A sharp reduction in UK health aid to some of the world’s most vulnerable countries, coupled with an increase in the recruitment of nurses from these nations, has drawn criticism for its impact on global health systems. Research conducted by the Royal College of Nursing (RCN) has highlighted the detrimental effects of these policies, urging the Labour government to address the issue.

Between 2020 and 2023, UK health-related aid to countries on the World Health Organization’s “red list” – nations experiencing critical health workforce shortages – dropped by nearly 63%, from £484 million to £181 million. Investments specifically aimed at strengthening healthcare workforces in these regions fell even more drastically, from £24 million to just £4 million.

A Growing Dependence on Overseas Nurses

While aid was scaled back, the UK significantly increased its recruitment of nurses from these same countries. The number of nurses from red-list countries on the UK’s national register nearly tripled, from 11,386 in 2020 to 32,543 in 2024. The RCN’s general secretary, Prof. Nicola Ranger, called this approach a “double blow” to fragile health systems.

“By maintaining the aid target at just 0.5% of gross national income (GNI), the UK is neglecting its international responsibilities and exacerbating chronic nursing shortages in under-resourced countries,” Ranger said. She urged the government to restore aid spending to its previous level of 0.7% of GNI, which had been cut under the Conservative government of Boris Johnson.

Real-World Consequences

The impact of these aid cuts has been devastating in some areas. In Sierra Leone, the abrupt cessation of UK funding in 2021 left ambulances without fuel, preventing patients from accessing emergency treatment. A UK health worker involved in the program confirmed that fatalities occurred as a direct result.

“Recruiting heavily from countries we’ve deprived of aid underscores the UK’s failure to adequately fund and develop our own nursing workforce,” Ranger added.

A Global Health Crisis

The WHO’s red list includes 55 countries, such as Ghana, Nigeria, Nepal, and Pakistan, which are severely affected by healthcare worker shortages. International recruitment from these nations is discouraged, although individual applications are permitted. The RCN’s analysis also revealed a decline in the proportion of health-related spending within the UK’s total aid budget, from 16.7% in 2020 to 7.6% in 2023.

While some red-list countries received aid through multilateral organizations like the Global Fund, the direct bilateral aid cuts have left significant gaps in support.

Government Response

A UK government spokesperson defended its actions, stating that the country remains one of the most generous donors among the G7. The spokesperson reiterated the government’s commitment to restoring aid spending to 0.7% of GNI when fiscal conditions allow.

“We are addressing global healthcare workforce shortages through leading multilateral health investments,” the spokesperson said, citing support for the World Bank and the Global Financing Facility.

The government also highlighted its code of practice for ethical recruitment of health and social care staff, which aims to ensure sustainability.

Calls for Reform

Critics, however, argue that ethical recruitment alone cannot offset the harm caused by reduced aid. Prof. Ranger emphasized that increasing domestic nursing recruitment and restoring international aid are essential steps toward fulfilling the UK’s obligations.

As the debate continues, the situation underscores the complex interplay between global health equity, domestic policy, and international responsibilities.