The increasing migration of skilled health professionals from developing to developed countries has sparked growing concern. This movement, often referred to as “brain drain,” is driven by a combination of push factors, including low wages, poor working conditions, limited career growth, and a lack of resources, and pull factors, such as higher salaries, better work environments, and advanced training opportunities in high-income countries.
While the exodus of healthcare workers from low- and middle-income countries (LMICs) has been a pressing public health issue since the 1940s, the Covid-19 pandemic exposed its dire consequences, bringing it to the forefront of global health discussions.
The Scale of the Problem
The World Health Organization (WHO) estimates that by 2030, there will be a global shortfall of 11 million health workers, with the most severe gaps in low- and lower-middle-income countries. Nations such as Zimbabwe, Nigeria, Ghana, Zambia, and South Africa face critical shortages of healthcare workers, while developed countries in North America, Europe, the Middle East, and Oceania are actively recruiting foreign-trained professionals to sustain their healthcare systems.
Alarmingly, one fifth of African-born physicians and one-tenth of African-born nurses are already working in developed countries. This trend disproportionately benefits wealthier nations, leaving sending countries with dwindling healthcare resources. In fact, only 3% of the global health workforce serves sub-Saharan Africa, which bears 25% of the global burden of disease. This imbalance places immense strain on the remaining workers, leading to increased workload, burnout, and declining health outcomes, particularly in rural and underserved areas.
Brain Gain: How African Countries Are Fighting Back
In response to the healthcare workforce crisis, several African nations have launched initiatives to reverse brain drain and capitalize on their diaspora’s expertise—a concept known as brain gain.
Harnessing Diaspora Engagement
- Ethiopia introduced the Diaspora Engagement Affairs initiative in 2011 and ratified its Diaspora Policy in 2013. This policy encourages Ethiopian professionals abroad to invest, conduct research, and contribute to healthcare development. The government established Diaspora focal desks within the Ministry of Health to facilitate engagement and address challenges faced by returning professionals.
- In August 2024, Nigeria approved the National Policy on Health Workforce Migration to facilitate the return of skilled healthcare workers. Under this policy, returning professionals will receive soft loans or grants to establish private health facilities, along with incentives to encourage retention, especially in underserved areas. However, the policy’s effectiveness remains to be seen.
Improving Retention Strategies
- Some African countries have implemented a national Performance-Based Financing (PBF) programme. The programmes aim to reward health facilities for achieving specific health outcomes, particularly in maternal, child, and HIV/AIDS care. Available evidence from Rwanda and Mozambique indicates that this programme supplements incomes, increases accountability and fosters teamwork.
- Ghana introduced incentives such as the Deprived Area Incentive Allowance (DAIA) for health workers in rural areas and the Additional Duty Hours Allowance (ADHA) for those working extended hours. More recently, the Ministry of Health announced a 20% increase in base pay for nurses and midwives to encourage retention. However, health professionals continue to demand incentives for career development, fair promotion policies, and better living conditions.
Global Support: International Collaboration in Brain Gain
The MIDA Programme (Migration for Development in Africa)
The International Organization for Migration (IOM) has been instrumental in leveraging diaspora skills and expertise through its MIDA programme.
- Ghana’s MIDA Health Project mobilizes Ghanaian health professionals living in Europe to support the country’s healthcare system. Returning specialists introduce innovations, mentor local practitioners, and leverage international networks to improve health services.
- The Democratic Republic of Congo (DRC) leveraged the Congolese diaspora to support education and capacity-building through the MIDA programme. So, instead of losing skilled professionals to migration, the initiative used virtual learning to facilitate knowledge transfer from diaspora academics to students at the University of Lubumbashi (UNILU).
Bilateral Agreements to Manage Migration
Some African governments have adopted bilateral agreements to regulate health worker migration while ensuring mutual benefits:
- Kenya-UK Agreement (2021): The UK signed a deal to legally recruit Kenyan nurses while providing training and financial support to Kenya’s health workforce. Through this deal, Oxford University Hospitals (OUH) became the first NHS Trust to welcome Kenyan nurses.
- Norway-Malawi Exchange Programme: Since 2007, Kamuzu Central Hospital (Malawi) and Haukeland University Hospital (Norway) have collaborated on surgical and maternal health training. The programme, backed by the Norwegian Embassy, fosters knowledge exchange and enhances cultural competence among healthcare professionals.
Moving Forward
While developed countries continue to attract health professionals from LMICs, African nations are actively reshaping their workforce strategies to mitigate brain drain and leverage the diaspora for development. The effectiveness of these efforts will depend on:
- Sustained government investment in salaries, infrastructure, and career advancement.
- Stronger policies to regulate migration and incentivize local retention.
- Greater collaboration with international partners for ethical recruitment and skills transfer.
The African health workforce crisis is far from over, but innovative policies, diaspora engagement, and strategic investments offer a pathway to transform brain drain into brain gain. This will ensure that health systems in Africa not only survive but also thrive.
Published April 08 2025