: 1972 to 2007. Ottawa. 2009
Health Canada: Pan-Canadian Health Human Resource Strategy. 2007-2008 Annual Report. Ottawa. 2008
Labonté R, Packer C, Klassen N: Managing health professional migration from Sub-Saharan Africa to Canada: A stakeholder inquiry into policy options. Hum Resour Health. 2006, 4: 22-
The World Health Report 2006: Working Together for Health. 2006, World Health Organization. Geneva
Mensah K, MacKintosh M, Henry L: The 'Skills Drain' of Health Professionals from the Developing World: A Framework for Policy Formulation. 2005, London: Medact
Labonté R, Packer C, Klassen N: The perverse subsidy: Canada and the brain drain of health professionals from sub-Saharan Africa. Policy Options. 2006, 74-78.
Joint Learning Initiative: Human Resources for Health: Overcoming the Crisis. 2004, Cambridge, Presidents and Fellows of Harvard College
Canadian Institute for Health Information: Supply, Distribution and Migration of Canadian Physicians, 2007. Ottawa. 2008
Bueno de Mesquita J, Gordon M: The International Migration of Health Workers: A Human Rights Analysis. 2005, London: Medact
Carney B: The ethics of recruiting foreign nurses. How should Catholic organizations approach this troubling question?. Health Prog. 2005, 86 (6): 31-35.
McMurry BJ, Solheim K, Kishi R, Coffin MA, Woith W, Janepanish P: Ethical concerns in nurse migration. J Prof Nurs. 2006, 22 (4): 226-235. 10.1016/j.profnurs.2006.03.006.
Labonté R, Packer C, Klassen N, Kazanjian A, Apland L, Adalikwu J, Crush J, McIntosh T, Schrecker T, Walker J, Zakus D: The Brain Drain of Health Professionals from Sub-Saharan Africa to Canada. African Migration and Development Series No. 2. Edited by: Crush J. 2006, Cape Town: Idasa and Kingston: Queen's University
Sandelowski M: Focus on research methods: Whatever happened to qualitative description?. Res Nurs Health. 2000, 23 (4): 334-340. 10.1002/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G.
Charmaz K: Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis. 2006, London: Sage
Morse JM, Noerager Stern P, Corbin J, Bowers B, Charmaz K, Clarke AE: Developing Grounded Theory: The Second Generation. 2009, Walnut Creek, CA: Left Coast Press Inc
Bernhardt D: Sask. recruiters lure 297 Filipino nurses. The Star-Phoenix. 2008, A11:
South African Medical Association: S Afr Med J. 2007, 97 (9):
Saskatoon Health Region. Nurse Recruitment Trip. (accessed 28 December 2010), [http://www.saskatoonhealthregion.ca/news_you_need/media_centre/media/2008/recruitment_trip_ethics.htm]
Saskatoon Health Region. (accessed 28 December 2010), [http://www.saskatoonhealthregion.ca/news_you_need/media_centre/documents/shr_our_values_in_action.pdf]
World Health Statistics 2009. 2009, World Health Organization. Geneva
Fely MEL, Galvez-Tan J, Icamina K, Javier L: Nurse migration from a source country perspective: Philippine country case study. Health Serv Res. 2007, 42 (3): 1406-1418. 10.1111/j.1475-6773.2007.00716.x.
Hopkins L, Labonté R, Runnels V, Packer C: Medical tourism today: What's the state of existing knowledge?. J Public Health. 2010, 31 (2): 185-198.
Barer ML, Stoddart GL: Toward integrated medical resource policies for Canada. Can Med Assoc J. 1991, 147 (7): 999-1005.
Alinsao V, Bednash G, Bentley J, Compas L, Foster P, Gabriel S, Gostin L, Harris K, Hellquist K, Joyner J, Ketter J, Loenhardy K, Luggiero C, Marston R, Mayor RM, Morrison B, Monahan J, Nichols B, Page P, Pendergast J, Peterson C, Pittman P, Sacco M, Sandifer S, Shaffer F, Tate V, Wilson A: Voluntary code of ethical conduct for the recruitment of foreign-educated nurses to the United States. 2008, Washington DC: AcademyHealth and O'Neill Institute for National and Global Health Law
The Commonwealth Organisation: Commonwealth Code of Practice for the International Recruitment of Health Workers. Adopted at the Pre-WHA Meeting of Commonwealth Health Ministers 18. 2003, May ; Geneva
McIntosh T, Torgerson R, Klassen N: The ethical recruitment of internationally educated health professionals: Lessons from abroad and options for Canada. 2007, Report Ottawa: Canadian Policy Research Networks
Packer C, Labonté R, Runnels V: Globalization and the cross-border flow of health workers. Globalization and health: pathways, evidence and policy. Edited by: Labonté R, Schrecker T, Packer C, Runnels V. 2009, New York: Routledge, 213-234.
Nygren-Krug H: International Migration, Health and Human Rights. Health and Human Rights Publication Series. 2003, Geneva: World Health Organization, 4
Roberfroid D, Leonard C, Stordeur S: Physician supply forecast: Better than peering in a crystal ball?. Hum Resour Health. 2009, 7: 10-10.1186/1478-4491-7-10.
