The paradoxical surplus of healthcare workers in Africa: the need for research and policy engagement

Abstract Background In many countries in Africa, there is a paradoxical surplus of under and unemployed nurses, midwives, physicians and pharmacists which exists amidst a shortage of staff within the formal health system. By 2030, the World Health Organisation Africa Region may find itself with a shortage of 6.1 million healthcare workers (HCWs) alongside 700,000 un- or underemployed health staff. This study aims to bring the nature and consequences of an existing paradoxical surplus of HCWs in low income countries into the HCW migration debate and to explore novel solutions. Methods The study draws on a rapid review of the literature and deeper insights from expert information, using examples from Uganda, Kenya and Niger. Results In Niger, between 2010-2014, 55% of health graduates were unable to find permanent work in the sector leaving 15 000 HCWs unemployed or in precarious jobs. In Sudan, an 8-fold increase of the number of places at medical colleges (between 1996-2012) was not accompanied by a commensurate investment in physician positions leading to increased unemployment and brain drain. In Kenya, in 2021, 27243 HCWs were un or under-employed. In Uganda, 20590 nurses and midwives were reported as unemployed in 2023. Despite this, the emphasis in policy debates about the healthcare workforce crisis in most national and global levels is on staff shortage and the need to train more HCWs. In contrast, an existing surplus HCWs and their association with patterns of migration are largely unknown. Little time is given over to understand the economic, political and social factors that have driven their emergence and the governance challenges and potential interventions to improve employment rates. Conclusions The results highlight the complexity of migration, labour market conditions and health systems, in particular in low income countries in Africa. Both qualitative and quantitative data is necessary for policy makers to find effective solutions to the problem.