Research - 27.11.2025 - 15:00
According to an analysis by the Swiss Health Observatory, Switzerland will need an additional 36,500 nursing and care staff between 2019 and 2029. Hospitals (+17%), nursing homes (+26%) and Spitex services (+19%) will be particularly affected. Healthcare is increasingly relying on migrant workers. Many of these care workers, most of whom are women, often come from Southern and Eastern Europe or Latin America and work in precarious conditions, often with limited social security and without adequate legal protection.
While informal care work takes place in the private sphere and therefore often remains invisible, workers with transnational migration backgrounds also perform central but often less visible functions in formal settings such as hospitals. Medical care does not rely solely on doctors and qualified nursing staff; rather, nursing, cleaning and kitchen staff form the backbone of daily operations.
These transnationally intertwined work and care arrangements, especially in hospitals, are the focus of the Swiss National Science Foundation (SNSF) research project “The Global Hospital – Reproducing Healthcare through Entanglements of Labour, Mobility and Knowledge”. With a total budget of around CHF 1.5 million, this collaborative project between the University of St.Gallen (HSG), Bern University of Applied Sciences and Arts and the University of Vienna focuses on hospitals as globally networked places where social, political and economic dynamics interact.
The sub-project "Dis/entangling routes of labour: Tracing diasporic and recruitment pathways of hospital workers", led by Prof. Dr. Jelena Tošić of the University of St.Gallen, focuses on the biographical, educational and socio-economic backgrounds of hospital workers in their respective countries of origin, as well as the role of diasporic networks and international recruitment agencies in their recruitment.
Professor Jelena Tošić, in your project you use the term “global hospital”, which goes beyond the traditional understanding of a local place of care. What does this term encompass?
Prof. Dr. Jelena Tošić: With the term global hospital, we are focusing on hospitals as hubs of global supply chains. They are social spaces in which – through the diverse migration biographies of hospital workers – care and treatment practices as well as knowledge from different socio-cultural contexts come together.
Little research has been done to date on how employees from different backgrounds work together in hospitals. In our project, we therefore ask which international training and mobility paths lead to hospitals, who takes on which work, how knowledge is passed on and how this affects everyday clinical practice. The focus is on cooperation between the various groups of non-medical staff, such as nurses and cleaning staff from Colombia or the post-Yugoslav region.
Based on their language skills and migration biographies, these employees spontaneously take on additional, often invisible and unpaid tasks in addition to their official duties. These include translations, assistance with personal hygiene, and psychological support in their own language. In the project, we use the terms “reproductive work” and “more-than-medical labour” to refer to work that makes medical care possible in the first place – from cleaning and nutrition to emotional support and relationship work. These activities mediate between patients, doctors and other professional groups and create an important infrastructural basis for everyday clinical practice.
The targeted recruitment of nursing professionals from third countries, as envisaged in the nursing initiative, is seen as a key response to the ongoing shortage of skilled workers in the healthcare sector. However, initial projects, such as the recent one with Filipino nursing staff, reveal challenges such as language barriers, high training costs and, in some cases, critical feedback from existing staff. At the same time, many care migrants, especially from Eastern Europe, continue to perform informal care work in private households, as a study by the ZHAW shows. How does your project take into account this dual reality of formal recruitment and informal care work in the Swiss healthcare system?
Prof. Dr. Jelena Tošić: Informal care contexts such as so-called “live-in care” are among the central topics of our time, especially in affluent societies such as Switzerland. Demographic change, with rising life expectancy and declining birth rates, is increasing the demand for care work. In research, this development is referred to as the “crisis of care”: political and economic structures are outsourcing central tasks of social reproduction (especially care) to marginalised and often precariously employed population groups, primarily women and people with a migration background.
The measures initiated in the course of the ongoing implementation of the care initiative are important steps towards improving the situation of care workers. In my view, these can be combined with adjustments to migration policy so that workers from third countries can continue to work in Switzerland beyond the current 18-month period of the stagiaire agreement. Whether and in what form “live-in care” will be relevant to our project will only become clear as the research progresses. However, as we are analysing recruitment pathways and taking into account the career paths of hospital workers, we are also interested in whether and how pathways from “live-in care” lead to the hospital sector.
