Hospitals and care homes across the Western world depend on professionals trained and raised elsewhere. This reliance is not a short-term quirk. It is built into how these systems staff themselves, and the countries paying for it are often the ones that can least afford to.
The numbers
Britain is a clear example. Thirty-six per cent of UK doctors and 24% of nurses and midwives were trained elsewhere in the world. When the government promised 50,000 extra nurses, 93% of the target was met through international recruitment, according to England's chief nursing officer. The largest sources were India and the Philippines, but nearly 3,500 nurses also came from Nigeria, a country on the WHO safeguards list.
Why the dependence exists
It is cheaper and faster. Training a doctor or nurse takes years, and a ready-qualified recruit fills a vacancy now. An inquiry found the NHS saved more than £14bn by recruiting doctors, nurses and midwives from overseas. Another expert called the nurse target a relatively quick fix.
Ageing populations and weak pipelines. Western societies are getting older and need more care, while domestic training places, pay and working conditions have not kept up. This is my analysis, not a figure from the sources below.
Gaps domestic staff won't fill. International recruitment mainly helps hospital and elderly care, while vacancies stay persistently high in community, mental health and learning disability nursing.
Politics. Governments set headcount targets and promise lower migration at the same time, then quietly rely on the former.
Who pays
The cost lands on source countries. The WHO's ethical code discourages active recruitment from countries facing critical health workforce shortages, and it maintains a safeguards list of the most affected nations.
Yet Nigeria and Ghana appear among the sources. For Nigeria the loss is visible: the head of the Association of Psychiatrists in Nigeria blamed the "Japa syndrome" for greatly depleting the country's mental health practitioners. A nurse trained in Accra or Kano with public money may end up caring for patients in Manchester, while her home hospital stays short-staffed.
Is the dependence ending?
Not soon. The UK plans to cut international recruitment to around 10% by 2035, but MPs say this looks overambitious and that overseas staff will be needed for the foreseeable future. Visas granted to healthcare professionals have already fallen sharply. That raises a risk: tighter rules may cut off supply before domestic training catches up.
What a fair arrangement looks like
Train more at home. Expand places, pay and retention so recruitment becomes a choice and not a necessity.
Honour the WHO code. Avoid active recruitment from safeguard-list countries.
Pay back. The inquiry chair argued that a country benefiting from overseas-trained workers has a duty to help strengthen the systems they come from. This could mean funding training places, sharing teaching capacity and offering return-and-rotate schemes. Britain has pledged £15 million to strengthen the health workforce in Kenya, Nigeria and Ghana, but that is small against £14bn in savings.
Bilateral agreements. Structured deals with source countries should include benefits for their own health systems.
The West cannot keep treating other countries' trained professionals as a free resource. A dependence it will not admit cannot be managed fairly.
Mustapha Bature Sallama
Medical/ Science Communicator,
Private Investigator, Criminal Investigation and Intelligence Analysis,
International Conflict Management and Peacebuilding. (USIP)
[email protected]
+233555275880
References
The Guardian, "Plans to cut NHS international workforce appear overambitious, say MPs," 16 March 2026 (APPG on global health and security). Reproduced at https://www.pslhub.org/news/plans-to-cut-nhs-international-workforce-appear-overambitious-say-mps-r9570/
Nursing Standard/RCNI, "50,000 extra nurses pledge met mostly via overseas recruitment." https://rcni.com/node/202981
Reuters via Interaksyon, "Britain plugs nursing gaps with international staff amid WHO concern." https://interaksyon.philstar.com/?p=251836
WHO, circular letter C.L.25.2026, Health Workforce Support and Safeguards List 2026 update, on the Global Code of Practice on International Recruitment of Health Personnel.
Nairametrics, "Nigeria has fewer than 200 psychiatrists for over 200 million people – APN," January 2026. https://nairametrics.com/?p=503420
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