Africa's Brain Drain Crisis: How the West Recruits African Doctors and Nurses

Africa's Brain Drain Crisis: How the West Recruits African Doctors and Nurses

A nurse in Ghana earns around $150-300 per month.

In the UK, that same nurse—with the same training, the same skills—earns £2,500 or more. Ten times as much. Enough to send money home, support extended family, build a house.

The math is simple. The consequences are devastating.

Between 2019 and 2022, the number of Ghanaian-trained nurses joining the UK's NHS increased by 1,328 percent. In 2022 alone, more than 1,200 Ghanaian nurses registered with the UK nursing council.

By some measures, there are now more Ghanaian nurses working in the NHS than in Ghana itself.

This is the brain drain: Africa trains its best and brightest, invests scarce resources in their education, then watches them leave for wealthier countries that couldn't be bothered to train their own.

The Scale of Africa's Brain Drain

The Numbers:

Healthcare: The Hardest Hit Sector

Africa's healthcare crisis in one statistic:

Doctor Ratios by Country:

The WHO estimates Sub-Saharan Africa will be short 5.3 million health workers by 2030.

Country-by-Country: The Great Departure

Nigeria

• 9,000+ doctors lost to UK, US, and Canada (2016-2018)

• Less than half of 80,000 registered doctors actually practice in Nigeria

• December 2021 - May 2022: 727 Nigerian doctors relocated to UK

• 2021: Over 13,600 Nigerian healthcare workers granted UK working visas

Ghana

• 6,000+ nurses relocated abroad in just two years

• Another 14,000 seeking financial clearance to leave

• Q1 2022: ~3,000 professional nurses left (400-500 per month)

• Survey finding: 60% of Ghanaian nurses intend to leave

South Africa

• 23,400+ health professionals lost to UK, New Zealand, US, Australia

• Estimated cost: $5 billion in "lost human capital" since 1997

• ~10,000 South Africans emigrate annually (half are professionals)

Zimbabwe

• 1990s: Trained 1,200 doctors

• By 2000: Only 360 remained

• 18,000+ Zimbabwean nurses now work abroad

• Kadoma: Nurse-to-resident ratio went from 1:700 to 1:7,500

• Nursing positions filled: dropped from 90% (1980) to 30% (today)

The Cost of Training—and Losing

It costs money to train a doctor. A lot of money.

Training Costs:

The UK's Savings:

A UK medical charity calculated:

• Cost to train a doctor in Britain: £220,000

• Cost to train a nurse in Britain: £125,000

When the UK employs Ghanaian doctors and nurses instead, it saves that money.

The charity estimated:

• 293 Ghanaian doctors saved UK £65 million

• 1,021 Ghanaian nurses saved UK £38 million

• Total savings exceeded annual UK aid to Ghana

The Perverse Subsidy

Poor countries invest scarce resources in training health workers. Rich countries harvest the results without paying for cultivation.

Africa loses approximately $2 billion annually to brain drain.

Meanwhile:

• Canada benefits by ~$384 million/year from African workers

• United States: $846 million

• Britain: $2 billion

The irony is bitter: Africa spends $4 billion a year on salaries for 100,000 foreign experts.

Why They Leave: Push and Pull Factors

Push Factors (Why Africa Can't Keep Them):

Low Pay:

These aren't small differences—they're life-changing.

Poor Working Conditions:

• Hospitals lack basic equipment

• Doctors operate without gloves

• At COVID-19 peak, Central African Republic (5 million people) had three ventilators

• Nigerian nurses report irregular salary payments, lack of basic supplies

Limited Career Advancement:

• Research opportunities scarce

• Professional development stunted

• Staying means stagnation

Insecurity and Instability:

• Violence, kidnapping, escalating security challenges

• Healthcare workers and their families are not immune

Pull Factors (Why the West Actively Recruits):

Aggressive Recruitment:

• NHS runs recruitment campaigns across Africa

• After Brexit closed European labor markets, UK turned to Commonwealth countries

Easy Immigration Pathways:

• Healthcare workers qualify for preferential status

• UK offers Indefinite Leave to Remain

• US offers employment-based green cards

• Paths lead to citizenship

Better Everything:

• Higher pay, better equipment, safer environments

• Career growth, children's education, quality of life

As one Nigerian doctor in the US explained: "I left Nigeria because I wanted to earn more money, learn new things, and practice in a better environment."

A Ghanaian nurse who moved to UK: "I couldn't afford many basics. Nurses suffer low and sometimes delayed salaries. Sometimes you don't have some basic things like gloves to work with but in the UK, things are totally different."

The Effects Back Home

A 2002 survey of Ghana's healthcare facilities found:

• 72% couldn't provide full range of expected services due to staff shortages

• 43% couldn't provide full child immunizations

• 77% couldn't offer 24-hour emergency services or safe childbirth deliveries

Between 1993-2002, Ghana trained 871 medical officers. By 2002, nearly 70% were practicing overseas.

The Ripple Effects:

Rural Areas Suffer Most:

• Doctors migrate internally (rural to cities) as well as internationally

• Patients walk long distances for care that may not exist

Preventable Deaths Increase:

• As one Ghanaian doctor warned: "If we lose public health nurses, then the babies that have to be immunized will not get their immunization and we are going to have babies die."

