Inside Africa’s push for health workforce overhaul

With the continent facing severe health worker shortages, Africa CDC and other local organisations are pushing new strategies to unlock talent, boost capacity, and strengthen healthcare systems.

Africa CDC is calling on governments, donors, and private sector partners to increase funding for health worker salaries through national health budgets. Photo: International Medical Corps

Africa stands at a turning point. Covid-19, Ebola, and mpox (monkeypox) taught hard lessons about the need for greater self-reliance in health security. As Dr Jean Kaseya, director-general of the Africa Centres for Disease Control and Prevention (Africa CDC), wrote at the launch of its 2023-2027 strategic plan, there is growing agreement that Africa can and must do more to protect its own health.

Recognising that a robust health workforce is essential for disease surveillance, outbreak response, and health service delivery, Africa CDC has made workforce strengthening a core pillar of its public health strategy and is urging governments on the continent to invest in health workers.

Dr Lul Riek, Africa CDC's regional director for Southern Africa, emphasises that "a system that is externally driven, unpredictably financed, and structurally inequitable cannot deliver lasting health security. The time for incremental change has passed." Africa needs reform centred on country ownership, long-term financing, health workforce investment, and local manufacturing capacity.

Africa CDC is calling on governments, donors, and private sector partners to increase funding for health worker salaries, training, and retention through national health budgets. The agency also highlights the importance of innovative financing mechanisms and digital solutions to protect and support the health workforce.

These efforts are part of a broader continental movement. The African Union’s Health Workforce Compact and the African Health Strategy 2016–2030 both aim to help African countries build stronger health systems by training and supporting enough motivated, skilled health workers to deliver essential services across the continent.

Africa’s health workforce crisis

The appeal comes in response to challenges that cut across most African countries. The most pressing include the lack of reliable data on the public health workforce, which makes it difficult for countries to plan for current and future talent needs, and an inability to attract and keep skilled public health professionals, according to the Africa CDC Strategic Plan 2023-2037.

Many of the most qualified health workers leave the continent because of poor working conditions, low pay and incentives, and limited career growth opportunities. Public health workforce training is often weak and inconsistent, largely due to the small number of public health training institutions and the lack of adequate human and financial resources to train and develop the workforce.

“We find ourselves in a paradoxical crisis… We are literally starving for care in the midst of plenty of personnel.”

As a strategy, Africa CDC is working with academic institutions and international organisations to expand and standardise training programmes, promote ongoing professional development, and address issues such as health worker migration and equitable distribution across rural and urban areas. By strengthening partnerships and prioritising workforce development, Africa CDC aims to build a resilient, skilled, and accountable health workforce capable of meeting Africa’s current and future public health challenges.

It is, however, a tall order given the continent is home to 17% of the world’s population, carries 25% of the global disease burden, and faces the most severe health worker shortages.

Health workers who are employed often face "moral injury"—the distress of knowing how to save a life but lacking the basic tools or medicines to do so. Photo: Beytlik

The region has a ratio of 1.55 health workers (physicians, nurses, and midwives) per 1,000 people. This is below the World Health Organization (WHO) threshold density of 4.45 health workers per 1,000 people needed to deliver essential health services and achieve universal health coverage.

Dr Frank Asiimwe, president of the Uganda Medical Association, says the most significant hurdle is that the training of health workers is not synchronised within countries. “Currently, medical education falls under the Ministry of Education, while the utilisation of that workforce falls under the Ministry of Health,” he explains.

In Uganda, as in many other African countries, this has led to several critical gaps. One is a lack of harmonisation as curricula are not always aligned across institutions, and supervision by the National Council for Higher Education remains ineffective. There is also a disparity between admission versus absorption. Medical students are admitted at the discretion of individual schools without a national plan for how many students the country can train and employ.

Asiimwe highlights a situation in Uganda he describes as "starving in the midst of plenty", where thousands of qualified doctors remain unemployed while the doctor-patient ratio stands at a “staggering” 1:25,000—far from the WHO recommendation of 1:1,000. “We find ourselves in a paradoxical crisis… We are literally starving for care in the midst of plenty of personnel,” he explains.

Asiimwe says a lack of fiscal space to absorb graduates into the public wage bill is driving brain drain and underemployment. “Our ‘plenty’ is either sitting idle or leaving the country,” he remarks, adding that even those who are employed often face "moral injury"—the distress of knowing how to save a life but lacking the basic tools or medicines to do so.

High-level solutions across the continent

Asiimwe says Africa CDC’s focus on strengthening the health workforce is timely and that his organisation is “advocating for a unified oversight body that bridges the Ministries of Education and Health to ensure that training is directly tied to the national human resource for health requirements.” “We must move from merely training health workers to integrating them into a functional ecosystem that serves the citizens,” he says.

