The Brain Drain: Training Doctors for the West

The Brain Drain

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

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

The math is simple. The consequences are devastating.

Between 2019 and 2022, the number of Ghanaian-trained nurses joining the UK's National Health Service 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 Numbers

The scale is staggering.

Approximately 70,000 skilled professionals leave Africa every year. By 2015, there were 3.6 million skilled African immigrants working in OECD countries — nearly five times the 730,000 in 1990. The IMF projects that African migrants in OECD countries could increase from 7 million in 2013 to 34 million by 2050.

Healthcare is the sector hit hardest.

Africa bears 24% of the global disease burden. It has just 3% of the world's health workers. The World Health Organization recommends at least one doctor per 1,000 people. Africa averages one doctor per 5,000 patients — five times worse than the minimum standard.

The numbers by country are even more alarming:

• Chad: 0.00 doctors per 1,000 people

• Burundi: 0.1 per 1,000

• Ethiopia: 0.2 per 1,000

• Liberia (2015): 51 doctors for 4.5 million people

• Sierra Leone (2015): 136 doctors for 6 million people

Compare this to the United States: 2.6 doctors per 1,000 people. The UK: over 370,000 physicians for 68 million people. Nigeria, with 211 million people, has fewer than 75,000.

And the gap is widening. The WHO estimates Sub-Saharan Africa will be short 5.3 million health workers by 2030.

The Great Departure

Nigeria has lost at least 9,000 doctors to the UK, US, and Canada between 2016 and 2018 alone. Less than half of the 80,000 doctors registered with Nigeria's Medical and Dental Council are actually practicing in the country. Between December 2021 and May 2022, 727 Nigerian-trained doctors relocated to the UK. In 2021, over 13,600 Nigerian healthcare workers were granted UK working visas.

Ghana has seen an exodus. According to the Ghana Registered Nurses' and Midwives' Association, over 6,000 nurses relocated abroad in just two years, with another 14,000 seeking financial clearance to do the same. Approximately 3,000 professional nurses left Ghana in the first quarter of 2022 alone — roughly 400-500 nurses every month. A survey found that 60% of Ghanaian nurses intend to leave the country.

South Africa has lost more than 23,400 health professionals to the UK, New Zealand, US, and Australia. The International Organization for Migration estimates this has cost South Africa over $5 billion in "lost human capital" since 1997. An estimated 10,000 South Africans emigrate annually, half of them professionals.

Zimbabwe trained 1,200 doctors during the 1990s. By 2000, only 360 remained in the country. More than 18,000 Zimbabwean nurses now work abroad. In Kadoma, there used to be one nurse for every 700 residents; now there's one for every 7,500. In 1980, Zimbabwe could fill 90% of its nursing positions; now only 30% are filled.

The Cost of Training — and Losing

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

In Kenya, the total cost of educating a single physician — primary school through medical school — is approximately $65,000. Some estimates put the figure higher: one study calculated $517,931 for every doctor Kenya loses.

For nurses, the investment is smaller but still substantial: around $339,000 in accumulated education costs for each nurse who emigrates.

When these professionals leave, the investment walks out the door with them.

A UK medical charity calculated that it costs £220,000 to train a doctor in Britain and £125,000 to train a nurse. When the UK employs Ghanaian doctors and nurses instead, it saves that money. The charity estimated that employing 293 Ghanaian doctors saved the UK £65 million, while 1,021 Ghanaian nurses saved another £38 million — a total exceeding annual UK aid to Ghana.

This is a perverse subsidy. Poor countries invest scarce resources in training health workers, then rich countries harvest the results without paying for the cultivation.

The UN Conference on Trade and Development estimated that each migrating African professional represents a loss of $184,000 to Africa. Multiply that by 70,000 annual departures and the continent loses billions every year in human capital alone.

Africa loses approximately $2 billion annually to brain drain. Meanwhile, the countries receiving African professionals gain enormously: Canada benefits by approximately $384 million per year from African workers, the United States by $846 million, and Britain by $2 billion.

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

Why They Leave

Push factors:

Low pay. A doctor in Nigeria earns roughly ₦200,000-380,000 per month — at current exchange rates (₦1,600/$1), that's $125-237. The same doctor in Saudi Arabia could earn $12,000-17,000. A doctor in Uganda earns $67 monthly; in the US, that becomes $10,554. These aren't small differences — they're life-changing.

Poor working conditions. Hospitals lack basic equipment. Doctors operate without gloves. At the peak of COVID-19 in 2020, the Central African Republic — a country of 5 million — had just three ventilators. Nigerian nurses report irregular salary payments and lack of basic supplies like gloves.

Limited career advancement. Research opportunities are scarce. Professional development is stunted. For ambitious professionals, staying means stagnation.

Insecurity and instability. Escalating security challenges, kidnapping, and violence push healthcare workers to seek safety abroad. Their families are not immune to the dangers that plague their countries.