Health Council of Canada: Value for Money: Making Canadian Health Care Stronger. Toronto. 2009
Egger D, Lipson D, Adams O: Achieving the right balance: The role of policy-making processes in managing human resources for health problems. Issues in health services delivery: discussion paper no. 2. 2000, Geneva: World Health Organization
International Organization for Migration: Migration and human resources for health: From awareness to action. International Dialogue on Migration. No 9. Geneva. 2007
Haines A, Sanders D, Lehmann U, Rowe AK, Lawn JE, Jan S, Walker DG, Bhutta Z: Achieving child survival goals: Potential contribution of community health workers. Lancet. 2007, 369 (9579): 2121-2131. 10.1016/S0140-6736(07)60325-0.
Labonté R, Sanders D, Baum F, Schaay N, Packer C, Laplante D, Vega-Romero R, Viswanatha V, Barten F, Hurley C, Ali HT, Manolakos H, Acosta-Ramírez N, Pollard J, Narayan T, Mohamed S, Peperkamp L, Johns J, Ouldzeidoune N, Sinclair R, Pooyak S: Implementation, effectiveness and political context of comprehensive primary health care: Preliminary findings of a global literature review. Australian Journal of Primary Health. 2008, 14 (3): 58-67.
Ogilvie L, Mill JE, Astle B, Fanning A, Opare M: The exodus of health professionals from sub-Saharan Africa: Balancing human rights and societal needs in the twenty-first century. Nurs Inq. 2007, 14 (2): 114-124. 10.1111/j.1440-1800.2007.00358.x.
Chapman A: The Divisibility of Indivisible Human Rights. Economic Working Paper Series: Working Paper 9. 2009, University of Connecticut, The Human Rights Institute
Hunt P: Promotion and Protection of all Human Rights, Civil, Political, Economic, Social and Cultural Rights. Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Paul Hunt. A/HRC/7/11. 7th session, agenda item 3. 2008, Geneva: United Nations Genearl Assembly
Affiliation of Multicultural Societies and Service Agencies of BC (AMSSA): A Synopsis of Initiatives Affecting the Labour Market Integration of Foreign-Trained Professionals and Trades Workers. Vancouver. 2000
Singh JA, Nkala B, Amuah E, Mehta N, Ahmad A: The ethics of nurse poaching from the developed world. Nurs Ethics. 2003, 10 (6): 666-670. 10.1191/0969733003ne655oa.
Attaran A, Walker R: Shoppers Drug Mart or Poachers Drug Mart?. Can Med Assoc J. 2007, 178 (3): 265-266. 10.1503/cmaj.071733.
Butler J: Third world pays for the mismanagement of health-care labour force in rich nations. Canadian HR Reporter. 2003, 16 (22): 26-
Dauphinée WD: Physician migration to and from Canada: The challenge of finding the ethical and political balance between the individual's right to mobility and recruitment to underserved communities. J Contin Educ Health Prof. 2005, 25 (1): 22-29.
Mills EJ, Schabas WA, Volmink J, Walker R, Ford N, Katabria E, Anema A, Joffres M, Cahn P, Montaner J: Should active recruitment of health workers from sub-Saharan Africa be viewed as a crime?. Lancet. 2008, 371 (9613): 685-688. 10.1016/S0140-6736(08)60308-6.
Clemens M: Skill flow: A fundamental reconsideration of skilled-worker mobility and development. Working paper 180. 2009, Washington DC: Center for Global Development, (accessed 28 December 2010), [http://www.cgdev.org/content/publications/detail/1422684/]
Kapur D, McHale J: Give us your Best and Brightest: The Global Hunt for Talent and its Impact on the Developing World. 2005, Washington DC: Center for Global Development
Scott ML, Whelan A, Dewdney J, Zwi AB: "Brain drain" or ethical recruitment? Solving health workforce shortages with professionals from developing countries. Med J Aust. 2004, 180 (4): 174-176.
Wood DJ: Corporate social performance revisited. Acad Manage Rev. 1991, 16 (4): 691-718. 10.2307/258977.
Garriga E, Melé D: Corporate social responsibility theories: Mapping the territory. J Bus Ethics. 2004, 53 (1-2): 51-71. 10.1023/B:BUSI.0000039399.90587.34.
Doane D: Beyond corporate social responsibility: Minnows, mammoths and markets. Futures. 2004, 37 (2-3): 215-229. 10.1016/j.futures.2004.03.028.
Richter J: Codes in Context: TNC Regulation in an Era of Dialogues and Partnerships. Corner House Briefing No. 26: TNC Regulation, Dialogues and Partnerships. 2002, Dorset: The Corner House
Gray R: Taking a long view on what we now know about social and environmental accountability and reporting. Radical Organization Theory. 2005, 9 (1): 1-31.
Moullan Y: Can Foreign Assistance Break the Medical Brain Drain?. 2009, Paris: Centre d'Économie de la Sorbonne
Pogge T: World Poverty and Human Rights. 2002, Cambridge, Polity Press
Pogge T: Relational conceptions of justice: Responsibilities for health outcomes. Public Health, Ethics and Equity. Edited by: Anand S, Peter F, Sen A. 2004, Oxford: Clarendon Press, 135-161.