He supports the introduction of mandatory absorption plans that ensure every medical graduate has a clear pathway into the workforce to reduce underemployment and emigration. The introduction of a National Health Insurance Scheme in Uganda, which parliament has passed as a bill but has not yet signed into law, would help to unlock domestic financing, he adds.

“It is vital to create the sustainable funding needed to employ these ‘idle’ doctors and equip our facilities,” Asiimwe says. “We can achieve our health goals; we need to re-prioritise and realign our systems.”

“We cannot achieve universal health coverage or global health security unless Africa fully takes charge of its own health security and sovereignty.”

Riek agrees there are big challenges—but believes they are not insurmountable. “We are moving ahead with key initiatives including the Africa Health Security and Sovereignty (AHSS) agenda, The Lusaka Agenda, and the Africa Health Financing in a New Era, also known as the ‘Green Book’, which puts sustainable financing at the centre of Africa’s public health systems.”

Riek says a high-level meeting in February in Addis Ababa, co-hosted by Kaseya and Dr Sidi Ould Tah, the African Development Bank Group president, on the sidelines of the African Union Summit, focused on strengthening collaboration between finance and health leaders to advance Africa’s health security and sovereignty.

Mandatory absorption plans help medical graduates follow a clear pathway into the workforce, reducing underemployment and emigration. Photo: Denis Ngai

"We cannot achieve universal health coverage or global health security unless Africa fully takes charge of its own health security and sovereignty," he says. "This means Africa must lead the way—setting its own priorities, strengthening its systems, and driving solutions that work for its people."

Africa-led solutions in play

The principle of Africa-led solutions is already being put into practice. International Medical Corps, an NGO operating across Africa, exemplifies the approach through its health worker training programmes conducted in partnership with national governments.

In Nigeria, the approach takes shape through local training and workforce support. “We train and recruit medical professionals to fill gaps in the health service system and work with local health authorities to advocate improving health services,” says Dr Issa Sawadogo, director of country programmes.

The organisation works with the Ministry of Health in Nigeria on needs assessment. This is critical as there are often shortages of personnel, particularly in rural areas affected by conflict and displacement.

“High workloads also create gaps, so we work with the health ministry to build capacity and deploy qualified staff to plug those cracks,” Sawadogo says.

International Medical Corps trains and recruits medical professionals to fill gaps in the health system in Nigeria. Photo: International Medical Corps

International Medical Corps has trained more than 107,000 health workers since 2023, including doctors, midwives, nurses, and community health workers. The programme aims to not only equip health workers with skills but have a multiplier effect, where trained personnel teach other health workers and their peers. Its goal is to build capacities in the health workforce and empower communities through training that promotes self-reliance.

Sawadogo says International Medical Corps is leveraging new technology by developing and using e-learning materials, which are cost-effective and enable remote instruction.

Strong partnerships deliver skilled workforces

Effective health worker training requires strong partnerships on the ground. Seed Global Health demonstrates this collaborative approach in Malawi, where the non-profit works in close partnership with the government, training institutions, and regulatory bodies to strengthen primary healthcare by investing in skilled health workers and systems that support them.

Seed Global Health Malawi country director Anda Nindi Nyondo says this approach brings training, service delivery, and learning together in one place, closing the gap between classroom theory and real-world practice. The result is that health workers are not just trained; they are trained well and in clinical settings where they can immediately apply what they learn.

In Malawi, this means supporting practical innovations at the primary care level: integrated care pathways for screening and chronic disease management, better maternal and newborn services, and expanded family medicine and midwifery programmes. It also involves strengthening how experienced clinicians mentor newer staff.

Training happens in clinics and hospitals through upgraded skills labs, preceptorship programmes, and bedside mentorship. "Students and providers learn in the same environments where they're delivering care," explains Nyondo. "It's not theoretical; it's real-time learning."

“It shows that when you invest in health worker education, you don't have to wait years to see results—you get immediate service improvements while building long-term workforce capacity.”

This approach delivers a double benefit, she says. "We're improving clinical competence and confidence while also strengthening the care patients receive," Nyondo says. "It shows that when you invest in health worker education, you don't have to wait years to see results—you get immediate service improvements while building long-term workforce capacity."

The most important shift is that health worker training is considered “part of everyday service delivery", Nyondo adds, "not just occasional, one-off training sessions".

When training, service delivery, and financing are aligned, countries are better positioned to retain skilled providers, improve quality of care, and sustain progress toward universal health coverage, Nyondo says, emphasising that building this collaboration across the continent requires coordinated institutional support.

Riek agrees, emphasising Africa CDC's central role in strengthening the health workforce. "Our role is to support all African countries to build strong, resilient health systems," he says. "There is really no limit to what we can do, as long as there is a clear need and the resources are available."