Nigeria’s healthcare system is losing its most valuable asset: its people. Medical professionals are leaving in growing numbers, drawn by better welfare and opportunities abroad. The government’s 2024 response, the National Policy on Health Workforce Migration, aims to manage rather than restrict this trend. In this piece, we highlight that while well-intentioned, its impact may be limited unless funding gaps, uneven state-level adoption, and the structural drivers of migration are addressed.
Nigeria’s health sector has faced an increasingly visible challenge in recent years: the steady departure of doctors, nurses, and other healthcare professionals to foreign healthcare systems. In response to this trend, the Federal Government approved the National Policy on Health Workforce Migration (NPHWM) on 12 August 2024. The policy emerged at a time when the migration of healthcare workers had become difficult to ignore.
In 2024, Nigeria recorded 4,193 doctors and dentists leaving the country, while more than 43,000 healthcare professionals, including pharmacists, medical laboratory scientists and psychiatrists, migrated abroad between 2023 and 2024.
This outflow is occurring despite existing shortages, with Nigeria’s doctor-to-population ratio estimated at 1:5,000, far below the World Health Organisation (WHO) recommended ratio of 1:600. This gap means millions of Nigerians already have limited access to qualified medical professionals, and continued migration further strains an already overstretched health system, particularly in rural and underserved communities.
The government’s new policy sought to address the issue pragmatically. Rather than attempting to restrict movement, it recognised that health worker migration is part of a global labour market shaped by economic opportunity, professional development and mobility rights. The policy therefore emphasised the need for better governance of migration processes, drawing on international principles such as the WHO Global Code of Practice on the International Recruitment of Health Personnel. It also signalled a shift toward a more structured approach built on stronger workforce data, clearer responsibilities across institutions and dialogue with countries that recruit Nigerian health professionals.
Almost two years after the policy’s approval, the central policy question is not whether migration can be managed in principle, but whether the current framework can realistically transform workforce mobility from a pattern of net loss (“brain drain”) into one that generates reciprocal benefits (“brain gain”) for Nigeria’s health system. Early implementation signals, such as discussions on bilateral recruitment agreements and proposals to improve welfare conditions for health professionals, suggest a growing policy focus on retention and diaspora engagement. Yet the effectiveness of these measures will ultimately depend on whether they translate into tangible improvements in working conditions, career prospects and professional incentives within Nigeria.
Policy Objectives and Their Significance
The NPHWM seeks to tackle workforce mobility through a set of mutually reinforcing priorities. These include strengthening workforce data systems, improving retention conditions within the domestic health sector and establishing cooperative migration arrangements with destination countries.
One major objective is the development of more reliable information systems for health personnel. Effective workforce planning depends on accurate data on training outputs, migration trends and intra-system deployment.
Retention constitutes another key focus. The policy recognises that migration decisions are often influenced by conditions within the domestic health system. As a result, it highlights the need for measures that make local employment more attractive. These include expanding training opportunities, strengthening career progression pathways and introducing incentives aimed at supporting professionals who work in underserved communities.
Importantly, the policy does not frame international mobility as inherently detrimental. Instead, it encourages structured engagement with destination countries to promote transparent recruitment practices and mutually beneficial cooperation. Such arrangements could, in principle, support circular migration, skills exchange and institutional partnerships that strengthen Nigeria’s health system.
Beyond its technical provisions, the policy has contributed to reframing national discourse on migration. Rather than treating workforce departures solely as an inevitable consequence of global inequalities, it positions migration as a governance challenge that can be addressed through strategic planning and institutional reform.
Gaps Between Policy Design and Implementation
Despite the policy’s strong conceptual framework, translating its provisions into concrete action has proven challenging. A major limitation is the absence of detailed funding arrangements tied to specific implementation activities. Many of the initiatives outlined in the policy, such as expanding training capacity and improving workforce data systems, require sustained investment that has not yet been fully secured. Recent federal budget trends illustrated this challenge. Under the Appropriation Act 2024, Nigeria allocated about ₦1.34 trillion to the health sector, representing roughly 4.6 per cent of the national budget.
Although the allocation increased in absolute terms to around ₦2.48 trillion in the 2025 budget, the sector’s share of total spending has remained relatively low and continues to fall short of the 15 per cent target set by the 2001 Abuja Declaration. This means that, while policy commitments to strengthen the health workforce have expanded, public financing has yet to fully match the scale of investment required to support effective implementation.
Some of the policy’s proposed reforms remain at early stages. For instance, plans to establish dedicated human resource management structures for health at subnational levels are still being developed in several states. In Ekiti State, the 2025–2030 Human Resources Mapping and Recruitment Plan aims to recruit 80–880 healthcare workers annually and improve their distribution across the state’s 16 LGAs, with incentives to support rural retention. Gombe State is implementing a similar multi-year Human Resources for Health recruitment strategy for primary healthcare facilities. Likewise, efforts to integrate workforce data systems across institutions are progressing slowly. States like Kebbi State utilised iHRIS 5.0 data (an open source software) to identify critical staffing gaps and justify the recruitment of 500 Primary Health Care workers in 2024.
