The challenges to achieving self-sufficiency in Canadian medical education

The issue of self-sufficiency in human resources for health has become increasingly salient in many countries, particularly in light of concerns about looming shortages and the global consequences of the increased reliance on internationally educated health professionals. The Harvard-based Joint Learning Initiative (2004) report, for example, explicitly recommends reducing the ‘pull’ forces of health professionals in source countries through the emphasis on aiming for educational self-sufficiency on the part of destination countries. It argues that it would be wise for wealthy countries to strive for self-sufficiency because reliance on immigration is short-sighted, inequitable and risky; self-sufficiency is both sound and fair (JLI 2004: 106). These calls were echoed by the World Health Organization (WHO) (2006) and the World Health Assembly (WHA) (2006). In the 2006 World Health Report, the WHO recommends self-sufficiency through recommendations directed at increased domestic production, improved recruitment and retention, and enhanced political and technical workforce strategic planning. Paralleling this, the fifty-ninth World Health Assembly, recognizing the importance of achieving the goals of self-sufficiency in health workforce development, passed a resolution in May 2006 for the rapid scale-up of health workforce production (WHA 2006: 2).