Ethical international recruitment and the WHO safeguards list
The WHO Health Workforce Support and Safeguards List (2023) names 55 countries facing the most severe relative health-workforce shortages, and it is the basis for the UK’s (and other destination countries’) restrictions on active recruitment from those countries. This is a genuine ethical constraint, not a formality — it exists because aggressive recruitment from the most vulnerable health systems can actively worsen the shortage it is meant to relieve. Here is what it actually restricts, and what it does not.
Quick answer
- WHO list size (2023)
- 55 countries, selected on health-workforce density below the global median and a UHC service-coverage index below the WHO’s threshold.
- What "active recruitment" means
- Advertising, targeting, agency sourcing, or incentivised referrals aimed at a listed country — the institutional act, not an individual applying.
- What stays permitted
- A person from a red-list country applying, on their own initiative, to a specific advertised vacancy.
- Amber list
- A small number of countries where active recruitment is allowed only under a specific government-to-government agreement — check current membership and agreement status.
Why this exists
The countries on the WHO list are, by the WHO’s own selection criteria, the ones least able to absorb the loss of trained clinicians without harming their own population’s access to care. The Global Code of Practice — a voluntary WHO instrument dating to 2010 — asks destination countries to balance the benefit of international recruitment (to both the recruit and the destination system) against this risk. The UK Code of Practice, and equivalents elsewhere, are the practical, domestic implementation of that balance.
What an employer should actually do
- Check the current red and amber list membership before running any targeted sourcing campaign, agency brief, or paid-advertising placement by country — this is the point at which most breaches happen, not at the point of hiring an individual applicant.
- If a strong, unsolicited application arrives from a red-list country, it can still be considered — the restriction is on your sourcing activity, not on the person’s own choice to apply.
- If using a recruitment agency, confirm it is on the NHS Employers Ethical Recruiters List (for UK NHS sourcing) or holds an equivalent commitment for other destination countries.
- Keep a record of how each candidate was sourced — it is the evidence that distinguishes lawful individual application from prohibited active recruitment if ever questioned.
Frequently asked questions
What is the WHO Health Workforce Support and Safeguards List?
A World Health Organization list — 55 countries on the 2023 edition — identifying countries with a health-workforce density below the global median and a universal health coverage service-coverage index below the WHO’s threshold, meaning they face the most pressing shortages relative to their own population’s needs. It operationalises the 2010 WHO Global Code of Practice on the International Recruitment of Health Personnel, which is a voluntary instrument, not binding international law unless a country enacts it domestically.
Is the UK "red list" identical to the WHO list?
The UK Code of Practice’s red list is drawn from the WHO 2023 list, but the exact country count and membership referenced across UK guidance sources has varied in our own research (we found both "55" and "51" cited), and both the WHO list and the UK Code are periodically revised. Do not rely on a remembered count — check the current NHS Employers red and amber list page (linked in Sources) before making a sourcing decision.
What exactly is prohibited — and what is not?
Prohibited: active recruitment — an employer or agency targeting, advertising to, or sourcing from a red-list country, including incentivised referrals from existing staff. Not prohibited: an individual from a red-list country applying, on their own initiative, to a specific advertised vacancy. This distinction is the core of the Code and is confirmed directly by NHS Employers’ own FAQ.
What is the amber list and how does it work?
A small number of countries occupy an amber list, where active recruitment is permitted only under a specific government-to-government agreement — for example Kenya (bilateral agreement, 2021) and Nepal (MOU enabling managed recruitment via a named trust, 2022) at time of our research. Without such an agreement, an amber-list country should be treated as effectively red for active recruitment. Check the current amber-list membership and agreement status before relying on this.
Does this framework apply outside the UK?
The WHO Global Code of Practice is a global instrument adopted under the WHO Constitution, and other destination countries have their own domestic implementations with their own specifics — this guide describes the UK’s Code of Practice implementation specifically. An employer sourcing into a different country should check that country’s own ethical-recruitment framework rather than assuming the UK rules apply.
Sources & further reading
These are the primary, official sources for everything on this page. Where figures appear, confirm the current value at the source before relying on it.
- WHO — Health workforce support and safeguards list 2023
The official WHO publication naming the 55 countries with the most pressing health-workforce shortages, and the density/UHC criteria used to select them.
- WHO — Global Code of Practice on the International Recruitment of Health Personnel
The 2010 WHA resolution and code text that the UK Code of Practice, and equivalent codes elsewhere, implement domestically.
- NHS Employers — Code of Practice for International Recruitment
The current (March 2025) UK Code of Practice text that implements the WHO Global Code of Practice for health and social care employers in England.
- NHS Employers — Code of Practice red and amber list of countries
The current red-list (no active recruitment) and amber-list (government-to-government agreement only) country membership. This list is revised — always check the live page for current membership.
- NHS Employers — Code of Practice frequently asked questions
What counts as "active recruitment" versus an individual’s own direct application.
- GOV.UK — Code of practice for the international recruitment of health and social care personnel in England
The government publication underpinning the Code of Practice.