Pay first salaries for jobless nurses and midwives while governments take over

Why this matters

WHO's Africa office estimates that 943,000 trained health workers had no job in 2024. That is nearly three times the number who graduate each year. Among new graduates, 69% of nurses and 46% of midwives have no job. WHO finds the causes in tight budgets, limits on how many staff governments may hire and slow public hiring.

Graduates who cannot find work leave. At least 46% of health workers plan to emigrate, and nurses in rich countries earn about seven times what they earn in Africa. Canada, the United States and the United Kingdom are the destinations named most often. Each nurse who leaves takes years of African public training with her.

Employing all 447,590 unemployed nurses and 135,342 unemployed midwives would cost about $2.1 billion a year. That assumes average yearly salaries of $3,733 for a nurse and $3,288 for a midwife. The Africa Health Workforce Investment Charter, adopted in Windhoek in May 2024, asks each government to sign a national plan for its health workers. It also asks governments to raise their health wage bill by about 15% a year. WHO's 2026 report is the starting point for checking progress. A salary fund would therefore have both a home and a way to measure results.

Four levels of action

1. 1

   What Africa asks of the world

   Countries that recruit African nurses should help pay for first jobs in the countries they recruit from. This should be a term in every recruitment agreement between governments.

   Who

   Canada, the United States, the United Kingdom and other countries that recruit African health workers

   When

   The 80th World Health Assembly, May 2027

2. 2

   What the African Union does

   WHO's Africa office, which holds the Charter, sets up a salary fund with African foundations and public development lenders. Each government writes its take-over schedule into its national plan for health workers.

   Who

   WHO's Africa office, with African foundations and public development lenders

   When

   Design agreed by March 2027; first nurses and midwives in post by September 2027

3. 3

   What regional groups do

   The East African Community, ECOWAS and SADC agree common standards for nursing and midwifery and recognise each other's qualifications, as the Charter recommends. Staff placed by the fund can then work across borders. Mali, Burkina Faso and Niger belong to WHO's African region, so they can join through WHO without a decision by the AU or ECOWAS.

   Who

   Health ministers of the East African Community, ECOWAS and SADC

   When

   Mutual recognition agreed by June 2027

4. 4

   Which country goes first, and why

   Kenya and Zambia go first. Both are among nine countries that reported health worker unemployment to WHO for 2024. Zambia also published a study of its health job market in 2024. Kenya signed an agreement with the United Kingdom in 2021 that opened a route abroad for its qualified but unemployed health workers. That gives Kenya a recruiting country to ask for money.

   Who

   The health and finance ministries of Kenya and Zambia, with their nursing councils

   When

   Plans signed and first-year share budgeted for 2027/28 by June 2027; first group in post by September 2027

Before another country can do this

• Published counts of unemployed nurses and midwives.
• A national plan for health workers signed under the Charter.
• Named empty posts in local clinics and health centres.
• A finance ministry that writes the take-over into budget law, within any IMF limit on the public wage bill.
• A payroll that pays on time.

What does not carry over from the first country

• Kenya's recruitment agreement with the United Kingdom.
• Counts of unemployed staff by profession, which only nine countries reported for 2024.

Who else is ready

Has this worked before?

Nigeria's Midwives Service Scheme, started in 2009, placed nearly 2,500 midwives in 652 rural clinics. An evaluation by the RAND Corporation, a US research group, found 12% more antenatal care and no measurable gain in the health of mothers or children. Midwives left because their pay was irregular and state and local governments did not keep their side. A take-over schedule and pay on time matter more than the number of people placed. Source (opens in a new tab)

RAND Corporation: evaluation of Nigeria's Midwives Service Scheme

First steps

1. African UnionWHO's Africa office, two or three African foundations and one public development lender agree the fund's design and how it reports, by March 2027.
2. Regional groupshealth ministers of the East African Community and SADC agree to recognise the qualifications of staff placed by the fund, by June 2027.
3. Kenya and Zambiahealth and finance ministries sign plans with a take-over schedule and budget the first year's share for 2027/28 by June 2027, and nursing councils place the first group by September 2027.

Who acts, and with what

Who leads

WHO's Africa office under the Charter, with African foundations and public development lenders; Kenya and Zambia go first

Instrument

A salary fund with signed take-over schedules, paid through each government's own payroll

How progress is checked

The number of nurses and midwives employed, the share of salaries paid on time, and a government share that rises each year

Signal to change course

A government misses a take-over step, or salaries fall two months behind

What stands in the way

IMF limits on the public wage bill may block the take-over. A fund that keeps paying while a government fails to take over only delays the problem.

Cost and money

WHO estimates that employing every unemployed nurse and midwife would cost about $2.1 billion a year: $1.67 billion for nurses and $0.45 billion for midwives. At $3,733 per nurse, 10,000 placements would cost about $37 million a year before the government share rises. The funders and the size of the fund are not yet known.

Who else contributes

What each audience can do