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Statement on Workforce and Migration in the Health Sector to the Subcommittee on
Global Health of the German Bundestag
30 June 2023
We, members of the Hub Community on Global Health and Migration [1], welcome the initiative
of the German Bundestag's Subcommittee on Global Health to shed light on the issue of
migration and the workforce [2]. We are grateful for the invitation to share our insights and
expertise. This exchange marks the beginning of what we hope will be a fruitful collaboration
moving forward. Given our expertise in migrant health, we want to concentrate on two important
areas: facilitating the integration of highly qualified migrant population into the healthcare
sector’s job market and thus address Germany's workforce shortage and ensuring adherence to
the World Health Organization's (WHO) ethical recruitment practices [3].
Addressing the German health workforce shortage by recognising the unrealised
potential of a highly trained migrant population and avoiding negative consequences
on the Global South
This is a pressing issue that requires attention and action. The hearing held by the Global Health
Subcommittee on 22 May 2023, highlighted the intensifying shortage of domestic health workers
[4]. Moreover, the demographic transition of an ageing German population is contributing to a
growing workforce gap [5].
German public authorities have a strategic choice to address shortages of healthcare workers
by:
1. Addressing maldistribution through incentives to work in underserved settings:
Inspired by successful examples in the US, Canada, and Australia [6, 14], Germany could
actively reallocate new migrant health workers to rural areas. Deploying health staff to
underserved regions for a predefined period will help address disparities in healthcare
access.
2. Increasing domestic health workforce capacity and task shifting through skills mix:
To address the recognition and integration of migrant health professionals, we can take
other measures to tackle the rising shortage of domestic health workers [6]. These
measures include increasing health workforce routine surveillance and monitoring of
healthcare quality, proactively planning the health workforce, and building the capacity
of the domestic health workforce through training and reorganization to enhance
efficiency and capacity.
3. Seamlessly facilitating the recruitment of healthcare professionals from overseas:
Germany should take active steps to expand its existing health workforce and address the
challenges faced by migrant healthcare professionals. One crucial aspect is the
recognition and integration of these professionals, particularly those migrating to
Germany as refugees or migrants. Currently, lengthy and inadequate
recognition and integration processes discourage foreign health workers from settling in
Germany, leading to suboptimal integration and retention, exacerbated by language
barriers [8]. To overcome these challenges, Germany should establish streamlined
processes in the healthcare sector to expedite the recognition of qualifications for foreign
health professionals. Additionally, a competency-based approach should be developed to
validate their expertise and ensure successful integration into the German healthcare
system [9, 10]. This would involve expediting the processing of skilled health workers from
foreign countries and revising the legal framework for recognizing foreign diplomas,
allowing deployment of highly skilled medical professionals shortly after their arrival [11].
Furthermore, to facilitate smooth integration, additional cultural and linguistic training
and support should be provided to the foreign health workforce. This would enable them
to effectively care for the increasingly diverse patient population and foster cultural
awareness among their German colleagues.
4. Implement measures to retain health workers and prevent attrition: Germany could
establish a supportive infrastructure that fosters transparency in the migration process,
working conditions, and financial incentives to actively implement measures aimed at
retaining healthcare workers and preventing attrition. This action would facilitate ongoing
knowledge transfer between nations and provide transparent information to interested
foreigners and incoming migrants, thereby improving social and working conditions while
mitigating unethical practices, particularly in the private sector [11].
Ensuring fair recruitment by adhering to the WHO Global Code of Practice on the
International Recruitment of Health Personnel
An analysis of the health labour market reveals that most national policies aimed at harnessing
the potential of health workers do not effectively enhance the pull factors [9]. Therefore, we
strongly recommend consistently implementing the WHO Global Code of Practice to ensure the
ethical recruitment of foreign health personnel. This requires the development of more
efficient, transparent, and supportive public immigration laws and policies to mitigate the
negative effects of a free-market approach to recruitment and unfair labor practices [12].
Considering that Germany benefits from the influx of skilled professionals, cooperation with
international partners, especially those from the Global South, should be based on equitable
negotiations around the demand for mutual benefit as outlined in the WHO Global Code, which
highlights the need for bilateral agreements, technical and financial support for healthcare
systems in countries of origin, and measures to prevent negative effects on the healthcare
systems of those countries [13].
Finally, we respectfully suggest organizing an additional Subcommittee hearing that primarily
focuses on migration and the health workforce, specifically discussing the optimal utilization of
culturally diverse healthcare professionals present in Germany and the implementation
of the WHO Global Code of Practice on the International Recruitment of Health Personnel.
To support the Bundestag’s Subcommittee on Global Health in this endeavour, we are committed
to conducting thorough and tailored research and sharing our findings with diverse communities.
