Africa’s health workforce agenda 2026–2035: from training to retention
Africa’s health workforce agenda 2026–2035 links training, employment and retention to address shortages alongside unemployment among qualified health professionals.
Between 2024 and 2025, five African countries ranked among the world’s top ten for the quality of their health workforce data reporting. This indicator highlights the African Region’s progress in producing data, even though the regional workforce meets only 46% of health staffing needs, according to the World Health Organization (WHO), making this one of the main obstacles to universal health coverage on the continent.
Against this backdrop, Member States, professional councils, universities and technical partners meeting in Pretoria from 24 to 26 November 2025, under the auspices of the WHO Regional Office for Africa, reached a consensus on the priorities of the Africa Health Workforce Agenda 2026–2035. Formal adoption is expected at the 76th session of the WHO Regional Committee for Africa, to be held in Addis Ababa from 24 to 28 August 2026. The agenda marks a shift in approach: the aim is no longer simply to train more health workers, but to address planning, employment and retention as an integrated system, with a quantified target of three million additional workers trained, employed and retained over the decade.
Strategic context
Africa’s health workforce challenge is characterised by a paradox documented by WHO: substantial unemployment among trained health professionals coexists with severe geographical shortages, particularly in rural areas and primary-level health systems. In institutional economic terms, this disconnect between training capacity and employment capacity constitutes a failure of the health labour market: the skills are available, but the mechanisms to fund posts, deploy staff and retain them are lacking.
In recent years, the regional workforce grew from 4.3 million health workers in 2018 to 5.72 million in 2024, bringing staffing density to nearly 10 per 10,000 people. This increase nevertheless remains insufficient to meet needs. WHO has, however, revised its projection of the regional shortage by 2030 downwards, from 6.1 million to 5.85 million unfilled posts. The organisation itself regards this progress as marginal and fragile.
The 2026–2035 agenda builds on the Africa Health Workforce Investment Charter, adopted in May 2024 at the first Africa Health Workforce Investment Forum in Windhoek, Namibia. The charter already called for coordinated, sustained investment to address shortages in underserved areas, create decent jobs, particularly for women and young people, and strengthen health systems in support of universal health coverage and the Sustainable Development Goals.
The priorities agreed in Pretoria cover five areas: strengthening governance and strategic leadership; modernising and expanding education and training; improving employment and retention; increasing investment through the charter; and institutionalising health labour market intelligence to support evidence-based planning and accountability. This responds directly to the unemployment–shortage paradox identified above.
The numbers behind unemployment, training and migration
The scale of the unemployment–shortage paradox is documented in unprecedented detail in the report ‘State of the Health Workforce in Africa 2026’. In a sample of nine countries with disaggregated data, 99,013 trained health professionals, out of a combined workforce of 329,785 across eight professions, were unemployed in 2024: an overall unemployment rate of around 30%. The rate varies considerably by profession, reaching 47.2% among paramedical practitioners, 40.9% in medical imaging, 34% among midwives, 31.7% among doctors, 28.8% among laboratory technicians and 26.3% among nurses.
The imbalance starts at graduation. According to the same report, a substantial proportion of graduates remain unemployed immediately after qualifying, with graduate unemployment reaching 69% among nurses, 58% among doctors and 46% among midwives in the countries studied. More than 4,000 training institutions now produce over 325,000 graduates a year across the continent, a volume that employment systems and funding for posts are not absorbing at the same pace.
This limited capacity to employ graduates in turn fuels migration: nearly 46% of health workers report an intention to migrate because of deteriorating working conditions and limited career prospects, while losses linked to absenteeism are estimated at up to 20% of the sector’s wage bill. This indicates an erosion of health systems’ effective capacity, irrespective of nominal staffing levels.
Case analysis: the ‘State of the Health Workforce in Africa 2026’ report
The report ‘State of the Health Workforce in Africa 2026: Plan, Train, Retain’, launched on 6 May 2026 in Accra at the second Africa Health Workforce Investment Forum, is the first assessment published since the adoption of the 2024 charter and provides a reference for monitoring the 2026–2035 agenda. It documents a notable methodological shift: beyond descriptive analysis of staffing levels, the report now incorporates labour market assessments and forward-looking projections, treating the health workforce as a central determinant of health system performance rather than merely a sectoral input.
In terms of achievements, the region made substantial progress in data availability and quality between 2024 and 2025, with five African countries ranked among the world’s top ten for health workforce data reporting. This analytical foundation is essential to evidence-based planning. The report also sets a quantified target: to create up to one million jobs in the sector through investment intended to grow by around 15% annually, equivalent to approximately four US dollars per person per year, drawing on external funding, the private sector and diaspora contributions.
The report also makes an economic case for investment: each dollar invested in the health workforce could generate up to ten times its value in direct financial returns and more than thirty times its value in wider social and economic benefits, according to WHO estimates. WHO Regional Director for Africa Dr Mohamed Yakub Janabi summarised the change in approach by explaining that the challenge was no longer limited to the number of professionals trained, but now encompassed employment, distribution, quality and retention.
This ambition nevertheless faces a fundamental financing constraint: in most low- and middle-income countries, health ministries’ fiscal room to accommodate such an investment trajectory remains dependent on external aid. The agenda seeks precisely to reduce this dependence by institutionalising assessments of domestic fiscal space, although domestic financing arrangements have not yet been detailed country by country.
Policy pillars and recommendations
First pillar: treat retention as a financing objective in its own right, separate from training. The unemployment–shortage paradox documented by WHO cannot be resolved simply by increasing the number of people trained. It calls for dedicated funding for budgeted posts, particularly in rural areas, separate from allocations for initial training.
Second pillar: build health labour market intelligence systems before allocating resources. The institutionalisation of robust labour market data, as envisaged in the agenda, must precede investment decisions, rather than follow them retrospectively, to avoid reproducing the geographical imbalances already observed.
Third pillar: clarify the domestic financing trajectory. The target of 15% annual growth in investment, or four dollars per person, would benefit from being translated into verifiable national commitments with timelines, rather than presented as an aggregate continental target.
Fourth pillar: structure the mobilisation of external and diaspora funding to complement, rather than replace, public health budgets, in order to preserve the long-term sustainability of the jobs announced.
Fifth pillar: address the mismatch between training and employment before graduation. Differences in graduate unemployment across professions, reaching 69% among nurses in some countries, suggest that the planned flow of graduates should be aligned with public-sector recruitment budgets rather than driven solely by the supply of training places.
Institutional challenges and conclusion
The Africa Health Workforce Agenda 2026–2035, scheduled for formal adoption by Member States at the 76th session of the WHO Regional Committee for Africa in August 2026 in Addis Ababa, proposes a coherent change in approach: moving from the quantitative expansion of training to integrated planning that combines governance, employment, retention and labour market data.
The main institutional challenge lies in Member States’ capacity to translate a continental framework into binding national budget commitments, amid persistent pressure on external funding for public health in Africa. Unemployment rates by profession and intentions to migrate are early warning signals of the sustainability of the current model for producing health workers. The consistency between the agenda’s ambition and the resources actually mobilised by national finance ministries will be the main test of its credibility, to be assessed when it is formally adopted in August 2026.
Limitations and objections
Unemployment figures by profession are based on a sample of nine countries whose health workforce accounting systems are sufficiently mature to produce disaggregated data. Their representativeness across the 47 countries of the WHO African Region has not been established, and they should not be extrapolated without caution. Similarly, the estimated return on investment (tenfold financial returns and thirtyfold social benefits) comes from modelling conducted by WHO itself, a stakeholder in and promoter of the agenda. It should therefore be distinguished from an independent retrospective evaluation.