ICN contributes to Global Code of Practice on the International Recruitment of Health Personnel

WHO
15 August 2024
WHO Global Code

The International Council of Nurses (ICN) has submitted a comprehensive evidence-based report highlighting gravely concerning nurse recruitment trends, as part of the latest reporting round on implementation of the World Health Organization (WHO) Global Code of Practice on the International Recruitment of Health Personnel.

ICN urgently calls on countries worldwide to submit national reports to WHO before the 31 August deadline. With global nurse migration reaching crisis levels and many countries failing to report their data, ICN urges nurses and national nursing associations (NNAs) to leverage their collective influence in motivating their country’s designated WHO authority to make a submission during this round.

ICN President, Dr Pamela Cipriano said:

“Nurses and NNAs have a vital role to play in supporting WHO reporting and driving change. ICN has previously flagged the issue of low reporting rates: in the last Global Code submissions round, just 77 countries submitted data, and European countries’ reporting rates declined compared with previous rounds. Country-level reporting is essential to accurately assess global nurse recruitment trends, identify areas of concern, and inform evidence-based policy that protects populations and health workers alike. By raising their collective voice, nurses and NNAs can help ensure the comprehensive data collection we need to strengthen the Code and drive safe, sustainable, and fair health recruitment practices worldwide.”

ICN’s Global Code report comes alongside several recent advocacy efforts aimed at addressing growing unethical nurse recruitment practices, which include interventions at the World Health Assembly, media publications and engagements, and the ICN President’s recent open letter to the G20 leaders.

ICN’s report highlights a significant increase in nurse migration from low and middle-income countries to high-income nations over the past three years, largely driven by a small number of high-income nations engaging in active recruitment to address domestic nursing shortages. It stresses the detrimental impact of heightened nurse migration exacerbating shortages and weakening health systems in low-income countries and discusses how over-reliance on quick-fix international recruitment masks underlying workforce retention issues in destination countries. ICN’s submission also sounds the alarm over reports of abusive and exploitative practices by some recruitment agencies, with migrant nurses subjected to misleading information, debt bondage, and poor working/living conditions. ICN points to a lack of comprehensive data on agency involvement as well as recruitment and migration flows more generally.

Additionally, ICN’s report draws attention to issues with nursing shortage data that is based on simplistic stock-and-flow measures. Stock-and-flow data does not capture nurse coverage in relation to countries’ real and projected health needs or the impact of international recruitment dynamics, and thus may not accurately reflect widening global nursing inequalities.

The ICN report also highlights a study by the ICN Global Nursing Leadership Institute (GNLI) Scholars Europe Group of Chief Nursing Officers (CNOs) and National Nursing Associations (NNAs) across 36 European countries which found that 25% of CNOs and 46% of NNAs reported that they did not have access to reliable data on internationally educated nurses, further highlighting the need for comprehensive, transparent, and accessible data collection systems across all sectors of health care.

In the report, ICN provides several key recommendations to strengthen the Code and its implementation, including:

  • A temporary moratorium on active recruitment of nurses from the most vulnerable countries on the WHO Health Workforce Support and Safeguard List.
  • Clear and binding accountability measures for non-compliance with the Code.
  • Improved data collection, reporting and monitoring on international nurse migration and recruitment, including use of a “self-sufficiency indicator”.
  • Use of needs-based modelling and analysis of nursing coverage in the upcoming second State of the World's Nursing (SOWN) report, including data on the actual healthcare needs of populations, projections based on the increased numbers of nurses required to achieve Universal Health Coverage (UHC), and assessments of growing global nursing inequities and the unequal economic capacities of countries to employ nurses.
  • Independent monitoring of bilateral agreements and recruitment agency activities.
  • Development of equitable bilateral agreements that incorporate tangible investments in strengthening source countries' health systems.
  • Strengthened measures to protect migrant nurses' rights and combat exploitation, discrimination and unsafe working and living conditions.
  • Firm commitments by high-income countries to prioritize building self-sufficient nursing workforces and address retention issues.
  • Coordinated action among the main high-income nurse recruiting countries to drive joint, ethical solutions.

These recommendations echo Dr Cipriano's recent letter to G20 leaders, which emphasized that “without bold, collaborative resolutions to curb the depletion of nursing workforces in vulnerable nations, global healthcare access gaps will continue to widen”. Dr Cipriano warned that unethical nurse recruitment is “compromising our shared global health ambitions to achieve the Sustainable Development Goals (SDGs) and universal health coverage (UHC)” and called for solutions based on “building resilient, equitable, and sustainable health systems that leave no country behind”.

[1] Brubakk, K., Godfrey, M., Kwaku, F., Solberg, T., Toure, Y. (2024). Can Bilateral Labour

Agreements Safeguard the Rights, Health and Well-being of Internationally Educated Nurses in Europe? Global Nursing Leadership Institute (GNLI) Scholars Europe Group 2023. Full Report. https://doi.org/10.25419/rcsi.26114605.v1