Opening Scene
On a humid Tuesday morning in Kampala, Aisha, a 28-year-old nurse, sits at a small desk with two envelopes in front of her. One contains her current employment contract at a public hospital: 1.2 million Ugandan shillings per month (about USD 320).
The other is an offer from a recruitment agency for a healthcare assistant role in the UK paying nearly ten times her local salary, plus accommodation and health insurance. She knows the choice she’s about to make will change her life and leave a vacancy her hospital will struggle to fill for months.
Aisha’s story plays out every day across Africa and Asia. It’s a human face on a systemic problem: a growing mismatch between the demand for skilled health workers and the ability of local health systems to retain them.
The result? A widening skills gap that weakens service delivery at the exact moment when populations are ageing, chronic disease burdens are increasing, and health emergencies are more frequent.
The Scale of the Gap
The World Health Organization projects a global shortfall of 10 million health workers by 2030 — with the largest gaps concentrated in low- and lower-middle-income countries (WHO, 2020).
Sub-Saharan Africa has only 1.55 doctors, nurses, and midwives per 1,000 people, far below the 4.45 per 1,000 threshold needed for universal health coverage (WHO Global Health Observatory).
The challenge is compounded by attrition. In the Philippines, more than 19,000 nurses resigned from domestic posts between 2020 and 2022 to work overseas (Philippine Overseas Employment Administration).
In Ghana, the Nurses and Midwives Council recorded a 25% attrition rate in some specialties in 2021, primarily due to migration.
Why Wages Matter
At the heart of the retention problem lies a stark wage disparity:
| Country | Annual Salary – Entry-Level Nurse | Equivalent in USD | Relative to UK (approx.) |
|---|---|---|---|
| Ghana | 36,000 GHS | $2,800 | 10% |
| Philippines | 255,000 PHP | $4,800 | 19% |
| UK | £22,383 | $28,000 | 100% |
For many, the wage gap outweighs loyalty to home systems. Even factoring in cost of living, the purchasing power of a UK or Gulf country wage can be 3–5 times higher.
Training Without Retention is a Leaky Bucket
Large-scale training programs without retention strategies risk becoming pipelines for international migration. Countries bear the cost of education (often subsidised) but lose the economic and service return when graduates emigrate.
A WHO analysis estimated that Malawi’s loss from emigration of domestically trained doctors to the UK alone was equivalent to $26 million in forgone investment between 2000 and 2010.
Policy Levers for Sustainable Livelihoods
- Competitive Wage Policies – Some countries are experimenting with indexed pay scales that rise in line with inflation and are benchmarked against regional averages.
- Incentives for Rural and Hardship Postings – Thailand’s rural doctor program, launched in the 1970s, significantly reduced turnover by offering salary bonuses, loan repayment, and career advancement for service in underserved areas (Wibulpolprasert & Pengpaibon, 2003).
- Career Pathways and Specialisation Tracks – In South Africa, the introduction of advanced practice nurse roles created promotion opportunities without migration.
- Bilateral and Ethical Recruitment Agreements – The WHO Global Code of Practice on the International Recruitment of Health Personnel calls for compensation or investment in source-country health systems when active recruitment occurs.
Advocacy: Beyond the Payslip
Retention is also about professional dignity and working conditions. Adequate staffing ratios, safe working hours, continuing professional development, and recognition all influence whether workers stay.
In East Africa, Oakvale Learning’s workforce studies found that when career development opportunities are integrated into employment contracts, retention improves by 20–30%, even if wage increases are modest.
We believe in a “livelihood parity” approach:
- Pay that reflects skill and training investment.
- Benefits that reduce the real cost of living (housing, transport, child care).
- Career mobility that makes staying an attractive choice — not a default for those who can’t leave.
Closing Narrative
When Aisha finally made her choice, she accepted the overseas offer — but she told her supervisor she would return one day. The reality is, without systemic change, many like her won’t.
Bridging the healthcare skills gap in Africa and Asia requires more than producing competent graduates. It demands that we create environments where staying is as viable and rewarding as leaving.
At Oakvale Learning, we not only train healthcare professionals to global standards — we partner with providers, policymakers, and NGOs to design workforce systems that value, retain, and reward the people at their heart.