Not on the radar: the impact of rural health realities on Canadian public policy and HHR migration from Sub-Saharan Africa.

The policy environment of Health Human Resource (HHR) demands in rural and remote areas of Canada seems to compel health system planners either to ignore or only pay lip service to memoranda of understanding and other non-binding international agreements on ethical principles of recruitment. Despite common acknowledgement that the migration of health professionals from Sub-Saharan Africa (SSA) and the resultant loss of capacity to deliver health services are devastating for populations in that region, Canadian public policy consideration of the "brain drain" of health human resources from SSA seems cursory, at best. As a result, broadly based domestic HHR policies and international development policy objectives invariably seem to conflict and produce unsatisfactory results that continue to be detrimental to populations of source countries in the developing world, while doing little to alleviate the continued reliance of Canada's rural and remote "'gateways" on foreign-trained health professionals. A key challenge for Canadian public policy, at all levels of government, is to coordinate and find common ground, whereby brain drain issues and specific domestic Canadian HHR needs can be simultaneously and effectively addressed. This research explored the congruity between rural HHR policy principles and international development objectives in the context of federal, provincial, and territorial government relations in Canada.