A patient receiving a vaccination in an international hospital.

Case study

Migration of nurses from sub-Saharan Africa

Using previously published reports Dovlo (2007) analyses the trends and impact of nurse migration in sub-Saharan Africa (SSA). At the time of the report, WHO estimated that SSA suffered 25% of the global diseases burden but retained only 1.3% of the trained healthcare workforce.

The shortages in the healthcare workforce are linked to an emerging health crisis demonstrated through a fall in life expectancy due to the rising incidence in communicable diseases and the impact of HIV/AIDs in almost half of the countries. The migration of nurses from SSA to developed countries is considered a major contributor to the health crisis, though an important finding was that limited primary quantitative data existed.

Push factors, or those influences arising in the home country which encouraged a nurse to leave, were broad, and included income differential, job satisfaction, perceptions of the work environment and the ability to use one’s skills, the organisational environment and career opportunities. A number of wider social issues were cited, such as political and administrative governance, occupational risk and protection due to HIV/AIDS and the welfare and benefits for health professionals during and after employment.

A range of factors collectively titled ‘stick’ or ‘stay’ factors are also identified, which refer to influences associated with the home country but which act to mitigate against the nurse leaving. Such factors include family life and ties and social links.

The ratio of nurses to doctors in SSA is high but the ratio to population is much lower than in other parts of the world, primarily due to the scarcity of resources. However, bureaucracy is also identified as a feature allowing nurses to remain unemployed in areas of shortage. The shortage of nurses in Africa has been exacerbated through reductions in the recruitment to nurse training, which is now unable to maintain already poor staffing levels.

Some of the studies of individual countries are particularly dramatic. For example, between 1999 and 2001, 60% of the workforce left a single hospital in Malawi and in 2000, 500 nurses left Ghana. Although the wage differences were important for nurses migrating to developed countries, studies conducted in Kenya and Benin have demonstrated that a mix of financial and non-financial incentives are successful in enhancing motivation to remain in the home country. Strategies such as group and efforts-based rewards, team-building, career development and transparent promotion and continuing education enhanced staff satisfaction.

Staff shortages are the direct effect of nurse migration with the result that nurses may be unable to deliver necessary care. Further losses may be in areas of specialist skills and educators. Many countries in SSA invest centrally in the education of nurses. Their investment is, therefore, lost as a result of migration. There may be some balancing of the equation if the remittance sent home is high, such as to Nigeria or Eritrea.

Your task

Share your reflections on the impact of nurse migration for the countries cited in this study.


Dovlo, D. (2007) ‘Migration of Nurses from Sub-Saharan Africa: A Review of Issues and Challenges’. Health Services Research [online] 42 (3), 1373-1388. Abstract available from http://dx.doi.org/10.1111/j.1475-6773.2007.00712.x [20 November 2017]

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This article is from the free online course:

Nursing in Crisis? Exploring Current Challenges

Coventry University