Quality Declines:

• Those who stay are overworked and under-resourced

• Burnout and demoralization spread

Training Capacity Erodes:

• When experienced professionals leave, young graduates lose mentors

• Emigrants tend to be aged 45-60—precisely the people who should train the next generation

The Ethical Facade

The WHO maintains a "red list" of countries with critical healthcare shortages from which wealthy nations should not actively recruit.

Ghana and Nigeria are on that list.

The UK claims to respect this. It says "active" recruitment from red list countries is prohibited without government agreements.

The Reality:

• Social media means nurses can see NHS job vacancies directly

• Agencies facilitate the process

• The WHO's director acknowledged Brexit was a major factor: "Having closed off the potential labor market from European freedom of movement, what we're seeing is the consequences..."

Howard Catton of the International Council of Nurses:

"My sense is that the situation currently is out of control. We have intense recruitment taking place mainly driven by six or seven high-income countries but with recruitment from countries which are some of the weakest and most vulnerable."

The UK has discussed compensating Ghana—paying for each nurse recruited. But as Catton noted, such deals are "trying to create a veneer of ethical respectability rather than a proper reflection of the true costs."

The Counter-Argument: Remittances

Defenders point to remittances—money migrants send home.

2024 Remittance Figures:

This is twice overseas development assistance ($42 billion) and exceeds foreign direct investment ($48 billion).

For some countries, remittances are lifelines:

• Lesotho: 24% of GDP

• The Gambia: 26%+ of GDP

About 75% of remittances go to immediate needs: food, housing, healthcare, education.

But Here's the Problem:

Remittances are not development. They are survival.

They consume rather than invest. They maintain the status quo rather than transform it.

And the people sending remittances are the people Africa needed most. A nurse sending $500 home every month is still a nurse not treating patients in Ghana. A doctor's remittances don't deliver babies in rural Nigeria.

Moreover, the flow is a fraction of what was lost:

• Africa loses $2 billion annually in training costs and foregone productivity

• Remittances come from cumulative departure of millions over decades

• Much comes from low-skilled workers, not the professionals whose absence is felt in hospitals

The Structural Trap

Brain drain is not natural. It's engineered.

How Policy Creates Brain Drain:

Structural Adjustment Programs (1980s-90s):

• Slashed public sector wages and healthcare budgets

• Doctors and nurses saw salaries collapse

• Conditions that push professionals out were created by policy

Training Without Employment:

• Ghana scaled up nurse training by 370% (2008-2018)

• Then couldn't employ them

• Graduates sit idle while government struggles to find positions

• Pushes them to look abroad

Debt Burdens:

• Countries spending 40%+ of revenue on debt service can't raise healthcare wages

Global Labor Market Imbalances:

• As long as a UK nurse earns ten times a Ghanaian nurse, the incentive to leave exists

What Would Sovereignty Look Like?

Within the Current System:

Bilateral Agreements:

• Recruiting countries compensate source countries per professional

• Nepal has such an arrangement with the UK

• But no payment can truly compensate for a trained doctor lost

Compulsory Service Periods:

• Graduates work domestically for set time before emigrating

• Enforcement difficult, feels coercive

Improved Domestic Conditions:

• Higher wages, better equipment, career pathways

• Most sustainable—but requires resources debt-burdened governments don't have

The Fundamental Problem:

Brain drain cannot be solved while underlying inequalities persist.

As long as:

• Structural adjustment impoverishes public services

• Debt drains budgets

• Commodity dependence limits options

• The global system extracts more than it gives

...professionals will leave.

The question is not how to stop individuals from seeking better lives. The question is why African countries cannot offer those lives themselves.

Frequently Asked Questions

What is brain drain?

Brain drain refers to the emigration of highly skilled professionals (doctors, nurses, engineers, academics) from developing countries to developed countries, depleting the source country of trained talent.

How many African doctors work in the UK?

Thousands. Nigeria alone lost 9,000+ doctors to the UK, US, and Canada between 2016-2018. Over 13,600 Nigerian healthcare workers were granted UK working visas in 2021 alone.

Why do African healthcare workers leave?

Low pay (a Nigerian doctor earns ~$125-237/month vs. $10,554 in the US), poor working conditions (lacking basic supplies), limited career advancement, insecurity, and aggressive recruitment by wealthy countries.

Do remittances compensate for brain drain?

Partially. Remittances to Africa total ~$96 billion annually. But remittances are for survival (food, housing), not development. And the professionals sending money are still not treating patients or training the next generation at home.

Is it ethical for the UK to recruit African healthcare workers?

The WHO maintains a "red list" of countries with critical shortages from which wealthy nations shouldn't actively recruit. Ghana and Nigeria are on that list. Yet recruitment continues through indirect channels.

The Deeper Extraction

Brain drain is resource extraction by another name.

Instead of minerals dug from the ground, it's human capital cultivated over decades. Instead of oil pumped from beneath the earth, it's the accumulated knowledge of trained professionals.

The machinery is different—immigration systems instead of mining concessions—but the flow is the same: from Africa to the West.

British patients benefit from Nigerian doctors. American hospitals profit from Ethiopian nurses. The NHS saves billions by not training its own workforce.

Meanwhile:

• African patients die for want of care

• African children go unvaccinated

• African mothers give birth without skilled attendants

Save the Children's director general:

"It is shameful that many poor countries are spending millions of pounds training nurses and doctors to prop up the UK's National Health Service."

True sovereignty would mean African-trained professionals serving African populations.

Until then, the brain drain continues—one more current in the endless outflow of African wealth.