Leading Spanish newspaper El País amplifies ICN's stand against unethical international recruitment

The International Council of Nurses (ICN) is prominently featured in a new article by leading Spanish newspaper El País highlighting the devastating impact of inequitable nurse migration on global health, with a focus on African nations such as Ghana, where 400–500 nurses leave every month.

The article describes how high-income countries' aggressive recruitment of nurses from low-income states is threatening global health equity and leaving communities already suffering severe shortages without access to care. Recruiters often specifically target experienced and specialist professionals who are especially difficult to replace.

El País quotes ICN’s CEO, Howard Catton, who expressed strong concern that while foreign-educated nurses are “a fundamental pillar” of healthcare systems in wealthy nations, their large-scale departure from countries in sub-Saharan Africa “widens the gap between rich and poor countries” at a time when the world is already facing a global health emergency due to a severe and widespread shortage of nurses.

ICN has consistently condemned unsustainable and unethical recruitment of nurses from the world’s most fragile health systems who can least afford to lose their health workers and called for an end to these practices, which have been described by some African nursing leaders as a form of “neo-colonialism.” As the El País article notes, there has been a surge in international health personnel recruitment following the pandemic. ICN has principally attributed this trend to high-income countries seeking a quick fix for workforce shortages which stems from chronic underinvestment in training and retaining their nurses.

The true global cost of unethical recruitment

The El País reporting documents the alarming human impact of these practices on the ground. The Ghana Registered Nurses and Midwives Association (GRNMA), who are members of ICN, described intensive care units forced to close due to the exodus of nurses; severely strained regional hospitals; and increased pressure and workload experienced by the nursing professionals who remain.

When nurses leave, developing countries also lose the significant investment they have made in their training. ICN has highlighted that training a nurse in the UK, for instance, costs approximately £50,000, while recruiting one from elsewhere costs only £10,000. This cost saving for wealthy countries comes at the expense of further destabilizing low-income states who are left without the much-needed and irreplaceable health workers whose education they have funded. In the El País article, Mr Catton points to a troubling paradox: the world’s wealthiest nations are providing development aid to African countries at the same time they are undermining those same countries’ healthcare infrastructure through aggressive recruitment. Ghana has a grave shortage of nurses to meet its population’s needs but many nurses face unemployment because there is a lack of resources to hire them — not because there is a real surplus of nurses.

Ghana is on the World Health Organization’s (WHO) “Red List” of states deemed so vulnerable that healthcare personnel should not be recruited from them without specific agreements in place, but migration still seems to be increasing. In fact, the number of nurses and midwives from WHO Red List nations has almost tripled over the past three years in the UK alone.

ICN’s advocacy and critical next steps

ICN sounded the alarm on this growing problem and its consequences in a detailed 2024 report to WHO on the Global Code of Practice on International Recruitment. ICN has also made strong calls to strengthen WHO’s Code by implementing clear, binding accountability measures for nations actively engaging in unethical recruitment practices and ensuring that countries who lose their health personnel are adequately compensated.

Though in some cases, there are bilateral agreements in place between recruiting countries and source countries, as the El País article explains, these rarely provide fair, mutual benefits. ICN has urgently called for wealthier countries to offer tangible, meaningful compensation when recruiting from vulnerable states. This could take the form of direct investments in building health infrastructure and supporting nursing schools and nursing jobs in the countries they recruit from to “offset” the negative impact.

ICN has specifically called on the world's largest economies to take coordinated action to protect developing nations’ workforces, with recent efforts including an open letter from ICN’s President, Dr Pamela Cipriano, urging the G20 leaders to address this escalating crisis. The 2024 G20 Health Ministers' Declaration reflected ICN's calls for action, acknowledging the need to “mitigate any negative effects and implement strategies to better manage migration of the health workforce supporting and safeguarding the countries with the most pressing health workforce needs”.

As we move into 2025, ICN will continue to prioritize advocacy on this issue. WHO plans to present the latest round of reporting on the implementation of the Global Code at the 78th World Health Assembly in May 2025 and this year will also see the release of a new WHO State of the World’s Nursing Report (SOWN), an important opportunity to analyse data on global nursing workforces and migration patterns alongside populations’ health needs.

Mr Catton said:

“2025 is a critical year for nursing and global healthcare policy. We need to ensure that SOWN and the upcoming Global Strategic Directions for Nursing and Midwifery accurately reflect the complex realities of developing nations like Ghana which simultaneously face nursing shortages and nurse unemployment — and then use this data to implement urgent changes to our world’s health systems. 2025 marks the start of the five-year countdown to achieving the UN’s Sustainable Development Goals by the 2030 target, and rampant unethical nurse recruitment is pushing us further off track to meeting our shared global commitment to Universal Health Care. Now is the time for our world’s leaders to take bold, decisive action to develop truly resilient, equitable health care infrastructures and stop depleting nursing workforces in the world’s most vulnerable countries.”

To read the El País article please click here.