PSI at UNISON Health Conference: Supporting Migrant Health and Care Workers

Decent Work, Quality Public Health Services and Fair and Ethical Recruitment of Migrant Health and Care Workers

By Genevieve Gencianos, Public Services International [1]

A migration story

Let me start by sharing a story.

Fifteen years ago, I got a text message from my niece, Gwendy. She lives in the Philippines, where I was born.
“Tita,” she said—that’s what we call ‘aunt’ back home—“I’m finally graduating. I’ll be a nurse!”

My heart was so full.

You see, Gwendy is like a daughter to me. I helped support her nursing education—partly through the remittances I sent home, a portion of my salary. And many of you here know what that means.
Remittances are more than just money—they’re a lifeline for our families and our communities.

In the Philippines, as in many developing countries where migrant health and care workers come from, education comes at a high cost. And that cost is usually carried by working families.

My sister is a doctor—she migrated to the U.S. thirty years ago. We’re originally from Mindanao, in the southern Philippines, where poverty is widespread and violence, many years back, was almost a part of everyday life.

Our parents were public servants—my mother, a public school teacher; my father, a municipal worker. Their salaries were low, but their dedication was high. After work and on weekends, they ran a small store in the market, and all of us helped out.

That’s how they got my sister through medical school. I was lucky enough to study on scholarships.

Eventually, my niece Gwendy earned her nursing degree and passed her board exams. And then, like so many others, she considered migrating.

But in the end, she chose to stay and work in the Philippines.

She knows she’s one of the lucky few who had the option to stay.
Because really, migration should be a choice—and not a necessity.

My story is just one of many behind every migrant worker. I’ve had my own migration journey and now I’m working for the global union federation, Public Services International (PSI) . PSI brings the strength of more than 700 trade unions that organize 30 million public service workers in 154 countries. A third of our affiliates represent around 12 million workers in the medical, health and social care sectors. I want to tell you that UNISON is one of our largest affiliated unions and without your support, we couldn’t speak up for public sector workers everywhere – so I also want to thank you.

At PSI, among other things, we use the policies you make at conferences like this one to influence global policy at the United Nations, the International Labour Organization and the World Health Organization. I lead the migration strand of PSI’s work. This also includes building the capacity of all our affiliates to speak up for, to organize and to represent migrant workers everywhere.    

As PSI’s lead on migration policy, I would like to speak to you today on the issue of Decent Work, Quality Public Health Services, and Fair and Ethical Recruitment for migrant health and care workers.

Facing our common challenges

By 2030, the world will face a shortage of 11.1 million health and care workers, according to the World Health Organization (WHO). This shortage is characterised by stark inequalities. For instance, over half of the shortage—6.1 million workers—is in the African Region. Despite having 17% of the global population, Africa has only 4% of the world’s healthcare workers. This severe disparity, exacerbated by disease, conflict, and climate crises, has led the WHO to create a ‘Red List’ of 55 countries—37 of which are in Africa. The red list aims to protect the healthcare systems facing critical shortages by discouraging active recruitment from these countries.

Meanwhile, the 10 major high-income countries in the world have almost a quarter (23%) of the global number of healthcare workforce, while serving less than a tenth ( 9%) of the world’s population. On the one hand, you have the African region whose healthcare systems are under strain and are suffering from workforce shortages, while on the other hand we have the high income countries in the world with a much higher number of healthcare workers. It’s a challenge of global health equity.

Yet we know that these high income countries, which includes the UK, are also facing serious shortages. Working with local staff, we know that migrant workers are the backbone of the NHS and social care. The lack of investment in training, poor wages and difficult terms and conditions of work have created a health and care workforce crisis. For example, by 2030, the UK is forecasted to have a shortfall of about half a million health care staff. It is not unknown that the UK has benefited and continues to benefit from the international recruitment of migrant healthcare workers. It has saved the NHS. The same is true in social care, which is facing a shortage of about half a million care workers by 2030. 

Despite being essential to the functioning of these systems, migrant health and care workers remain undervalued, undercompensated, and vulnerable to exploitation. Many face precarious employment conditions, racism, discriminatory practices, and barriers to career progression. The recent UNISON survey on migrant care workers has further confirmed these challenges.

In the other high-income countries that are receiving migrant health and social care workers, such as Australia, Belgium, Canada, France, Germany, Saudi Arabia, Switzerland, United Arab Emirates and USA, we are facing the same challenges of exploitation and undervaluing of healthcare workers. All of these countries are benefiting from the international recruitment and are becoming increasingly dependent on it, which is a problematic model of development.

