The Quebec government’s tone of pride regarding the active recruitment of nurses abroad in French-speaking countries, particularly in Cameroon, Senegal, Haiti and the Democratic Republic of the Congo, is particularly deaf with regard to our social responsibility. with our global partners.
The shortage of healthcare workers is one of the biggest challenges to global health, with an estimated shortage of 18 million healthcare workers worldwide, half of whom are nurses and midwives, according to the World Health Organization (WHO, 2020).
To meet the primary health care needs of a population, the WHO Sustainable Development Goals (2018) propose a minimum density of 4.45 doctors, nurses and midwives per 1000 population. In Cameroon, one of the countries targeted by the first phase of recruitment for Quebec, there are 0.55 doctors, nurses and midwives per 1,000 inhabitants and this number deteriorated between 2008 and 2018 (WHO, 2021). The disparity is stark with 14.2 of these professionals per 1,000 population in Canada.
The unequal distribution of health resources among nations is a global injustice. It threatens the ability of countries to provide primary health care to their people. According to the WHO, Africa accounts for 25% of the global burden of disease, but only 3% of the health workforce (WHO, 2021). Quebec offers very attractive incentives, which makes local retention strategies difficult, creating a vicious circle in which more nurses are pushed from their home country. A similar vicious cycle exists here; many locally trained nurses are leaving Quebec or the public sector in search of better wages and conditions elsewhere, worsening our current nursing shortage.
The WHO Global Code of Practice for the International Recruitment of Health Personnel (2010) was established to guide ethical practices in global recruitment. A key statement asserts that “Member States should discourage the active recruitment of health personnel from developing countries facing acute health workforce shortages” (WHO, 2010). In its current plan, Quebec is intentionally recruiting from five countries identified by the WHO as requiring specific safeguards to discourage active international recruitment given the severity of their own healthcare worker shortages (WHO, 2020). Quebec is violating WHO ethical guidelines in the international recruitment of nurses and depriving these countries of their own health expertise, which they desperately need.
This injustice is particularly glaring given Quebec’s long history of budget cuts, devaluation of the nursing profession, and the recent elimination of retention measures for nurses (see Wasserman
To improve health care in Quebec, the government should start by listening to nurses, addressing the factors that are pushing our own locally trained nurses to leave the province and the profession, and improving working conditions. Quebec should rethink its international recruitment strategy and commit to making nursing a valued and attractive profession here to ensure the long-term sustainability of health care.