Health workforce migration is often framed as a staffing issue. At times, it is treated as an ethical debate. Occasionally, it appears in discussions of health system shortages. But it is rarely discussed as an issue of the international political economy: how politics and economics shape one another across borders. That framing matters because health workforce migration is not simply the result of individual choice or employer demand. Global labor markets, wage differentials, public investment, immigration policy, fiscal constraints, regulatory power, and unequal bargaining relationships between countries shape it. Put simply, it is about who moves, who benefits, who pays, and who bears the risk.
Across the world, high-income countries increasingly rely on foreign-educated health professionals to sustain their health systems. Nurses are often the most visible example because they make up one of the largest segments of the health workforce and are among the professions most actively recruited across borders. But the same dynamics affect doctors, midwives, laboratory professionals, pharmacists, rehabilitation workers, and other essential cadres.
The demand side is increasingly clear. The Organisation for Economic Co-operation and Development (OECD) has reported that health systems across its member countries continue to rely heavily on migrant doctors and nurses. In 2020-2021, there were more than 830,000 foreign-born doctors and 1.75 million foreign-born nurses working in OECD countries. In 2021-2023, OECD countries counted 606,000 foreign-trained doctors and 733,000 foreign-trained nurses. OECD health data also shows that the number of foreign-trained nurses exceeded 800,000 in 2023, a 69% increase since 2010. These figures point to a structural shift, not temporary adjustment. Health workforce mobility has become part of how many destination countries manage demographic change, care demand, and domestic workforce gaps. That does not make international recruitment inherently wrong. But it does mean that it should be analyzed honestly as part of a global political economy of care. The source-country picture is more complicated than the familiar story of scarcity suggests.
Many countries face severe health workforce shortages while also struggling to absorb the professionals they have already trained. The WHO Regional Office for Africa (AFRO) captured this paradox in its 2026 State of the Health Workforce in Africa report. Africa’s health workforce reached 5.72 million in 2024, but the region still had only 46% of the health workers it needs. At the same time, AFRO estimated that 943,000 trained health workers were unemployed in 2024, even as health systems remained understaffed.
This is where the political economy lens becomes essential. If the problem were only a lack of trained workers, the answer would be straightforward: train more. But when trained health professionals cannot find funded posts, or spend years waiting to enter the workforce, the issue is not only education. It is about public financing, wage bills, hiring controls, fiscal space, and the distribution of costs between households, states, and destination-country health systems. In some countries, a nurse may wait years after graduation before securing a formal job, even while communities continue to experience shortages. That is not a contradiction. It is a political economy problem: the education system may produce graduates, but the health system may lack the funding to provide positions to employ them.
The result is a difficult and often under-discussed reality. Migration can become a safety valve for unemployed or underemployed health professionals. For the individual worker, migration may be a rational path toward income and professional development. For the sending country, however, the picture is more mixed: it may lose workers it needs, while lacking the fiscal capacity to employ them at home. For the receiving country, international recruitment can relieve immediate pressure without requiring the same level of long-term investment in the domestic workforce. That is why health workforce migration cannot be understood through markets alone. It is also shaped by state power and public policy.
Destination countries decide which occupations receive visa priority, how quickly credentials are recognized, which employers may recruit internationally, and how much to invest in domestic training. Source countries decide how many health workers to train, whether to encourage overseas employment, how to manage recruitment, and whether they can finance sufficient public-sector posts. International organizations set norms and guidance, but much of the system still depends on voluntary compliance rather than enforceable global rules. This political dimension is often missing from policy forums. We speak of shortages as if they are natural facts. We speak of migration as if it is merely the sum of individual decisions. We speak of ethical recruitment as if principles alone can govern a labor market shaped by unequal fiscal capacity and unequal bargaining power. But health workforce migration is produced by policy choices, institutional arrangements, and power relationships as much as by supply and demand.
