Implementation of neoliberal policies in countries such as Canada, the USA and Germany have provoked crises in the health sector. The commodification and privatization of health systems and increasing precariousness have imposed unsustainable workloads, increased injuries and has provoked many health workers to quit and even leave the sector.

The COVID-19 pandemic exacerbated existing problems. Work in the health sector has become less attractive to new professionals. When all of this is combined with low birth rates and aging populations the strategy of recruiting foreign workers seems like an attractive alternative - a strategy that could reduce the shortages without having to deal with complicated underlying problems.

Brazilian professionals are frustrated upon arrival in Germany because they work as auxiliaries regardless of the position they held in Brazil

But international recruitment is also complicated and must respect the needs of workers, their autonomy and their rights. Governments must be made responsible to ensure immigrant workers have support to adapt culturally and professionally, in accordance with local laws and international labour standards guided by the conventions of the International Labour Organization (ILO).

PSI and its affiliated unions work to protect and guarantee the rights of health professionals around the world in a coordinated manner. In addition, PSI works within the UN system to establish global agreements to protect migrant workers and propose monitoring systems. PSI representatives participated directly in the elaboration of the ILO's Fair recruitment initiative: General principles and operational guidelines for fair recruitment and definition of recruitment fees and related costs.

In Brazil, we are working with the National Federation of Nurses (FNE), the National Confederation of Health Workers (CNTS) and other health affiliated unions jointly with the Ministry of Labor and Employment of Brazil to ensure better conditions and clarity in the hiring and recruitment processes.

Understanding that the right to migrate is equivalent to the right not to migrate, what these entities defend is that the recruitment and hiring of foreign professionals cannot be the solution to the neoliberal crisis faced internally by rich countries. As in any industry, the best guarantee to protect and extend rights and improve working conditions are strong and active unions.

False promises

The unregulated growth of health worker migration has clear and high risks of fraud, exploitation, frustration, racism, harassment and abuse of all kinds. There is, at this time, no guarantee that the fundamental rights of these workers are being respected.

Problems have increased in recent years because the activities of private recruitment agencies that offer false claims has grown in the same proportion as the shortages of workers. The increased precariousness and asymmetries of education and skill requirements faced by Brazilian nurses in Germany have been attracting attention.

A German contracting company took 67 per cent of a Costa Rican nurse's salary - €1,200 out of a salary of €1,800. The nurse was left with only €600 of her salary during the qualification recognition period

"There is a lack of structure to receive so many foreigners of various nationalities, both in terms of cultural integration and working conditions," says a Brazilian nurse who migrated to Germany in 2019 recruited by a company to work in the country. This nurse refused to share her identity publicly because of fear of reprisals.

According to this nurse's report, the education and work of a nurse in Germany and Brazil are very different. A 4 to 5-year university-level degree with theoretical and practical training is required to work as a nurse in Brazil. Whereas, in Germany three years of technical training is sufficient.

In practice, Brazilian nurses have more authority, while in Germany they perform tasks that would be assigned to nurse technicians or auxiliaries. Brazilian professionals are frustrated upon arrival in Germany because they work as auxiliaries regardless of the position they held in Brazil.

In addition, the process for the recognition of the professional is slow and frustrating. "During diploma recognition, we are not hired even as a nursing assistant. We are hired as if we were students. In theory, it was supposed to be a more observational work, because under German law, we can't even administer intravenous drugs, for example. But in practice, we take on duties like any other nurse," she says.

The Brazilian National Federation of Nurses (FNE) is extremely concerned with the use of false numbers that show an excess of nurses in Brazil which is used to support the argument that recruitment of Brazilian nurses doesn’t have any negative impacts.

The construction of a false excess is based on minimum staff ratios are not met in Brazil. There would be a massive shortage of nurses if the minimum rations were respected. Additionally, the FNE reports that many professionals have given up working in Germany and returned to Brazil frustrated and demoralized for a variety of reasons including the abusive conditions imposed by recruitment agencies and the asymmetries between responsibilities of nursing professionals in both countries.

The Federal Nursing Council of Brazil - COFEN and the Federal Employment Agency of Germany - BA signed a cooperation agreement to define criteria for a "fair" intermediation of workers as nursing professionals in Germany in an attempt to increase immigration and reduce abuses. However, representative unions were not consulted in either country and the agreement was signed without dialogue with the Brazilian Ministry of Labor and Employment.

"What I hear from new hires in Latin America is that now the recruiting companies are holding these people hostage for too long! When we get here, these companies are responsible for finding accommodation for us and taking care of bureaucracies such as health insurance, opening a bank account, and registering with the city hall. But when we open bank accounts for us, they include various fees that are automatically taken from our salaries. Then, as soon as the person receives their salary, much of it goes directly to the recruiting company. I heard reports from a nurse from Costa Rica who told me that there were barely 600 euros left for her to spend for the month. Our salary during the qualification recognition period is 1800 euros on average"

After meetings with representatives from PSI and Brazilian affiliates, the head of international relations at the Brazilian Ministry of Labour, Valter Sanches confirmed that "for the Brazilian government, represented by the ministries of Health, Labor and Employment and Foreign Affairs, any migratory process of Brazilian professionals that eventually occurs, must necessarily be guided by the principles of fair migration of the UN and, through an understanding with the labor unions of Brazil and Germany, that good working conditions are guaranteed,  salary, hours, benefits, etc. In this specific case, the national nursing salary minimum wage should be the reference for the salaries offered during the preparation period. In addition, we will negotiate contributions with the government of Germany, since it was the Brazilian State that invested in the training of these professionals".

PSI will continue to coordinate international strategies with affiliates to guarantee that workers' rights are respected, no matter where they choose to live and work.