Nigeria’s federal governance structure adds another layer of complexity. Responsibility for health services is shared between federal and state authorities, meaning that national policies require cooperation across multiple levels of government. In practice, this has led to uneven implementation. While some states have begun exploring workforce retention strategies, such as increasing health budget allocations, strengthening workforce planning through data-driven recruitment and expanding hiring to address staffing gaps in primary healthcare. Others have yet to incorporate the policy’s recommendations into their own planning frameworks.
At the same time, many of the conditions that encourage migration remain unresolved. Healthcare workers frequently cite excessive workloads, outdated infrastructure, limited professional support and constrained career opportunities as key motivations for seeking employment opportunities abroad. Addressing these issues requires broader reforms across the health system entirely that extend beyond the migration policy itself.
The policy also highlighted the need for clearer oversight of international recruitment processes and the development of bilateral arrangements with destination countries. Progress in this area has been gradual, and formal agreements remain limited. As a result, migration pathways are still shaped largely by market forces rather than coordinated governance.
Related Policy Initiatives
Efforts to strengthen Nigeria’s health workforce have not been limited to the migration policy alone. In October 2025, the government introduced the National Strategy for Nursing and Midwifery (2025–2030), which aims to enhance training, deployment and professional development for nurses and midwives. The strategy reflects global priorities outlined in the WHO Global Strategic Directions for Nursing and Midwifery, which emphasise retention, leadership development and improved working environments.
Government assessments of the health sector also point to ongoing recruitment efforts. However, significant disparities remain in how health workers are distributed across the country. Urban areas continue to attract the majority of professionals, leaving rural communities with persistent shortages. National workforce indicators further illustrate the scale of the challenge, with the doctor-to-population ratio still far below levels typically associated with universal health coverage.
These trends highlight the importance of ensuring that policies are accompanied by practical measures capable of addressing both workforce shortages and uneven distribution.
Moving from Policy Commitments to Measurable Results
To ensure that the migration policy produces tangible improvements, attention must shift from policy formulation to implementation. Several practical actions could help translate the policy’s objectives into measurable outcomes.
Convert policy commitments into funded implementation plans
Turning Nigeria’s health workforce migration policy into measurable outcomes requires linking each commitment to a clear, costed implementation plan. The federal and state governments should outline funding, timelines and responsible agencies for initiatives like workforce registry expansion, new training positions and rural incentive programs. Transparent budgeting will allow monitoring, guide development partner support and ensure high-impact interventions in underserved areas receive priority.
Recent state budget trends indicate several states are increasing their health sector budget allocations, with some meeting or exceeding the 15% benchmark. Examples include Nasarawa (17.95%), Kwara (17.71%), Oyo (17.50%), Ogun (17%), Kano (16%), Taraba (15.98%), Abia (15%), and Bauchi (15.03%), signalling a growing investment in health. Federal guidance and funding could also incentivise states to align human resources for health strategies with national priorities through matching grants or performance-based allocations. This approach turns policy statements into concrete actions that improve workforce retention and deployment.
Expand retention pilots and scale successful models
Rapid, state-level pilot programmes should test integrated retention packages combining rural hardship allowances, housing and transport support, continuing professional development opportunities, and safeguards against excessive workloads. These pilots should be evaluated using clear indicators such as vacancy rates, retention over 12–24 months and patient access to services. Successful models can then be expanded nationally.
Strengthen workforce data systems
Completing the rollout of the human resources for health registry and establishing interoperability standards across relevant information systems will be critical. Regulators and major employers should report regularly on workforce exits and verification requests, while a national workforce dashboard could enhance transparency and accountability.
Conclude ethical bilateral agreements
Nigeria should move from policy commitments to concrete bilateral agreements with major destination countries, particularly the United Kingdom, Canada and the United States. These agreements could include provisions for training partnerships, short-term placements, fair recruitment standards and structured pathways for circular migration or return programmes. For example, Nigeria could pursue ethical bilateral partnerships similar to the United Kingdom’s agreements with countries such as India and the Philippines. It could also draw lessons from the Migration for Development in Africa Ghana Health Project, which was designed to facilitate the temporary return of Ghanaian health professionals in the diaspora to support local health institutions.
Integrate frontline perspectives into implementation
Health professionals themselves should play a central role in policy implementation. Professional associations, unions, and frontline clinicians can provide valuable insights into workload pressures, safety concerns, and career development needs. Establishing structured consultation mechanisms would ensure that policy adjustments reflect the realities faced by healthcare workers.
Conclusion
The adoption of Nigeria’s National Policy on Health Workforce Migration represents an important acknowledgement that the mobility of healthcare professionals must be addressed through deliberate policy action. By recognising migration as a phenomenon that requires management rather than prohibition, the policy laid the groundwork for a more strategic national response.
However, policy frameworks alone cannot resolve workforce shortages. Real progress depends on sustained investment, coordination across levels of government, reliable data systems and meaningful improvements in working conditions for health professionals.
If these elements come together, Nigeria will be better positioned to manage health worker mobility in a way that protects the domestic health system while recognising the realities of a global labour market. In doing so, the country could move closer to a more balanced model in which professional mobility coexists with a resilient and adequately staffed health system.
Author
Anuoluwapo Babalola / Health Policy Analyst / Contact