Nurse Retention Crisis in Sub-Saharan Africa: New Study Reveals Urgent Need for Workforce Reform and Global Accountability

A recent study Kiptulon et al. (2025) titled “Retaining nurses in Sub-Saharan Africa: A systematic review and meta-analysis,” published in the International Journal of Nursing Sciences, reveals that educational barriers also persist, with outdated training models and insufficient mentorship

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Nurse Retention Crisis in Sub-Saharan Africa: New Study Reveals Urgent Need for Workforce Reform and Global Accountability -Kiptulon et al. 2025

The study presents a critical evaluation of the persistent nursing workforce crisis across Sub-Saharan Africa (SSA). With healthcare systems under severe strain, the report underscores the urgent need for comprehensive strategies to improve nurse retention, strengthen healthcare delivery, and prevent a deepening public health emergency. The analysis reveals that, on average, only 53% of nurses in SSA remain in their jobs, and just 57% express an intention to stay (ITS) in their current roles. Regional variations are stark: East Africa reports the highest ITS at 65%, followed closely by West Africa at 63%, while Southern Africa lags far behind at just 35%.

Despite some progress, the region faces systemic challenges, including underinvestment in health infrastructure, political interference, and inconsistent HR management. Nurses often work in poor conditions marked by supply shortages, burnout, and inter-staff conflict. Educational barriers also persist, with outdated training models and insufficient mentorship. Compounding the crisis is aggressive global recruitment, particularly by wealthier countries, which continues to siphon skilled nurses out of Africa—exacerbating the brain drain.

How the Study was Conducted

Study Methodology Overview
This study employed a systematic review and meta-analysis, rigorously adhering to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, which are the gold standard for ensuring transparency and reliability in evidence synthesis. The review was registered with PROSPERO (ID: CRD42024580615), a global registry for systematic reviews that helps prevent duplication and enhances credibility.

Search and Selection Strategy
The researchers performed a comprehensive literature search across five major databases—PubMed, Ovid Medline, Embase, CINAHL, and Scopus—and supplemented this with grey literature from sources like ResearchGate and Google Scholar. The search spanned from each database’s inception up to August 2024, using keywords such as “nurse,” “retention,” and “intention to stay,” alongside the names of all 39 Sub-Saharan African (SSA) countries.

To be included in the review, studies had to meet strict criteria: they must be conducted in one of the 39 SSA nations, focus primarily on nurses, and report data on retention rates, intention-to-stay (ITS), strategies for retention, or challenges faced. Only peer-reviewed articles published in English within the past 15 years were considered.

Following the initial organization and deduplication of articles in EndNote, the researchers used Covidence software to manage the screening process. Four reviewers independently assessed the titles, abstracts, and full texts in a blinded manner to ensure objectivity.

Data Handling and Quality Evaluation
Key data points—such as author information, country of study, research design, sample size, findings on retention, and reported strategies or barriers—were extracted from the selected studies. The quality of each study was evaluated using the Mixed Methods Appraisal Tool (MMAT), with all 31 included studies achieving high scores between 80% and 100%, indicating strong methodological quality.

Meta-Analysis and Subgroup Insights
The pooled analysis was conducted using MetaXL software, employing a random-effects model to account for variability across studies. Retention and ITS rates were standardized as percentages, even when originally reported using different scales. High heterogeneity was detected in both metrics (I² > 95%), which led the authors to perform a subgroup analysis based on African regions.

What the Authors Found

Sub-Saharan Africa faces a critical nurse retention crisis, with only 53% of nurses remaining in their jobs and 57% intending to stay—highlighting severe workforce instability driven by poor working conditions, migration, and weak policy implementation, especially in Southern Africa, where retention is lowest at 35%.

Why is this important

1. Nurses Are Vital to SSA’s Health Systems: Sub-Saharan Africa carries 25% of the global disease burden with just 3% of the world’s nurses, making them essential to frontline care—especially in rural and underserved areas.

2. Alarming Nurse Turnover Threatens UHC Goals: With only 53% retention, high nurse turnover leads to staff shortages, burnout, and poor patient outcomes, putting Universal Health Coverage (UHC) and SDG targets at risk.

3. Massive Financial Loss from Migration: SSA loses an estimated US$2 billion annually from nurse migration, as governments train professionals who are later recruited by wealthier nations.

4. Global Brain Drain Deepens Inequities: Active recruitment of African nurses by high-income countries drains SSA’s health systems and fuels a vicious cycle of poor health and further emigration.

5. Proven, Data-Driven Retention Strategies: The study highlights region-specific solutions like financial incentives, better housing, leadership development, career growth, and ethical recruitment practices.

6. Urgent Need for Global Accountability: Authors call for WHO, AU, and global partners to enforce ethical recruitment, invest in SSA’s workforce, and promote collaborative policies to protect health equity worldwide.

What the Authors Recommended

• Sub-Saharan African countries should provide permanent employment contracts, improve salary structures (including rural and hardship allowances), and build supportive work environments that prioritize safety, fair staffing ratios, and job satisfaction.
• Governments must expand nursing education capacity, align curricula with health system needs, recruit from underserved regions, and offer flexible professional development, including short courses, career ladders, and promotion pathways.
• Offer quality housing, modern facilities, and essential supplies in rural areas. Ensure transparent HR practices, fair transfers, and respect for religious and cultural values that influence job commitment.
• Establish AU-led frameworks to harmonize employment terms, create regional licensing for easier intra-Africa mobility, and develop a continental nursing protection policy through blocs like ECOWAS, EAC, and SADC.
• High-income countries and donors must support binding recruitment agreements, compensate SSA nations through bilateral deals, and fund digital training platforms to reduce migration pressure. Institutions like WHO, ILO, and the World Bank should prioritize health workforce sustainability in funding strategies.

In conclusion, the study by Kiptulon et al. (2025) presents compelling evidence that the nurse retention crisis in Sub-Saharan Africa is not only a regional emergency but a global concern. Urgent, multi-level interventions—from national workforce reforms to international accountability—are essential to stabilize the nursing workforce, achieve universal health coverage, and uphold global health equity. Without swift and strategic action, the cycle of poor retention, migration, and health system collapse will only deepen.