Canada provided $3.7 billion in foreign aid in 2005–2006, mostly through cida. It is a far cry from the 0.7% of gdp that Prime Minister Pearson long ago established as our goal, but what is equally lamentable is the hypocrisy of one arm of government, cida, sending aid for medical purposes to Third World countries, while another arm, Citizenship and Immigration Canada, encourages the skilled health care professionals from those countries to emigrate to Canada.

The choice for Canada appears clear: recruit more foreign health care professionals, or train more of our own. Given that the per-student cost to governments of undergraduate medical school education is upwards of half a million dollars, it would appear unlikely that there will be a dramatic increase in class sizes. As some have asked, what is the point of expensive training if you can get somebody else to do it for you?

The global choice is either to find ways to reduce the drain of medical professions from strapped Third World countries, or watch as half the world continues to become much worse off than it already is. In order to reduce foreign recruiting, Ronald Labonté believes Canada needs to follow Britain’s lead: ensure it is training its own supply of health care professionals. In the meantime, on the issue of compensation he agrees with Keith Martin. The problem, however, is that such compensation systems would only truly work under multilateral agreements — of which, presently, there are none. If Canada, for instance, paid for the training of two doctors in South Africa in return for receiving a fully trained South African doctor, what guarantee would it have that its new doctor would stay here, or that the two doctors trained in South Africa wouldn’t move elsewhere? Thus, while Labonté asks rhetorically, “Could Canada play a role?” and answers, “Well, somebody needs to start,” ultimately only a multinational approach will solve the vexing problem of foreign aid in reverse as it pertains to health care.