Reflections on the ethics of recruiting foreign-trained human resources for health

We conducted interviews with health human resources recruiters employed by Canadian health authorities to describe their recruitment practices and perspectives and to determine whether and how they reflect ethical considerations.We describe the methods that recruiters used to recruit foreign-trained health professionals and the systemic challenges and policies that form the working context for recruiters and recruits. HHR recruiters' reflections on the global flow of health workers from poorer to richer countries mirror much of the content of global-level discourse with regard to HHR recruitment. A predominant market discourse related to shortages of HHR outweighed discussions of human rights and ethical approaches to recruitment policy and action that consider global health impacts.We suggest that the concept of corporate social responsibility may provide a useful approach at the local organizational level for developing policies on ethical recruitment. Such local policies and subsequent practices may inform public debate on the health equity implications of the HHR flows from poorer to richer countries inherent in the global health worker labour market, which in turn could influence political choices at all government and health system levels.Canada has a long history of formal policies that have encouraged immigration, and accepts "more immigrants and refugees for permanent settlement in proportion to its population than any other country in the world [1]". For some decades this has included migration of foreign or internationally-trained health professionals, who often fill vacancies in rural and under-resourced regions of the country. Like several other developed countries (and particularly the Anglo-American nations), Canada has come to rely upon internationally-trained health human resources (HHR), particularly doctors and nurses, to meet its labour force needs. Of 260 000 nurses practicing in Canada in 2007, 8% of Registered Nurses (RNs), 2% of Licensed Prac