Overproduction of health workers in Africa- lack of regulation or opportunity for Europe?

Background

The WHO Africa region’s needs-based shortage of human resources for health (HRH) will rise to 5.3 million by 2030, while unemployment among African health workers tops 30% in some countries, and healthcare budgets remain stagnant. Increased private sector investment in health workforce training has resulted in a HRH oversupply, which countries such as Kenya and Ghana are successfully promoting for export. Sierra Leone, low-income and on the WHO safeguard list, absorbs unemployed workers informally by creating unsalaried volunteer posts in public sector facilities. This study presents insights on HRH unemployment from key informant interviews (KII) with Ministry or Health and senior stakeholders.

Methods

KIIs (n = 45) were part of salaried and unsalaried health workforce study in Sierra Leone, 2022-2025, which included 113 health worker interviews, 64 service users, 12 nursing students, in Bo, Port Loko Districts and Freetown. Interviews were audio-coded using Nvivo12 and thematically analysed. Data was collected from 10 out of 12 accredited HRH training facilities to estimate HRH production changes from 2019-2027.

Findings

MoH personnel were candid about nursing training being a lucrative business which is hard to control by MoH, as accreditation of new institutions, education standards verification and regulation enforcement all fall outside their remit. They also admitted that while the deployment of volunteer health workers was illegal, the health system heavily relied on the volunteers’ unsalaried contribution, as half of all HRH are volunteers.

Discussion

African countries on the WHO safeguard list, like Zimbabwe, have successfully promoted their unemployed health workers within Europe, Sierra Leone’s unemployed nurses may soon seek to be among them. The nature of the country’s under-regulated training and overreliance on unemployed HRH’s unsalaried labour, raises questions regarding how this can best be managed and in whose interest this would be.

Key messages

• HRH overproduction in Africa can signify poor regulation and can be a warning that countries need support to enforce HRH teaching quality for domestic and international labour markets.

• In some African countries with high HRH unemployment, informal employment within the public sector is so common that it creates a dependency that is easily disrupted when health workers migrate.