UK Recruitment of Nigerian Nurses Can Be Win-Win

One of the few silver linings from Brexit for the UK has been the increase in non-EU migration. But this has led to renewed concerns about a “brain drain”, the notion that the exodus of skilled workers from poorer countries will leave them unable to meet their own development goals. Yet these concerns assume that the number of “brains" is finite. Thankfully, we have the ability to create more skilled workers—by educating people.

Economic theory is very clear, going back to Gary Becker in the 1960s, that individual investment in human capital responds to the expected return on that investment. If skilled workers are able to access higher salaries, more people should be induced to gain the relevant skills. That theory has clearly been substantiated in the case of the Philippines; nurses who migrated were able to earn much higher salaries in the US, leading to a sharp increase in the number of Filipinos training to be nurses in the hope of a higher salary. For every nurse who took advantage of the new visa and migrated to the US, ten more were trained and ended up staying home. The authors found some negative impacts (for example, the number of nurses passing the licensing exam declined) but overall, the Philippines ended up with more nurses than they began with.

So what does this have to do with the UK? In mid 2020, the government established a new ‘Health and Care Visa’ route for health workers to come to the UK. This route enables an uncapped number of health workers to migrate here, provided they have a job offer; a recognized qualification; and a minimum level of English proficiency. Between July 2021 and June 2022, 47,194 Health and Care Visas were granted; by June 2023, that yearly figure was up to 121,290 visas, an increase of 157 percent. This growth was partly driven by the decision to open the visa up to social care workers.

Where are these migrants coming from? While there has clearly been a growth in applicants across the board, it is notable that Nigeria, Zimbabwe, and Ghana have all seen tremendous increases in the number of visas granted, with Nigeria now in the number two spot behind India.

Figure 1. Nigeria is now the second largest source of health and care migrants to the UK

UK ‘Health and Care Visa’ applicants, top ten countries of nationality, 2022 Q1 and 2023 Q1

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This has translated into nursing enrolments (figure 2). Between the start of 2021 and 2022, the number of Nigerian-born nurses joining the UK nursing register more than quadrupled, an increase of 2,325. Becker’s human capital theory would suggest that this increase in the potential wages earned by Nigerian-trained nurses should lead to an increase in Nigerians choosing to train as nurses. So what happened? Between late 2021 and 2022, the number of successful national nursing exam candidates increased by 2,982—that is, more than enough to replace those who had left for the UK.

Figure 2. Nigeria has seen a spike in new nursing graduates following UK visa changes

Trends in Nigerian nursing graduates and additions to the UK nursing register

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Correlation is, of course, not causality. We don’t know whether the growth in Nigerian nursing enrolments is attributable to the existence of the Health and Care Visa. Certainly other countries of destination are opening up nursing migration pathways; and increase in Nigerian nurse migration to these other countries of destination could mitigate any potential brain gain. Domestic considerations may also have played a factor. We would need to design a study similar to that in the Philippines to prove this, but the increase is certainly stark.

Such migration brings huge benefits, not only to the UK health service but also to the migrants themselves. On average, an entry-level registered nurse in Nigeria can earn between £37 and £64 per month in a government-run hospital; in the UK, they can earn approximately £2,300 per month. If we assume that these workers will send 15 percent of their income, that equates to £345 per month supporting communities back in Nigeria, not to mention the impact of broader skill transfers.

To fully realise these benefits, Nigeria would need to embrace emigration, realising that nurses are likely going to leave anyway and doing everything they can to reap the benefits. Yet, they appear to be doing the opposite. New guidelines announced on 7 February 2024 state that nurses must work for two and half years before being allowed to work overseas, a move nurses contest. This policy is far from optimal; restrictions on emigration are inefficient, inequitable, and unethical. Indeed, Ghana had a similar scheme, but ended up scrapping it because they were unable to employ all of their nurse trainees at home.

There would be an even greater development benefit if migration was channelled through a bilateral labour agreement (BLA). Nigeria is one of the countries deemed by the World Health Organization (WHO) to have a critical shortage of health workers. If health worker migration is to take place from these countries, the WHO recommends it be included within an agreement which encourages the country of destination to provide additional investments back to the country of origin. The UK could develop such an agreement with Nigeria, similar to the one with Kenya, investing in the recruitment and retention of health workers at home, with huge spillover effects.

Of course, it’s not all plain sailing. The gains associated with migration are so high that it has unfortunately attracted some fraud; the UK nursing council has found approximately 700 nurses cheated on their exams at one test centre in Nigeria. This is obviously unfortunate, and it’s good that the council has identified the issue and is addressing it. However it’s not a reason to avoid migration altogether, just another reason to ensure good cooperation between UK and Nigerian authorities.

In a world where labour shortages in rich countries coexist with unemployment in poorer countries, the real migration crisis is not enough migrants. Governments in the UK and Nigeria must face up to this reality and work together to maximise the benefit for both countries.

Note: This blog post was updated by the authors on 26th February 2024.