And the paradox is that, conservative, far-right and authoritarian governments are taking the policy of migration control, treating migration as a security issue and builds on a narrative of fear, overshadowing the importance of our humanity and the imperative of human rights.  The cruel and inhumane treatment of migrants in the US, where undocumented migrant workers and their families are rounded up, shackled in chains in mass deportations and detained in profit-generating prison facilities is an outrageous and dangerous display of what happens when we let politicians use  migration for election gains. But our comrades in the US unions and communities are fighting back. They mobilise on the streets, they provide resources and toolkits for migrants and advocates against immigration raids, they defend safe workplaces, they use the media and the justice system. PSI unions are rising as the vanguards of democracy, defending public sector workers’ collective bargaining rights and supporting communities on the ground in resisting against the erosion of our hard-fought values of diversity, equality and inclusion. Being in the union strengthens our resistance, keeping democracy alive in these very challenging times.

While relying heavily on migrant labour to keep public services and businesses running, conservative and far-right governments push a neoliberal agenda that tramples on the rights of low-wage migrant workers. They cherry-pick who gets in, and who gets rights. This discriminatory approach makes one thing clear: labour migration is a trade union issue — and that’s why unions like UNISON are stepping in.

As the global labour movement, we call for human rights-based, gender-responsive and people-centred migration governance, which includes decent work for all workers and the fair and ethical recruitment of migrant health and care workers.

In the countries of origin of migrant workers, health workers face the same situation. I quote from our Philippine affiliate, PSLINK:

“And while health worker migration is increasing, our own health workers in the country continue to suffer from very poor conditions. Many continue to be underpaid and overworked. Nurses are paid below living wages. A lot of health workers are in precarious jobs without security of tenure and adequate social protection. There are still areas in the country, especially the poorest and remote areas with no access to doctors and nurses.”

This illustrates how the lack of decent work is driving international migration.

Chronic underfunding of public healthcare and the diversion of resources into privatisation are deepening health inequalities. Patients and care recipients are being denied quality services, while staff face reduced numbers, worsening conditions, and burnout. This is driving high attrition, critical shortages, and the out-migration of health workers. In the UK, we’re even seeing re-migration—skilled overseas nurses leaving for better conditions elsewhere. That’s why UNISON is stepping up, with a motion at this conference focused on improving conditions for overseas nurses—because they are vital to the NHS, and they deserve every reason to stay.

In the midst of this compounded crisis, unscrupulous and predatory recruitment agencies are thriving—profiting off the desperation of migrant health and care workers. These agencies exploit the gaps in the system, taking advantage of weak regulation and a fragmented migration policy. We urgently need to align migration frameworks with labour and employment laws, and enforce strong, transparent regulation to hold bad actors accountable and protect workers' rights.

International recruitment and the migration of health and care workers affect us all—whether we’re in countries of origin or destination. Yes, migration brings benefits. But without rights-based, gender-responsive policies and strict regulation, it can drain health systems, exploit workers, and put profits over people’s right to health and care.

PSI Response: shaping global policy

So what does PSI do about this? 

As your global union federation, PSI is shaping key international rules on health worker migration.

At the International Labour Organization, we contributed to the development of the ILO Fair Recruitment Guidelines in 2016, which clearly states the prohibition of recruitment fees imposed on migrant workers. No worker should pay to get a job. Recruitment fees, often sky-high, can trap migrant workers in modern-day bonded labour. UNISON’s recent survey on migrant care workers lays this out clearly. As a member of the ILO, the UK government is obligated to implement this labour standard. It must step up to completely eliminate these illegal fees on paper and in practice.

To this effect, UNISON’s campaign to scrap the employer-tied care visa and shift responsibility to government is a bold and smart step towards fixing a system built on inequality.

At the World Health Organization, where PSI is the only global union federation with official relations, we’re pushing for stronger implementation of the WHO Global Code of Practice on the Ethical Recruitment of Health Personnel that was adopted in 2010. The code protects migrant health workers and the health systems of poor countries that are impacted by international recruitment.

The UK says it follows this code—but gaps remain. That’s why UNISON and PSI are pressing the UK to walk the talk and fully implement these ethical standards.

On the governance front, PSI played a crucial role in shaping the UN Guidance on Bilateral Labour Migration Agreements in 2022, putting human rights and fair recruitment at the center. The guidance provides for strong union involvement and for real social dialogue.

Building on that, we worked with WHO to develop the 2024 Guidance on Bilateral Agreements on Health Worker Migration. It’s a win that this guidance recognizes trade unions as key players—not just in negotiations, but also in implementation and oversight.

