The ‘ethical recruitment’ of international nurses: Germany’s liberal health worker extractivism

Abstract

International institutions increasingly promote ‘ethical recruitment’ as a standard for health worker migration from poor to rich countries. We analyze how this notion is interpreted in a country considered to be an exemplary, ‘ethical’ recruiter of international nurses. In Germany, international nurse recruitment initiatives are proliferating, and programs such as the public Triple Win scheme and a private-sector voluntary fairness certificate promise gains to all participating actors. We find that ‘ethical recruitment’ is a regime of largely voluntary protection of and care for migrant workers, which legitimizes the extraction of health workers from the Global South but hides underlying structural inequalities between countries and workers. Gains for sending countries are postulated, yet de facto merely assumed to happen through remittances, and developmental demands by sending countries remain unaddressed despite talk about circular migration and support for health systems. In short, ‘ethics’ facilitates a regime of liberal health worker extractivism: This regime recognizes individual rights (however imperfectly) but disregards developmental and social rights, and it limits state intervention to market facilitation and soft regulation. We draw on primary sources including documents retrieved through freedom of information requests, and over thirty interviews with recruiters, regulators, employers, unionists, and civil society experts.