“Keine Pflegekräfte, keine Hebamme und keine andere Allied Health Professionals (AHP) sollte zu einer verlorenen Zahl werden. Fähigkeiten, die Leben retten könnten, bleiben ungenutzt, während die Welt nach Fachkräften sucht.”

“No nurse, midwife, or allied health professionals should become a statistic of waste. Skills meant to save lives are left unused while the world searches for talent.”

Introduction 

When the World Health Organization (WHO) last updated its Safeguards List in March 2023, it singled out 55 countries struggling to keep enough doctors, nurses, and other professionals to reach universal health coverage goals by 2030. More than two thirds of these countries are in Africa, with the rest spread across the Eastern Mediterranean, South-East Asia, the Western Pacific, and the Americas. According to the WHO, the accelerated pace of international recruitment, worsened by the pandemic and disruptions to health services, threatens already fragile health systems.

A glance through the Safeguards List looks like a protective measure for these countries, shielding them from further depletion of their health workforce. We asked ourselves the very big question: What happens when the problem is not simply the migration of health professionals abroad, but the fact that thousands remain unemployed/underemployed at home?

Case Study: Ghana’s Health Workforce Challenge

Since we enjoy sharing practical examples, let’s use this opportunity to take you to Ghana. Since 2021, thousands of health graduates, especially nurses and allied health professionals from public/ private training institutions and universities, have found themselves trapped in unemployment. Their situation is not a reflection of poor training or unwillingness to serve. Rather, it stems from the government’s inability to recruit or retain them. The result has been devastating, causing trained health professionals to be sidelined, their skills slowly eroding while health facilities locally and across the globe continue to struggle with staff shortages. 

Just recently, at a Public Encounter Series, the Ghanaian Minister for Health laid bare the depth of the problem. He explained that the number of trained health professionals who are still waiting for jobs has gotten well beyond earlier expectations, reaching over 70,000 across different fields. What makes this even more alarming is that the figure likely reflects only those trained in government training institutions and universities. To add more “pepper,” if graduates from private schools and universities are also counted, the numbers could be far higher than what has been officially acknowledged. 

Additionally, private health facilities, though important in service delivery, are unable to carry the burden. Their recruitment capacity is small, and the compensation plans on offer often unsustainable. Our love for real-time information caused us to engage in informal conversations with some of these graduates and it became evident that many who dream of saving lives through healthcare are instead engaged in menial jobs, hustle in unrelated trades, or depend on their families for survival. Others simply sit at home, watching the years pass, their professional knowledge remaining stuck between promise and reality, neither building their own system nor allowed to support others abroad. What is unfolding is not just a health workforce challenge, but a quiet tragedy of wasted human capital. 

Is this a Painful Paradox or a Global Contradiction?

We could describe this as a tragic comedy, given how the situation blends both ridiculousness and setback. While health systems in Germany, the United Kingdom, Canada, the United States of America, Australia, etc. are desperately searching for nurses, midwives, and allied health professionals, Ghana continues to produce these skilled workers who remain unemployed or underemployed at home. The result is a painful paradox: skills that could save lives are left unused, even as global demand grows. The reality is sobering. On paper, these professionals are protected by the WHO Safeguards List. In practice, they are restricted from migrating to serve abroad, yet are not fully absorbed into their own health systems. It is a kind of limbo that the global health community has yet to confront. This raises an uncomfortable but necessary question: Should the WHO Safeguards List only protect countries from losing health workers to international migration, or should it also spotlight internal policies and economic conditions that leave thousands of professionals idle? In our view, without addressing both sides of the equation, the statistics of waste will keep growing. 

The Ethical Framing and Rights-Based Approach.

When you look at the reason for the Safeguards List, it is framed as ethical protection of vulnerable health systems, but in practice it creates two layers of injustice, which we describe below: 

- to individuals, by denying professionals the right to pursue meaningful work abroad when their own state cannot absorb them, and 

- to the health system, by allowing its trained workforce to deteriorate in skill, wasting the very human capital the policy seeks to safeguard. 

At the heart of the above is a question of rights. Every health professional, whether a nurse, midwife, or allied health worker, has the fundamental right to pursue dignified and meaningful work. This includes the freedom to apply their skills where they are needed, to earn a fair living, and to contribute to the wellbeing of communities. The WHO Safeguards List, while designed to protect vulnerable health systems, unintentionally restricts these rights when domestic recruitment freezes leave trained professionals idle. A rights-based framework reminds us that protecting populations should not come at the cost of stifling individual opportunity. 

While international ethics are important, the reality on the ground suggests that the policy, unchanged since its introduction, is blunt, inflexible, and increasingly out of step with current challenges. Employment is not just about income; it is about dignity, purpose, and contribution. It is important to note that international labor standards, such as those of the International Labour Organization, affirm the right of individuals to pursue decent work regardless of borders. In its current form, the WHO Safeguards List risks undermining this principle by restricting opportunity without providing viable domestic alternatives. 

What’s Possible? 

The silent crisis of unemployed nurses, midwives, and allied health professionals in Ghana is not an isolated story. It is a symptom of a wider disconnect among health workforce planning, economic governance, and global health policy. While state-to-state negotiations or bilateral partnerships could be one of the context-sensitive approaches in dealing with this crisis, individuals have a fundamental right to seek dignified work wherever it is available, though this must be guided by ethical recruiting. Hence, they should be free to seek opportunities when they present themselves. 

Conclusion 

The WHO Safeguards List was created to protect fragile health systems from exploitation. In practice, it has also become a barrier for thousands of trained professionals whose skills are wasting away in unemployment or underemployment. If the WHO list is to remain credible, it must evolve into more than a migration safeguard. It must also become a framework for accountability, compelling governments and partners to ensure that trained professionals are not left unused while populations remain underserved. Saving lives should never be limited by artificial boundaries. Universal access to healthcare can only be achieved when those with the skills are allowed to put them to use anywhere in the world, without unnecessary restrictions. At a time when the global health sector is in dire need of skilled professionals, this policy presents the perfect opportunity for re-evaluation. It won’t be misplaced to have a more balanced approach, one that protects health systems while empowering individuals and which can ensure that ethics and opportunity work hand in hand, rather than in opposition. No nurse, midwife, or allied health professional should become a statistic of waste.