# Health Workers in Sub‐Saharan Africa: Concurrent Skilled Health Worker Shortages and Under‐Employment

## TL;DR

Many countries in Sub-Saharan Africa face both health worker shortages and under-employment due to lack of investment and reduced international aid.

## Contribution

The paper highlights the limitations of the 2021 WHO Safeguard list and proposes better support for fair migration agreements.

## Key findings

- The 2021 WHO Safeguard list includes more LMICs at risk from health worker recruitment by HICs.
- Many listed countries have high unemployment among trained health workers due to poor investment.
- Reduced international aid worsens health worker shortages in LMICs.

## Abstract

In 2021, the World Health Organization (WHO) introduced the Health Workforce Support and Safeguards List, updating the 2010 WHO Global Code of Practice on the International Recruitment of Health Personnel. The change introduced a new way of defining what constitutes a country with a critical health worker shortage. The new calculations are based on a combined score of countries' health worker density per 1000 population and the Universal Health Coverage (UHC) service coverage index. It has led to an increase in the number of low‐ and middle‐income countries (LMICs) considered at risk from active recruitment by high income countries (HICs). However, the 2021 WHO Safeguard list review failed to explicitly recognise the main causes of low health worker density in countries on the list. Many included countries are unable or unwilling to invest in their health sectors, which restricts the number of staff that can be hired. These countries experience high unemployment among trained and qualified health workers, despite their high need for health workers. Recent dramatic reductions in international aid and development support, means that LMICs that fail to invest in their health workforce, will face ever greater shortfalls in meeting the basic health needs of their populations. For WHO Safeguard‐listed countries establishing bilateral health worker migration agreements, better support is needed to create fair deals that allow them to receive compensation from destination countries for the training costs of their emigrating health workers, which can be used to directly hire additional health workers back home.