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  • Daniel Yates

Recruitment of nurses or a new form of colonialism?

If you have been treated in an NHS hospital in the last year, you may have been struck by the diversity of our health workers. Our health service draws its strength from the many nations of people that support it, and never before in its 76 years of existence have so many nations been represented: current figures demonstrate that over 1 in 5 of workers come from overseas. However, there are increasing questions over the practice of hiring abroad, with many deeming it a new form of colonialism that extracts from health services that are the most vulnerable.

Officially, the United Nations has guidelines on how health workers should be recruited from abroad. It declares that wealthy nations wishing to do so must work through ministries of health and specify the benefits to both parties involved. Furthermore, they published alongside this a list of 55 countries considered to be most vulnerable to loss of health workers and therefore disruption to their health systems. Yet, according to the Royal College of Nursing, the UK recruits from at least 14 countries on the list.  Of these 55 countries, 37 were in Africa – a disproportionate number leading many to consider whether, in the words of Kwame Nkrumah, this is ‘neo-colonialism’. 

The effects in Africa have been catastrophic: in Ghana, an estimated 4,000 nurses left in 2022 and in Zimbabwe, 2,600 left in 2021 and 2022. The President of the Gambia National Association of Nurses and Midwives, Dr Baboucarr Cham, described having to leave her role in management to return to the ward to ease the shortfall in midwives. The practice is, therefore, completely at odds with the development and aid policies of any Western nation. The World Bank estimates the UK to have around 9.2 nurses per 1000 people and Germany 12.3; Ghana, on the other hand, has approximately 3.5. This already low figure is not even representative of the tangible condition of some African health services; for example, Ghana’s nursing count doesn’t differentiate between degree-educated nurses versus those who have not yet completed training. As a result, the targeting of experienced nurses doesn’t just reduce the number of nurses on a given ward, but also the quality of care that a nurse can deliver as those that remain are increasingly inexperienced. 

This poaching is a consequence of catastrophic strategic and diplomatic decisions which disrupted our existing labour base and the subsequent failure to replace this on equal terms. Since leaving the European Union, the UK has lost out on 4,285 doctors from Europe and the free trade area (based on numbers arriving before Brexit). To some, Brexit represented an opportunity to engage more in the Anglosphere, but this extractive recruitment will alienate our potential allies and does not reflect our liberal worldview. Many, such as Dr Cham, respect the human right to live and work wherever you desire, but these rights are born out of liberal ideals and the spirit of cooperation – which is absent. Remittances contribute considerable amounts to the economies of African nations, which begins to offset part of the economic costs. However, the agreements facilitate little recompense for their precarious health systems. 

This is part of a widening decline in British foreign aid and development. The Foreign and Commonwealth Office was merged with the Office for International Development as a part of a cost-cutting measure in 2020 and the British High Commission in Lusaka, Zambia, has shrunk from 25 staff members in 1995 to 2 in 2020. Therefore, our presence in Africa does not represent one of engagement, but of extraction. We need to improve goodwill in Africa and maintain our health system (whilst not decimating that of another) and recruit through fairer deals, achievable from increased investment and attention. This will not happen as department heads and experts are cut and we become increasingly isolated from our geographic and historic partners. If we do not engage respectfully and responsibly, we risk ruining what is left of our international reputation. 

Unfortunately, we have more reason to be pessimistic. The UK government shows little inclination to restore independence for the Office for International Development, which would be the main vehicle for ensuring fair negotiations. In addition, the country is likely to become more dependent on recruiting nurses from overseas, as we lose many to Australia and the USA – the latter paying some nurses nearly double. The UK government has shown disregard for nurses over the last 15 years as the value of their pay has declined 24.63% as a result of inflation and stagnant wages. 

Intragovernmental organisations should be involved in the recruiting of nurses to ensure a fair deal. The UK has a responsibility to adhere to these established guidelines, not only because it is the ethical thing to do, but because it will benefit us in the long run. Health requires development, and development requires health. 

Image: Flickr / Number 10



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