International migration of Africa-born health workers: a scoping review of drivers and policies, 2010–2024

Abstract

Africa faces a critical shortage of human resources for health (HRH), crucial for improving population health. We described drivers of and policies to manage the migration of Africa-born HRH from source (African) countries in Africa to destination (non-African) countries. We conducted a scoping review, using the Arksey and O’Malley framework, using data from peer-reviewed articles (2010–2024) and gray literature from institutions like Africa Centers for Disease Control (CDC) and World Health Organization (WHO). We used push–pull theory to identify economic, professional, social, and political drivers, and WHO’s HRH Workforce 2030 policy levers framework to identify policies at national, regional, and global levels. We focused on targeted migration policies—those aimed at strengthening health system resilience and health worker density in Africa (mitigating brain drain), ensuring ethical recruitment practices by destination countries, and upholding the individual right to professional mobility—based on the WHO Global Code of Practice on the International Recruitment of Health Personnel. Of 335 citations, 65 articles were relevant. Key push factors included inadequate pay, limited professional growth, and political instability; pull factors included better remuneration and career opportunities abroad. Return migration to Africa was influenced by high costs of living, discrimination, and deskilling. Source countries have focused on economic reforms and improving working conditions. However, destination countries should adopt ethical recruitment and strengthen destination country HRH training. Regional bodies like Africa CDC should harmonize HRH practices, while global actors like WHO should enforce ethical recruitment and fair compensation. Multiple drivers influence migration of Africa-born HRH. Recent changes in the US government’s global health funding will likely intensify these drivers. Targeted innovative approaches, including repatriation programs and public–private partnerships, offer the potential to improve HRH retention in Africa while protecting individual rights to mobility.