Submission ID 131633
| Issue/Objective | Every day, health systems in high-income countries are held together by nurses and health workers who crossed borders to serve them - and are quietly pushed out by the same systems that recruited them. In Canada, internationally educated nurses (IENs) grew from 8% to 12% of the nursing workforce between 2017 and 2022, yet remain less likely to renew registration and sustain employment than domestically trained peers. Globally, 23% of nurses in high-income countries are foreign-born, yet inequities in working conditions, leadership access, and inclusion persist structurally across receiving health systems. The prevailing response of 'recruit more', fundamentally misdiagnoses the problem. What global health faces is not a workforce supply crisis. It is a workforce equity and accountability crisis hiding in plain sight. |
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| Methodology/Approach | A narrative synthesis of global nursing workforce data, WHO human resources for health frameworks, and health equity measurement literature was conducted to identify critical gaps in how institutions measure workforce inclusion. Existing accountability instruments, such as diversity dashboards, DEI indices, and patient-centered equity tools, were examined for their applicability to the lived experiences of migrant and racialized health workers. These findings informed the conceptual architecture of the Workforce Equity Integration Index (WEII) |
| Results | The WEII identifies four domains systematically absent from current institutional accountability frameworks: credential recognition equity, leadership pathway access, psychological safety and inclusion climate, and retention parity across demographic groups. Where conventional diversity metrics count bodies, the WEII measures belonging - whether internationally educated and racialized health workers are genuinely integrated into, protected by, and empowered within the systems they sustain. |
| Discussion/Conclusion | Workforce equity is not a human resources issue. It is a global health justice issue. In a world of fragmenting governance, eroding multilateralism, and shrinking health investment, the health workers most burdened by systemic exclusion are often those keeping fragile systems functional. The WEII offers a transferable, scalable accountability tool for health systems, funders, and multilateral bodies ready to move beyond recruitment optics toward measurable, human-centered inclusion outcomes. Reclaiming global health equity must start with the people we have asked to carry it. |
| Presenters and Affiliations | Viksit Bali UHN Viksit Bali UHN |
