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From Competition to Collaboration

Ethical leadership in an era of health worker mobility

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We are pleased to launch From Competition to Collaboration: Ethical Leadership in an Era of Health Worker Mobility, a highly anticipated report which examines how the UK’s ambitions to increase international recruitment sit alongside – and often undermine – long standing UK commitments to support the development of health services in LMICs.  

To read the full report please click here.

In the UK we struggle to educate, train and retain enough health workers in sufficient numbers. Since the inception of the NHS in 1948, we have relied on a steady stream of professionals recruited from elsewhere. Many of these individuals, whose training has often been paid for by their own governments, come from countries facing grave shortages of health workers themselves, particularly low- and middle- income countries (LMICs) in Africa and Asia that can ill afford to lose such a precious resource.  

The report argues that the UK can no longer take for granted its status as a ‘destination of choice’ for health workers, and is written with a conviction that the UK’s response to the global shortage of health workers should be to forge closer, more collaborative links between our health service and those of LMICs in order to establish the UK as a trusted partner internationally.


Our aim for From Competition to Collaboration is to help guide our partners in government in these challenging times by articulating an ethical route through the immense challenges of workforce shortages, drawing on our second preoccupying concern as a charity: the fate and wellbeing of the NHS. The specific timing of this report is shaped by the UK’s decision to leave the European Union (EU); we must ensure that the UK’s efforts to help establish resilient health systems overseas are not undermined by our need to attract health workers to the UK. The report seeks, therefore, to articulate how we can work in ways that both strengthen the NHS and the health services of LMICs.


Report highlights


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The world will be short of 18 million health workers by 2030.

  • Without sustained commitments to educate, train and retain people in sufficient numbers at a national level, this shortfall will continue to grow. As such, over one third of health investments required for the Sustainable Development Goals will be needed for the health workforce.
  • In this paper, we make the case that greater collaboration and less competition between nations is ultimately the answer to tackling this shortfall and achieving health workforce sustainability in an increasingly mobile world. See Section 1.
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Of the top 15 countries NHS staff are most commonly recruited from, seven are LMICs.

  • We live in an increasingly competitive world where countries like the UK are accelerating their efforts to recruit health workers from overseas, exacerbating gaps in health systems that simply cannot afford to lose them.
  • THET believes that there are no winners in this escalation in international recruitment. In this report we articulate an ethical route, consistent with the WHO Global Code of Practice, through the immense challenges of workforce shortages. See page 4.
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In Uganda, 29,000 nurses are unemployed out of a total registered workforce of 64,000.

  • With a lack of financial resources, Uganda faces severe health worker shortages and staff absenteeism, coupled with a lack of necessary equipment and utilities, such as electricity, water and housing for health workers.
  • In this report, we identify how we can work in ways that can both strengthen the NHS and the health services of LMICs to achieve health workforce sustainability in an increasingly mobile world. See page 16.
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The UK is well placed to provide ethical leadership in shaping the migration and mobility of health workers.

  • While the UK is playing a leading role internationally in contributing to the advancement of health and wellbeing in LMICs, there is a contradiction in providing Overseas Development Assistance (ODA) to LMICs and recruiting health workers from the very same countries.
  • In this report we make the case that the UK can build on its track-record both in being the first country to deliver Universal Health Coverage to its citizens, and a country that is making a sustained contribution to the development of LMICs through ODA to play a leadership role on the national and international stage. See Section 4.

We welcome your thoughts, comments and reactions. If you would like to share these with the author please contact: graeme@thet.org

To read our previous Reports and Policy Positions, click here

I call on fellow governments in the UK as well as in other countries to heed this report’s recommendations.

Dr Diana Atwine - Permanent Secretary, Ministry of Health, Uganda

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