The paradoxical surplus of health workers in Africa: The need for research and policy engagement

In many countries in Africa, there is a 'paradoxical surplus' of under and unemployed nurses, midwives, doctors and pharmacists which exists amidst a shortage of staff within the formal health system. By 2030, the World Health Organisation Africa Region may find itself with a shortage of 6.1 million health workers alongside 700,000 un- or underemployed health staff. The emphasis in policy debates about human resources for health at most national and global levels is on staff shortage and the need to train more health workers. In contrast, these 'surplus' health workers are both understudied and underacknowledged. Little time is given over to understand the economic, political and social factors that have driven their emergence; the ways in which they seek to make a living; the governance challenges that they raise; nor potential interventions that could be implemented to improve employment rates and leverage their expertise. This short communication reflects on current research findings and calls for improved quantitative and qualitative research to support policy engagement at national, regional and global levels. In global health, debate on human resources and staffing focuses on a lack of trained staff.In many countries, there is also a paradoxical surplus of doctors, nurses, midwives and pharmacists.Research on the nature and consequences of this paradoxical surplus is rare.Both qualitative and quantitative data is necessary for policy makers to find effective solutions to the problem