Beyond the transcultural challenges of integrating workers from third countries, we are focusing on the hitherto little-researched exchange of knowledge and practice between hospital workers with different migration backgrounds. This is particularly relevant where the boundaries between medical and non-medical activities are blurred. After all, migration is not only a social challenge, but also a source of knowledge and innovation. That is why, in addition to formally highly qualified medical and nursing staff, we also consider service staff and other employees who may not have formal qualifications but who contribute valuable experiential knowledge through many years of experience in hospitals or through previous health training. This knowledge benefits new employees as well as patients.
Your approach is based on ethnographic methods. How does this direct insight deepen our understanding of care work?
Prof. Dr. Jelena Tošić: The project is based on a combined methodological approach. Based on current data on the healthcare sector in Switzerland and Austria and in compliance with research ethics standards such as anonymisation and informed consent, we work primarily qualitatively. We use three ethnographic approaches: firstly, hospital ethnography; secondly, so-called multisided fieldwork; and thirdly, participatory design research, which I would like to explain:
Hospital ethnography allows us to experience the complex everyday life on site over a longer period of time. Researchers observe processes, conduct interviews and informal conversations, and thus record situations, interactions, practices and perspectives of various hospital workers.
The multisided fieldwork approach expands these insights to include the social and political-economic backgrounds of hospital workers in their countries of origin – for example, in Colombia or the post-Yugoslav region. We trace their educational and mobility paths back to previous jobs, educational institutions, families and social networks. We also analyse the locations, actors and practices of international recruitment, including commercial recruitment agencies.
Finally, participatory design research culminates in a hybrid exhibition in hospitals and online, created in collaboration with hospital workers, which showcases their working and living environments.
How do labour migration, the recognition of foreign professional qualifications and bureaucratic hurdles influence the entry and work of nursing staff from abroad?
Prof. Dr. Jelena Tošić: As part of the sub-project, we deliberately leave the everyday hospital environment and travel to the countries of origin of hospital workers. Colombia is a relatively new country of origin in this context, which makes our research particularly topical. Workers from the post-Yugoslav region have been shaping everyday hospital life in Switzerland and Austria for decades. Our analyses should allow us to draw conclusions about the transnational interconnections in hospitals – and how these shape values within nursing and service activities, for example.
It is also interesting to note that many of these individuals, or their families, still lived in the former Yugoslavia, where nursing and social professions were held in high esteem. Since the late 1990s, however, neoliberal reforms and emigration have increasingly turned these areas into precarious fields of work, often carried out by women. Since the Covid-19 pandemic, these fields of activity in the post-Yugoslav region have also been increasingly taken over by new migrant groups from countries in the Global South.
Against this backdrop, we want to investigate the extent to which these new migration patterns are related to the varying degrees of liberalisation of labour migration in the medical and nursing sectors. This trend is particularly pronounced in Germany, but less so in Austria and Switzerland.
What impetus could your research provide for the further development of the healthcare system?
Prof. Dr. Jelena Tošić: Close cooperation with hospitals is very valuable to us. We structure the cooperation in such a way that it can have an impact beyond the duration of the project, for example through panel discussions, scientific publications or hybrid exhibitions. The project opens up the possibility of rethinking the hospital as a central component of a changing health and care sector from a transdisciplinary, global and collaborative perspective.
Our research shows how the experiences, networks and knowledge of different groups of hospital workers can be recognised and supported in a more targeted manner. Recognising the value and complexity of these activities is a key prerequisite for a functioning work and management environment. In addition, our research can provide impetus for making hospitals, as one of the most important workplaces in society, more inclusive and productive.
The research project “The Global Hospital – Reproducing Healthcare through Entanglements of Labour, Mobility and Knowledge” is funded by the Swiss National Science Foundation (SNSF) and the Austrian Science Fund (FWF) as part of an international Weave collaboration. The project will start in January 2026 and run until December 2029, with a total budget of around CHF 1.5 million. The project involves Dr. Julia Rehsmann from the Bern University of Applied Sciences and Arts (BFH), Prof. Dr. Janina Kehr from the University of Vienna and, on behalf of the University of St.Gallen, Prof. Dr. Jelena Tošić, who is leading the sub-project “Dis/entangling routes of labour: Tracing diasporic and recruitment pathways of hospital workers” with a share of CHF 510,990 of the total budget.
Prof. Dr. Jelena Tošić is a cultural and social anthropologist and professor of migration studies at the University of St.Gallen. Her research focus includes mobility, (post)migration and borders, social reproduction and ethnographic approaches to global inequalities, among other topics.
Cover image: Adobe Stock / KayExam/peopleimages.com
