Vitalité to recruit health workers from West African countries facing even worse shortages

New Brunswick's shortage of health-care workers has the province's health authorities embarking on international recruitment trips to boost staffing levels in their hospitals.

But at least one health authority plans to send delegates to recruit staff in countries that the World Health Organization says face severe shortages themselves.

Vitalité Health Network says it plans to send recruiters to Senegal and Ivory Coast "over the next few weeks" as part of its international recruitment efforts to hire nurses from West Africa and French-speaking Europe.

Both of those countries are part of WHO's Health Workforce Support and Safeguard List.

Published in early 2021, the list originally comprised 47 countries that WHO says "face the most pressing health workforce challenges" based on a scale measuring health service coverage.

WHO says it plans to update the list every three years, and during opening remarks at a recent executive board summit, director general Tedros Adhanom Ghebreyesus said another eight countries had been added.

According to the UN body, all countries on the list "should be provided with safeguards that discourage active international recruitment of health personnel."

It said the countries listed should also be prioritized for health personnel development and health system-related support.

WHO doesn't prohibit government-to-government health worker agreements that allow richer countries to hire personnel from the listed countries.

However, any agreement should be informed by a health labour market analysis to ensure adequate domestic supply of staff in the countries where recruiting is done.

The agreements should also involve health-sector stakeholders in the target country and be brought to the attention of WHO secretariat.

Jim Campbell, WHO's director of health workforce, said in an email to CBC that Senegal and Ivory Coast were two of 57 countries first identified in 2006 as having "critical health workforce shortages."

They were since included in the Workforce Support and Safeguard List in 2020, and continue to be part of it as of this year.

"Active recruitment of health workers from these countries would be contrary to the WHO Global Code of Practice and the consensus decisions of the World Health Assembly," Campbell said.

Conflicting information from Vitalité, ONB

Vitalité originally told CBC News that its nurse recruitment efforts extended nationally to cities in Quebec and internationally to countries including Senegal, Ivory Coast and Morocco.

But when asked in a followup email about ethical considerations about hiring nurses from those countries, Vitalité said Opportunities New Brunswick is organizing the recruitment missions and questions should be referred to them.

In a later email to CBC News, ONB spokesperson Michel LeBlanc said the agency plans to recruit care workers — not nurses — from those countries.

LeBlanc said the agency has worked closely with Vitalité and the authorities in the two countries through their respective employment agencies.

"No recruitment activities in the health field (or otherwise) takes place without prior consultation with Canadian embassies and national employment agencies," LeBlanc said.

Ivory Coast scores 45.44, Canada 89.36

The 47 countries originally listed on the Health Workforce Support and Safeguard List all got there for falling below 50 on a scale WHO uses, known as the UHC service coverage index.

Ranging from zero to 100, the index scores countries based on the service coverage for reproductive, maternal, newborn and child health; infectious diseases; noncommunicable diseases; and service capacity and access.

Based on the latest data from 2019, Senegal and Ivory Coast have scores of 48.99 and 45.44, respectively. Canada has a score of 89.36.

In addition to having an index lower than 50, the listed countries also have a density of doctors, nurses and midwives that is below the global median of 48.6 per 10,000 population, says the WHO.

Recruitment tactic problematic, researcher says

The latest WHO data for Canada shows it has 123.8 skilled health professionals per 10,000 people. 

Regardless whether Vitalité is hiring nurses or care workers, hiring health-care workers from those two countries is problematic, said Ivy Bourgeault, a sociology professor at University of Ottawa and lead of the Canadian Health Workforce Network.

"If you are taking out health workers at whatever role they are playing in Senegal and Côte d'Ivoire … and bringing them here to Canada, a high-income country, and integrating them in whatever role, that is still taking important health-worker resources away from countries that absolutely need them," Bourgeault said.

Bourgeault said another concern is that many health-care workers in countries such as Senegal often do the work of a nurse, but their formal qualifications result in their being given another title once recruited by foreign countries.

It's a good sign that Opportunities New Brunswick says it's working with authorities in Senegal and Côte d'Ivoire, but it's unclear whether health care in those countries benefits from the arrangement.

"For example, what could be said is 'We are going to, you know, recruit health workers. In return, our faculty are going to come and provide professional development for your faculty'," Bourgeault said.

CBC News asked Vitalité and ONB whether the two countries were receiving anything when their workers are recruited. LeBlanc said there is no instance where ONB would provide compensation to a country for recruitment.

Bourgeault said instead of looking outside the province, New Brunswick should be trying to retain current staff and inviting back those who've left. 

"Perhaps a better investment of that money could be on mentorship programs or retention initiatives or, you know, pathways to return people to work in different sort of work roles that could accommodate the reasons why they left in the first place."

Retention key, union says

New Brunswick Nurses Union president Paula Doucet agreed and said retention has as big a role to play as recruitment in fixing the staff shortage.

"If we don't start keeping the experience, and the nurses here in our system to mentor, orient and help train those that are being put into the system brand new, we're setting them up to fail," Doucet said

"One of the most recent things that I've pitched to our premier, our minister of health and others, is they need to seriously consider a retention incentive for those nurses that have continued to show up day in and day out in their system and hold our system together."

Vitalité said as part of its recruitment efforts, it's offering $10,000 signing bonuses to nurses who accept full-time work and sign a three-year contract.

The health network is also offering a $10,000 signing bonus for patient-care attendants who sign a two-year contract.