DEMEC 2025 Programme

Many high-income countries (HICs) are facing an escalating health and care workforce crisis, often of their own making. While global shortages against the achievement of Universal Health Coverage have declined—from 18 million in 2013 to 14.7 million in 2023—the burden remains unevenly distributed. Nearly 70 percent of the projected 11.1 million shortfall by 2030 will be concentrated in Africa and the Eastern Mediterranean. Yet, paradoxically, many HICs continue to under-invest in the domestic education and employment of health professionals, relying instead on the recruitment of foreign-born and foreign-trained health personnel from those countries with the greatest shortages.

National reporting by countries reveal that most HICs fall well below WHO’s recommended graduates-to-stock ratio of 8–12 % (roughly 1 graduate for every 10 active workers). Their education systems are failing to graduate enough doctors, nurses, and allied health workers to meet the demands of ageing populations and an ageing health workforce, or to accommodate new trends in health labour markets. To fill the gaps, many countries facilitate both ‘active’ and ‘passive’ recruitment from lower-income settings.

This dependence on international health personnel is not sustainable, and the ethics of it are questionable. It risks perpetuating global inequities, weakening health systems in source countries, and undermining efforts to achieve Universal Health Coverage and global health security . Governments and partners must therefore revisit human capital and labour market strategies with intentional investment in education, employment and retention if they wish to have a sustainable workforce. In the UK, the decision to develop a Ten Year Workforce Plan to accompany the Ten Year Health Plan for England, Fit for the Future, presents an opportunity for this review.