We’ve laid down the global standards. Now, the task is to bring it home—to use these frameworks to build union power at the national level.

From global policy to building workplace power

How do we work with UNISON and our other affiliates to build power? 

In the care sector, PSI is working with UNISON in realising the PSI’s Care Manifesto, framing the development of national care systems on the human right to care, gender equality and supporting organising and collective bargaining rights in the care sector.

As I highlighted earlier, the challenges faced by migrant health and care workers is not only happening in the UK. It is happening in Canada, in the USA, in Korea and in other European countries that are recruiting migrant workers.

One concrete win we’re proud of is the partnership between our union PSLINK in the Philippines and ver.di in Germany. Together, they successfully pushed their governments to include unions in the implementation of the Germany-Philippines Bilateral Agreement on Nurses—through a Joint Monitoring Committee. This means unions sit at the table with governments and hospital employers, monitoring nurses’ conditions, proposing improvements, and shaping a model contract for Filipino nurses migrating to Germany. That contract guarantees equal pay and conditions under collective agreements, bans recruitment fees, and ensures free language training and integration support for the migrant nurses. Importantly, the agreement also includes a commitment from Germany to support health workforce development in the Philippines. This is what social dialogue looks like—and it’s improving migrant workers’ lives and protecting health systems.

In Ghana, we worked alongside our health unions to include a reintegration policy into their collective agreements. This means that Ghanaian health workers who return home after working abroad will have their overseas skills and experience officially recognised—so they can be placed at the right grades and reintegrated back to work in the Ghanaian health sector.

In Kenya, we supported our healthcare unions to carry out outreach and education campaigns. As a result, several nurses reconsidered their plans to migrate and instead chose to stay—joining the union in the collective fight against healthcare privatisation and standing strong to defend their collective agreement.

Moving forward, PSI is facilitating union to union partnerships connecting unions in countries of origin and destination. These partnerships will help support workers at every step of their journey: by creating clear, accessible information before they migrate; sharing vital support between unions across borders; and organising migrant workers wherever they are—before departure, after arrival, and even when they return to their country of origin. We will engage governments to shape fair and ethical bilateral labour agreements, and making sure unions have a seat at the table in shaping, implementing and monitoring these agreements.

Recently, PSI, our Philippine affiliate PSLINK and UNISON began a pilot partnership to put this into practice. Among other things, so far, we’ve agreed that UNISON will run orientation and training sessions for newly arrived Filippino nurses. UNISON has also written to the UK Government to ask to take part in the Bilateral Labour Agreement between the Philippines and the UK. And in the Philippines, PSLINK will work to get the Department of Migrant Workers to distribute UNISON orientation and recruitment materials and to involve the unions in running pre-departure orientation seminars for the migrating nurses.   

We have also been discussing the possibility of a union passport. With this passport, Filipino nurses migrating to the UK who are  already union members in the Philippines can have some kind of short-term temporary membership to UNISON once they arrive. It’s early days but we are hopeful we can create a blue-print that we can replicate for other countries as well.

Conclusion and call to action

To conclude, as we face unprecedented challenges, we must stand united in solidarity within and across borders. And as we do so, we must also tackle the root causes that drive migration and exploitation. With PSI, UNISON is also actively involved in tackling these root causes.

In Kenya, Ghana, and Indonesia, we’re organizing health workers in private hospitals and clinics, ensuring they have a collective voice in even the most difficult environments.

In the Philippines, PSI affiliates received seed funding to run workshops for community health workers (BHWs), aiming to transition them from volunteers to formal government employees with full rights and protections.

During the 2018 West African Ebola outbreak, UNISON secured life-saving protective gear for health workers in Liberia, Nigeria, and Sierra Leone.

This is solidarity across borders.

As I began with a personal story, let me close by leaving you with three key messages:

1.      Solidarity knows no borders. Workers’ struggles are global, and together, we can overcome the forces that divide us.

2.      We are all migrants. Migration and mobility will continue, driven by demographic shifts, lack of decent work, and the devastating impacts of conflicts and climate change. Anyone can become a migrant. Thus, let us commit as a unified movement in fighting for decent work, fair and ethical recruitment, and justice and dignity for all migrant workers.

3.      And thirdly, the power of migrant workers lies in the union.

I wish you fruitful deliberations and a powerful conference!

[1]   Speech delivered at the UNISON National Health Care Service Group Conference, 7-9 April 2025, Liverpool, United Kingdom.