The governance gap is visible in the institutions we already have. The WHO Global Code of Practice on the International Recruitment of Health Personnel provides an important ethical framework, but it is voluntary. International Labour Organization (ILO) standards and care-economy work rightly emphasize decent work, fair recruitment, social protection, and recognition of care workers, including migrant workers. The International Organization for Migration’s (IOM) migration governance work places mobility within broader questions of rights, development, and multi-stakeholder cooperation. These frameworks matter. But they have not yet added up to a coherent global system for managing health workforce mobility. The result is fragmentation.
Health ministries focus on shortages. Migration authorities focus on visas. Regulators focus on credential recognition. Education ministries focus on training pipelines. Finance ministries often determine whether graduates can actually be hired. Development actors focus on brain drain. Each perspective is valid, but no single lens is sufficient. A stronger international political economy approach would ask harder questions.
Who pays for the training of health professionals who later migrate? Who benefits when destination countries recruit from systems with limited fiscal space? What obligations do receiving countries have to invest in source-country training, retention, or health-system capacity? How can sending countries protect professionals’ rights to migrate while also sustaining their own services? And how can credential recognition systems protect patients without creating unnecessary delays that leave qualified professionals underemployed? These questions do not lend themselves to simple answers but point toward a more honest policy agenda.
First, health workforce migration should be treated as part of global labor market governance. This means aligning migration policy, workforce planning, education investment, health financing, and ethical recruitment. Bilateral agreements can help, but only if they account for training capacity, employment absorption, worker protections, and the needs of both origin and destination countries.
Second, we need to improve how the system functions in practice. One of the most persistent barriers to efficient and safe mobility is a lack of trust in qualifications. Fragmented recognition processes create delays, increase costs, and leave skilled professionals underutilized. More transparent and interoperable approaches to verifying and benchmarking credentials would not lower standards. They would allow standards to be applied more consistently and efficiently.
Third, we need to think more carefully about distribution. If some countries are effectively contributing to the global supply of health professionals, what mechanisms exist to support and sustain that contribution? This does not mean restricting movement. Health professionals have the right to seek better opportunities. But it does mean building more balanced systems through shared investment, training partnerships, retention support, ethical recruitment commitments, and structured pathways that benefit both origin and destination countries.
Finally, this conversation needs to move into spaces where economic policy is shaped. Health workforce mobility has implications for productivity, fiscal sustainability, care infrastructure, gender equity, and social stability. It should be part of discussions not only within health ministries, but also among finance ministries, labor authorities, education planners, migration policymakers, and international economic institutions. Health systems do not sit outside the economy. They are foundational to it.
The COVID-19 pandemic made clear that health workforce capacity is not simply a sectoral concern. It is central to resilience. As countries continue to navigate demographic change, workforce shortages, and economic uncertainty, the movement of health professionals will only become more important. Nurses should remain central to this discussion because of the scale and visibility of nursing migration. But the policy framework should be broad enough to encompass the broader health workforce on which functioning systems depend. Treating health workforce migration solely as a staffing or migration issue misses the broader dynamics at play. Bringing it into the framework of the international political economy does not make the problem easier, but it does make it more visible. That is the first step toward policies that are not only more effective, but also more balanced—for the professionals who move, the systems that depend on them, and the countries that invest in their training.
Source notes
- OECD, International Migration Outlook 2025, chapter on international migration of health professionals to OECD countries (2025).
- OECD, Health at a Glance 2025, sections on international migration of doctors and nurses (2025).
- WHO Regional Office for Africa, State of the Health Workforce in Africa 2026: Plan. Train. Retain. (2026), and WHO AFRO news release, ‘Africa’s health workforce expands but shortages, unemployment and migration intensify’ (6 May 2026).
- International Labour Organization, Resolution concerning decent work and the care economy, International Labour Conference, 112th Session (2024).
- International Organization for Migration, World Migration Report 2024, including chapter on global migration governance (2024).
- World Health Organization, Global Code of Practice on the International Recruitment of Health Personnel (2010).
Benjamin Slaugh is an international affairs expert with experience in global economic engagement, government relations, and multilateral partnerships.