A decolonial perspective on healthcare worker migration - and its implications for education and training.

Abstract

Worldwide, health-care worker migration follows a dominant and unequal pattern: healthcare workers trained in the resource-constrained global South relocate to wealthier countries in the global North, leaving already fragile healthcare systems with even fewer hands. The World Health Organisation projects a ten-million-worker shortfall by 2030, with 83 low- and middle-income countries already sitting below the workforce density needed for basic healthcare. Traditional explanations may describe this imbalance but offer few structural targets for meaningful change. Decoloniality provides a deeper analytic lens. It argues that European colonialism created a colonial matrix of power that still organises labour, capital, and knowledge. Three intertwined colonialities keep that matrix alive today: power (who controls resources), knowledge (whose expertise is legitimised), and being (whose personhood is valued). Viewed through this framework, the persistent outflow of Southern healthcare workers is not an unfortunate accident of globalisation; it is a contemporary iteration of colonial extraction. Northern countries under-invest in domestic education, then recruit talent from regions they historically dominated, validating only Western credentials and relegating international healthcare workers to inferior status even as they become essential to service delivery. This scholarly reflection does more than rename the problem – it illuminates new points of intervention. Tackling coloniality of power suggests reparative resource redistribution, whether financial or epistemic, with investment in domestic training capacity; addressing coloniality of knowledge through the recognition of Southern training and bi-directional knowledge exchange; and disrupting coloniality of being through workplace reforms that grant international healthcare workers full professional agency. By foregrounding structure over individual choice, decoloniality equips educators, policymakers, and researchers with a systemic perspective for building a fair, sustainable global health workforce.