Can health worker migration become a development opportunity? | Experts’ Opinions

Healthcare workers’ international migration from poor to high-income countries has become a major challenge for Africa. Higher salaries, better working conditions and more professional development opportunities are key factors contributing to an exodus that is creating a significant shortage of health specialists in developing nations. According to the latest State of the Health Workforce in Africa report by the World Health Organization (WHO), the region has only 46% of the health workers it needs, and the shortage is projected to reach 6.28 million by 2035. At the same time, WHO estimates that over 940,000 trained health workers were unemployed in Africa in 2024 because the health facilities did not have the money to employ them.

To tackle this challenge, WHO has amended its international recruitment workforce frameworks, encouraging co-investments from origin and destination countries regarding health worker employment. The new approach aims to strengthen the health systems in developing countries through partnerships and investment, aiming to stop the brain drain. We asked six international development experts to share their insights on WHO’s initiative. Read the article below and share your opinion on the matter.

DevelopmentAid: Could co-investment in training and employment make international health-worker migration beneficial for developing countries, and what role should international development actors play in making such partnerships work?

“International health worker migration should concern receiving countries, sending countries, and development partners equally. It reflects and reinforces the economic and social inequalities that shape the North-South divide. Countries typically invest heavily in training health workers with the expectation that their skills will be used domestically. International migration disrupts this expectation. Economically stronger countries often benefit from skills they did not finance, while poorer states continue to train health workers but lack the capacity to retain them or sustain the cost of training. Co-investment in training facilities and sustainable economic opportunities in sending countries would increase the number and quality of health professionals available to both sending and receiving states. This would help share the significant financial burden of training health workers. Improving economic conditions in sending countries would also reduce current imbalances and help reverse brain drain by giving health professionals viable pathways that support global health standards. Development actors have a critical role in financing and strengthening the capacity of states and institutions. They also help develop standards and regulatory frameworks that respond to global and regional social and economic priorities, including the SDGs, which significantly influence domestic and global health outcomes. The World Health Organization has a central role in these efforts. It can promote ethical standards in migration agreements between states, monitor migration trends, support safeguards for vulnerable populations, and provide policy and capacity-building assistance to member states.”

“Co-investment in training and employment has the potential to create a system by which international health-worker migration can become beneficial for developing countries rather than contributing to brain drain. It is important to note that this potential success hinges on whether developing countries can strengthen and maintain their regulatory capacities. This means that governments must not only prevent erosion of democratic institutions but rather focus on consolidation as a route to institutionalizing regulations that are used systemically and cyclically, using co-investments as a capital input that continuously strengthens health systems over time. A system of co-investment without strong regulations runs the risk of leading to increased inequities if funds are misallocated. To prevent misallocation, and thus inequities, strengthening regulatory capacities for health systems could be best achieved through international development actors creating a co-investment delivery approach that incentivizes countries of origin to strengthen health system regulatory capacities. Incentivization could be achieved through the delivery of investment in tranches, in addition to a recruitment framework, for example, although the approach will differ by region and country.”

“Co-financing remains a key strategy for governments to leverage the expertise of international health professionals. It can strengthen skills, improve employability and support pathways that meet the needs of public services. By integrating it into national policies, countries can turn brain drain into a managed and useful rotating mobility for their systems. For this mobility to be beneficial to developing countries, it must avoid any net loss of staff: limited duration and planned rotations, mechanisms for transferring skills to local teams (tutoring, supervision, peer training) and/or return or service obligations. Migration can then be institutionalized through strategic tools: continental reference documents, operational plans and roadmaps. In Africa, the five regions (Centre, North, East, West and South) would benefit from formal memorandums of understanding based on mutual co-financing and shared performance indicators. International development partners must support this mechanism with technical expertise, governance and impact assessment. They could also make their funding conditional on the maintenance and retention of trained teams, and secure funds to ensure sustainable health resilience.”

“Yes, if co-investment targets Africa’s main bottleneck, which is jobs, not training. The region now has 46% of the health workers it needs; at the same time, WHO estimates that 943,000 trained health workers in Africa were unemployed in 2024. Migration drains a system when it takes staff that health services would have employed. When it draws on unemployed graduates and destination countries pay back into the system that trained them, the source country gains. The amended WHO Global Code of Practice on the International Recruitment of Health Personnel encourages co-investment across education, employment, and retention. Destination countries must fund training places, public sector posts, and rural retention pay so that migration adds to supply instead of replacing it. The Code is not mandatory, but voluntary. Without monitoring and binding terms, co-investment will stay a pledge while recruitment continues. Development actors have three things to do. They must broker bilateral agreements that tie recruitment to measurable reinvestment; direct loans and grants to public sector jobs, narrowing the pay and conditions gap that pushes staff abroad; and fund independent monitoring of co-investment commitments, so the voluntary Code carries weight.”

“The story of health workers’ migration from Africa has long been a brain drain narrative. However, the latest data suggest a more complex picture. Africa had 5,72 million health workers in 2024, but only 46% of the workforce it needed in the sector. Meanwhile, about 943,000 trained health workers were unemployed, as estimated by WHO. Furthermore, the WHO projects the shortage could reach 6.28 million by 2035. This contradiction raises another question: what if migration is a part of the answer? The answer could lie in co-investment. Destination countries need health workers and source countries need jobs, better facilities, and stronger health systems. Destination countries could fund training, employment, and retention in the country of origin. This can add workers in both countries, instead of sharing the same diminishing talent pool. The World Health Organization’s amended Global Code of Practice, adopted in May 2026, now encourages this approach. It demands co-investment so international recruitment benefits both source and destination countries. The practical part is for international development agencies to have a role here. They can help governments develop equitable recruitment agreements, follow investment flows, and assess whether both parties are benefiting. WHO already suggests bilateral deals that link worker mobility to health system investment. Migration won’t go away. The better way is to ensure it doesn’t exclude weaker health systems. If provision is made for an investment, a leaving nurse may not be a loss but part of a larger force that serves all.”

“Yes, co-investment can turn health-worker migration from brain drain into brain gain. If source and destination countries jointly fund training, the number of health workers increases overall. For example, destination countries could pay for extra medical seats in Africa, while source countries commit to a minimum service period before migration. This creates more jobs at home and abroad, so the 943,000 unemployed trained workers (estimated by WHO) get absorbed instead of being wasted. International development organizations like WHO and the World Bank, but also NGOs, should act as guarantors and coordinators. They can set up ethical recruitment agreements, track data, and ensure funds go directly to hospitals and schools, not just governments. They can also support “circular migration” where workers return to their home country after 3-5 years with new skills, adding an important aspect to their remittances. With proper regulatory frameworks, migration strengthens both systems instead of draining one. Partnership, not restriction, is the solution.”

See also: NEET: the global youth education vs. unemployment paradox: causes, consequences and solutions | Experts’ Opinions

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