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African Women and the
British Health Service




20th Century


Africans in the colonial period were restricted in their ability to further their careers in healthwork and so through the desire to further their education and find better job prospects Africans began to migrate to Britain. Migration of African women to Britain took place throughout the 20th century and this movement of people was largely stimulated by colonial recruitment who in response to the panic over peri and post-war staff-shortage in healthcare sought to supplement their numbers in Britain.

NHS and Recruitment

Encouragement of colonial nurses to migrate to Britain occurred as early as 1944 with circulars being sent to the colonies. With more nurses leaving Britain than coming in and the launching of the National Health Service in 1948, policy changes were implemented to further facilitate in-migration including the Nurses Act of 1949 which made easier the qualification of colonial nurses to the British standard, and the 1949 initiative by the National Advisory Council on Nurses and Midwives to encourage colonial territories in sending student candidates to the UK for nurse training. This would allow the trained nurses to provide care in their countries, sparing British nurses, and while training, serve the NHS.

Increased Migration

Favour Olagunju born in 1965 finished her training in general nursing in Nigeria in 1990. Whilst working in Ibadan she heard from a friend that there were people from the Uk that had come to recruit staff. After submitting her documents and passing her exam Favour entered the UK in late 2001 where she entered a training period and was given a pin number to apply to the NHS. Favour is just one case of the continuing recruitment of African health workers. From 1998-2003 there continued to be an upward trend in the number of African registrants to the UK Nurse Register despite the 1999 Code of Practice.

The UK began to be criticised for their active recruitment of African healthcare workers. A debate had arisen questioning the ethics of extracting much needed healthcare workers from developing countries. In response to the criticism, the UK issued a recruitment Code of Practice in 1999,  and a more stringent version in 2004, which banned active recruitment from a list of countries, most of which belong to the African continent. From the late 90s the UK had actively recruited international health workers from countries like Zimbabwe, Nigeria, Mozambique, Sierra Leone etc. to fill shortages in the NHS. Zimbabwe for example had experienced a severe economic and political crisis beginning in the early 2000s. 

Actions by the government led to outcry from Western countries and the withdrawal of international support. This resulted in a rapid economic decline and the migration of Zimbabwean professionals like doctors and nurses in massive numbers. The majority of ZImbabweans that made up this brain drain of healthcare professionals went to Western countries like the UK in the mid 2000s. Similarly in Ghana from the data available it seems that over half the doctors ever trained there had migrated.In Malawi in 2008 after a large migration of nurses the nursing vacancy level stood at 77% which greatly affected the country as it faced a high disease burden. Malawi became one of the countries considered to have the poorest health and social indicators.

The impact today

Even after the debate on the ethics of migrant recruitment, the UK remains one of the largest destination countries for migrant healthcare workers with skilled professionals in Africa emigrating at double the global rate to the benefit of the UK. Health Poverty Action’s 2017 study on the outpouring of wealth from Africa found that the cost to Africa from healthcare workers migrating out of the continent was $2 billion per year . The movement of healthcare workers from Ghana to the UK alone subsidises the Uk healthcare service by £39 million per year.  The legacy of active and unethical recruitment to the UK has led to the loss of skilled labour in African countries and poses significant losses to the future development of the healthcare systems in African Countries.


  • [1] Richard Paul Hatchett, “The history of ministerial workforce policy and planning in British nursing, 1939-1960” (PhD diss., London School of Hygiene & Tropical Medicine, London, 2005), 17-18, DOI:

  • [2] Training of Nurses in the United Kingdom: Circular Savingram to the Colonies from the Secretary of State for the Colonies, 11/8/44. PRO LAN 8/968 Recruitment of Nurses from the Colonies for Nursing Work in Great Britain; General Matters of Policy, 1944-48 in Hatchett, “The history of ministerial workforce policy and planning in British nursing,” 184.

  • [3] Diana Solano, Anne Marie Rafferty, “Can lessons be learned from history? The origins of the British imperial nurse labour market: A discussion paper,” International Journal of Nursing Studies 44, (2007): 1059

  • [5] Solano, Rafferty, “Can Lessons be learned from history,” 1060.

  • [6] Hatchett, R. P. 2005 “The history of ministerial workforce policy and planning in British nursing, 1939-1960.,” 181, 183.

  • [7] James Buchan and Delanyo Dovlo, “International Recruitment of Health Workers to the UK: A Report for DFID (Health Systems Resource Centre), 8.  

  • [8] Adhikari, Grigulis, “Through the back door,” 239-240.

  • [9] Angele Flora Mendy, “Health migration policies and ethical controversies: The case of African nurses in the UK” (Working Paper 119, International Migration Institute, 2015), 12.

  • [10] OECD (2004) ‘La migration des professionnels de santé: evaluation et enjeux à partir du cas sud- africain’, Tendances des migrations internationales. Paris: SOPEMI Edition 2003, 159-160 in Mendy, “Health migration policies and ethical controversies,” 13.

  • [11] Mendy, “Health migration policies and ethical controversies,” 6.

  • [12] Health Poverty Action 2014.”Honest Accounts? The true story of Africa’s billion-dollar losses”, 21 and Health Workers 4all 2013. “Aid in Reverse: The UK’s responsibility to address the health workforce crisis”,  2.

  • [13] Mlambo, A. S. 2014. A History of Zimbabwe: The Crisis Years 2000-2008, 234-235.

  • [14] Mlambo, A. S. 2014. A History of Zimbabwe: The Crisis Years 2000-2008, 244.

  • [15] A Perverse Subsidy pg. 106

  • [16] Adhikari, Grigulis, “Through the back door,”  pg. 239

  • [17] Honest Accounts? The true story of Africa’s billion-dollar losses 2014 by Health Poverty Action pg. 21

  • [18] Honest Accounts 2017: How the world profits from Africa’s wealth 2017 by Health Poverty Action, pg. 9

  • [19] Mackintosh, Raghuram and Henry 2006 A perverse subsidy pg. 104

  • [20] Honest Accounts? The true story of Africa’s billion-dollar losses 2014 by Health Poverty Action PG. 22

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