We believe that evidence-based policies resulting from this hearing could potentially drive
positive changes in the legal framework concerning incoming healthcare professionals in
Germany.
Authors:
The statement reects the results of discussions in the Hub Community on Global Health and
Migraon of the Global Health Hub Germany. The Community is comprised of a diverse group of
professionals from various academic disciplines, organizaons, and civil society representaves
who are dedicated to improving the well-being of migrant populaons and the health systems in
the host sociees that serve them [1]. Our work encompasses a range of important aspects
related to this topic, such as ethical migraon and addressing the issue of brain drain, which
necessitate careful consideraon and proacve measures.
The Hub Community on Migration and Global Health enthusiastically offers to continue
exchanging ideas and expertise on the challenges and opportunities associated with the
healthcare workforce and migration. We are readily available for consultation and can provide
insights on relevant inquiries. Our goal is to contribute to the development of a more inclusive,
sustainable, and equitable healthcare system that benefits all individuals.
Lead authors:
Dr. Bhaskar Sonu M. M.
Karciauskaite Indre
Kopelke Ruth
McGowan Maureen
Dr. Riemenschneider Henna
Dr. Tache Stephanie
Contribuons to this paper were made by:
Dr. Abijumaa Jinan
Dr. Diaz-Monsalve Sonia
Dr. Dodero Verónica I.
Wangerin Merle
Dr. Wirsching Michael
References:
1. Global Health Hub Germany’s Global Health and Migration Hub Community:
[https://globalhealthhub.de/de/news/detail/launch-of-the-new-hub-community-global-health-and-
migration]
2. Bundestag's Subcommittee on Global Health:
[https://www.bundesgesundheitsministerium.de/en/international/global-health-policy/global-health-
strategy.html]
3. World Health Organization (WHO) Global Code of Practice on the International Recruitment of Health
Personnel: [https://www.who.int/publications/i/item/wha68.32]
4. PwC (2022). Fachkräftemangel im deutschen Gesundheitswesen. Retrieved from
[https://www.pwc.de/de/gesundheitswesen-und-pharma/fachkraeftemangel-im-deutschen-
gesundheitswesen-2022.html
5. Hearing by the Global Health Subcommittee at the German Bundestag (2023): Deutscher Bundestag -
Bilanz zur Migraon von Fachkräen im Gesundheitswesen
6. Australian Government, Department of Health and Aged Care. Rural health workforce: Stronger Rural
Health Strategy. Retrieved from hps://www.health.gov.au/topics/rural-health-workforce/stronger-
rural-health-strategy
7. WHO. (n.d.). Global Strategy on Human Resources for Health: Workforce 2030. Retrieved from
https://apps.who.int/iris/bitstream/handle/10665/250368/9789241511131-eng.pdf
8. Can E, Konrad CM, Khan-Gökkaya S, Molwitz I, Nawabi J, Yamamura J, Hamm B, Keller S. Foreign
Healthcare Professionals in Germany: A Questionnaire Survey Evaluating Discrimination Experiences and
Equal Treatment at Two Large University Hospitals. Healthcare. 2022; 10(12):2339.
https://doi.org/10.3390/healthcare10122339
9. Khan-Gökkaya, S. and Mösko, M. (2021), Labour Market Integration of Refugee Health Professionals in
Germany: Challenges and Strategies. Int Migr, 59: 105-126. https://doi.org/10.1111/imig.12752
10. Recognition of foreign qualifications in Germany:
[https://www.bmbf.de/bmbf/en/education/recognition-of-foreign-professional-
qualifications/recognition-of-foreign-professional-qualifications.html]
11. McPake B, Maeda A, Araújo EC, Lemiere C, El Maghraby A, Cometto G (2013). Why do health labour
market forces matter? Bull World Health Organ. 91(11):841-6. doi: 10.2471/BLT.13.118794.
12. Kingma, M. (2006). Nurses on the move: A global overview. Health Services Research, 41 (3 Pt 2),
1232–1247. doi: 10.1111/j.1475-6773.2006.00543.x
13. World Medical Association (2019). The WMA Statement on Ethical Guidelines for the International
Migration of Health Workers. Retrieved from https://www.wma.net/policies-post/wma-statement-on-
ethical-guidelines-for-the-international-migration-of-health-workers/
14. Kelly M, Brown N, Esses VM (2022). CERC-Migration Policy Brief: Improving the Attraction and
Retention of Internationally Educated Healthcare Professionals in Small and Rural Communities.
Retrieved from https://www.torontomu.ca/cerc-
migration/Policy/CERCMigration_PolicyBrief06_JAN2022.pdf