Pull factors:

Aggressive recruitment. Western countries, facing their own healthcare shortages, actively recruit from Africa. The UK's NHS has run recruitment campaigns across the continent. After Brexit closed off European labor markets, the UK turned even more aggressively to Commonwealth countries.

Easy immigration pathways. Healthcare workers qualify for preferential immigration status. The UK offers Indefinite Leave to Remain. The US offers employment-based green cards. These paths lead to permanent residence and citizenship.

Better everything. Higher pay, better equipment, safer environments, career growth, education for children, quality of life — the advantages compound.

As one Nigerian doctor practicing 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 the UK after seven years at Korle-Bu Teaching Hospital put it simply: "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 Consequences

When doctors leave, patients die.

A 2002 survey of Ghana's healthcare facilities found that 72% of all clinics and hospitals were unable to provide the full range of expected services due to staff shortages. Forty-three percent couldn't provide full child immunizations. Seventy-seven percent couldn't offer 24-hour emergency services or safe childbirth deliveries around the clock.

Between 1993 and 2002, Ghana trained 871 medical officers. By 2002, 604 of them — nearly 70% — were practicing overseas.

The effects ripple outward:

Rural areas suffer most. Doctors migrate not just internationally but internally — from rural areas to cities, from public hospitals to private clinics. Patients in rural areas walk long distances for care that may not exist when they arrive.

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 of care declines. Those who stay are overworked and under-resourced. They burn out or become demoralized.

Training capacity erodes. When experienced professionals leave, young graduates lose mentors. Engineering bodies in South Africa note that emigrants tend to be experienced workers aged 45-60 — precisely the people who should be training the next generation.

The Ethical Facade

The World Health Organization 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.

But the reality is different. Social media means nurses can see NHS job vacancies directly and apply themselves. Agencies facilitate the process. The WHO's director of health workforce acknowledged to the BBC that Brexit was a major factor: "Having closed off the potential labor market from European freedom of movement, what we're seeing is the consequences of that in terms of attracting people from the Commonwealth and other jurisdictions."

Howard Catton of the International Council of Nurses described the situation: "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 which can ill-afford to lose their nurses."

The UK has discussed compensating Ghana — paying a sum 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-Narrative: Remittances

Defenders of the status quo point to remittances. African migrants send money home — lots of it.

In 2024, remittances to Africa reached approximately $96 billion — twice the level of overseas development assistance. In 2023, remittances exceeded both ODA ($42 billion) and foreign direct investment ($48 billion).

For some countries, remittances are lifelines:

• Egypt: $22.7 billion (2024)

• Nigeria: $19.8 billion

• Morocco: $12 billion

• Ghana: $4.6 billion

• Kenya: $4.94 billion

In Lesotho, remittances equal 24% of GDP. In The Gambia, over 26%.

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

But remittances are not development. They are survival. They consume rather than invest. They maintain the status quo rather than transform it.

And there's a deeper problem: 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 may total $96 billion, but that money comes from the cumulative departure of millions over decades — and much of it comes from low-skilled workers, not the professionals whose absence is most acutely felt in hospitals and universities.

The Structural Trap

Brain drain is not natural. It's engineered.

Structural adjustment programs in the 1980s and 1990s slashed public sector wages and healthcare budgets. Doctors and nurses saw their salaries collapse while workloads increased. The conditions that push professionals out were created by policy.

Training without employment is a common absurdity. Ghana scaled up nurse training dramatically — a 370% increase between 2008 and 2018 — but then couldn't employ them. Graduates sit idle while the government struggles to find positions, pushing them to look abroad.

Debt burdens prevent investment. Countries spending 40% or more of revenue on debt service can't afford to raise healthcare wages or upgrade facilities.

Global labor market imbalances mean wealthy countries will always be able to outbid poor ones for talent. As long as a UK nurse earns ten times what a Ghanaian nurse earns, the incentive to leave will exist.

What Would Sovereignty Look Like?

Some propose solutions within the existing system:

Bilateral agreements where recruiting countries compensate source countries for each professional. Nepal has such an arrangement with the UK. But as critics note, no payment can truly compensate for the loss of a trained doctor.

Compulsory service periods requiring graduates to work domestically for a set time before emigrating. But enforcement is difficult and such policies feel coercive.

Improved domestic conditions — higher wages, better equipment, career pathways. This is the most sustainable solution but requires resources that debt-burdened governments don't have.

The African Union's migration policy framework makes recommendations: "generate economic development programmes to provide gainful employment, professional development, and educational opportunities." The AU recognizes the African diaspora as its "sixth region" and seeks to harness diaspora expertise for continental development.

But fundamentally, brain drain cannot be solved while the underlying inequalities persist. As long as structural adjustment impoverishes public services, as long as debt drains budgets, as long as commodity dependence limits economic options, as long as 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.

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

And like mineral extraction, the profits accrue to those who do the extracting. 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 put it plainly: "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. It would mean healthcare systems resourced to provide care. It would mean wages that allow professionals to live with dignity in their own countries.

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