Sustainable Recruitment of Nurses (Triple Win)

  • Country of destination: Germany
  • Country of origin: Bosnia and Herzegovina, Indonesia, India, The Philippines, and Tunisia
  • Sectors: Healthcare
  • Skill level: Mid-level
  • Timeline: 2013 - ongoing
  • Number of beneficiaries: 4,900


Since 2013, Germany has recruited more than 4,300 nurses from Bosnia and Herzegovina, the Philippines, and Tunisia under its Triple Win framework. The program focuses on countries with large labor surpluses, facilitating the migration of skilled nurses to fill large skill shortages within Germany.

Why was it started?

Like many high-income countries, Germany is suffering from a nursing shortage. The sector is programed to need 150,000 new nurses by 2025, and the need is expected to grow, given Germany’s aging population. To care for the elderly alone Germany is programed need more than 200,000 additional nursing staff by 2030, including almost 100,000 geriatric nurses.

The World Health Organization (WHO) largely prohibits the active recruitment of nurses from low- and middle-income countries. To meet its need without violating WHO rules, Germany sought countries with large pools of trained nurses who were unable to be hired at home and brought them to Germany under a new multilateral framework.

How does it work?

The program is a collaboration between the German Development Agency (GIZ); the German Federal Employment Agency’s International Placement Service (ZAV); and employment agencies in Bosnia and Herzegovina, the Philippines, and Tunisia. ZAV and the employment agencies select nurses in the countries of origin, provide them with preparatory language and professional courses, and place them in jobs in Germany. Visas normally last one year, but extensions and eventually permanent residency are possible. Nurses are able to bring their families with them.

Germany reviews applicants’ qualifications for equivalence with the German system. Nurses must also have some practical experience in their home countries and achieve at least level B1 in German before they arrive. GIZ is responsible for supporting the process and easing integration.

In addition to the Triple Win Project, GIZ has been commissioned by the German Ministry of Health to implement skills partnerships in three countries (Mexico, Brazil, and the Philippines) to develop qualification measures for nurses that can be recognized directly in Germany.

What impact has it had?

The program has placed more than 4,300 nurses in clinics, geriatric care homes, and out-patient facilities in Germany. Of these nurses, 2,800 have started working in Germany, and other trainees are waiting for contracts. After two years, more than 80 percent of the nurses remained with their employers, and almost all of the nurses had passed the formal recognition exam (after an average of 10 months), according to a 2018 review. Internal evaluations found that the nurses had high skill levels and that employers were satisfied with their contributions. Remittance streams have been large (estimates suggest that a Filipino nurse can earn at least six times more in Germany than at home). As a result of these positive impacts, Germany is now looking to bring on new partner countries to the Triple Win framework. Brazil, Colombia, India, Indonesia, Jordan, and Mexico are being considered.