We serve a nation that doesn't value us: Kenya's nursing exodus reaches catastrophic levels
Despite Kenya’s acute nurse shortage, thousands of qualified nurses sit idle—trapped between a broken hiring system and a government pushing them to leave the country.
What you need to know:
- Kenyans account for 6.5 per cent of all African applicants seeking the US VisaScreen certification, a crucial requirement for foreign-trained nurses aiming to work in the US.
- This places Kenya third globally in terms of nurses applying for US work visas, behind only the Philippines ((51.3 per cent) and Canada (8 per cent).
- Nigeria and Ghana follow closely, at five per cent and four per cent respectively.
The stethoscope around Irene's* neck feels more like a symbol of betrayal these days. After graduating in 2018 and completing her mandatory internship, Irene entered what nurses call "the application abyss". The registered Kenyan nurse has applied for over 20 government jobs without success.
“These job postings often serve as a formality, with hiring decisions frequently influenced by personal connections," says Irene, her voice laced with the exhaustion of someone who's seen this script before.
Like many of her peers, Irene, who now works in a mission hospital, has navigated a landscape of scarce public sector jobs, low wages, and poor working conditions.
Despite Kenya’s acute nurse shortage, thousands of qualified nurses sit idle—trapped between a broken hiring system and a government pushing them to leave the country.
While nursing is a vital profession, the stark reality is that the demanding work is often met with dishearteningly low pay, making it difficult to achieve financial stability and personal goals. This struggle has motivated Irene to look for opportunities in the US, seeking better compensation, improved working conditions, enhanced career growth, and a more robust healthcare infrastructure.
Irene discloses that she’s in several WhatsApp groups where hundreds of nurses orchestrate their mass departure. The trend highlights a growing brain drain crisis as skilled nurses flee underfunded public hospitals for higher wages abroad, leaving Kenya’s healthcare system in peril.
“Many of my peers who have moved to the US report significantly better financial rewards. I am also in touch with numerous other Kenyan nurses currently navigating the emigration process,” she says.
Irene also cites the lack of recognition for higher academic qualifications within the Kenyan healthcare system. “I am a degree-holder yet I earn the same or even less than diploma-level nurses, which is demotivating. Furthermore, the heavy taxes on extra shifts are punitive,” she says.
For now, Irene awaits a visa interview email from the US Embassy.
Makena Miriti, also a nurse, has experienced both the challenges and opportunities of working in her home country, Kenya, and abroad. After graduating from the University of Nairobi with a nursing degree in 2014, Makena initially aimed to work with NGOs. However, securing such positions proved difficult due to their contractual nature and lack of long-term stability. She accepted a few short-term NGO contracts, including a three-month role with USAid, but found them unreliable.
Motivated by a friend's success in Dubai, she decided to explore opportunities in the UAE. Her friend, who had graduated the same year, was earning more in Dubai than nurses working in Kenyan hospitals.
Subtle bias
Makena travelled to the UAE on a visit visa without an agent, a decision that saved her a substantial amount compared to agency fees, which can range from Sh200,000 to Sh300,000. Two weeks after arrival, she secured a nursing position.
“I began my career in Dubai, earning 2,500 dirhams, (Sh88,000). Besides, the hospital I was working for provided transport, food, and accommodation. This allowed me to save almost my entire salary. I worked eight-hour shifts, with opportunities for overtime pay. Learning the local language also led to salary reviews,” she explains.
After six months, she moved to another hospital, where her salary increased to 3,500 dirhams (Sh123,000) due to her accumulated experience.
“It was during this time that I got married and had my child, and the hospital even provided accommodation for the family,” she says.
Makena observes that while there was a preference for Muslim staff and a subtle bias against African nurses, their physical strength and stature, compared to smaller Filipino and Indian colleagues, made Kenyan, Nigerian, and Ghanaian nurses desirable for handling patients. She adds that Arab employers often perceived African healthcare professionals as highly skilled.
Despite the professional and financial benefits, she returned to Kenya in 2022 due to the loss of her father, a desire to be closer to home, and concerns about her children losing touch with their Kenyan roots. She also found life in the UAE expensive for a family.
“Upon my return, I started working at a local health facility, where I noticed a stark contrast in working conditions. While I appreciated being back home, I found the healthcare system in Kenya wanting compared to the UAE. Arab countries boast top-notch healthcare systems with well-equipped facilities. In contrast, many large Kenyan facilities rely on external laboratories despite their size” she says.
Makena adds that she earns just a quarter of her UAE salary, and benefits like accommodation, transport, and food are not provided for. “Given the opportunity, I will readily return to work in the Gulf.”
The American dream
A new report by TruMerit has revealed that Kenya is the leading African nation in terms of nurse migration to the US. The data were derived from applicant information submitted to TruMerit’s VisaScreen service, a pathway through which a foreign-educated nurse or healthcare professional can migrate to and work in the US.
The 2024 TruMerit Nurse Migration Report indicates that Kenyans account for 6.5 per cent of all African applicants seeking the US VisaScreen certification, a crucial requirement for foreign-trained nurses aiming to work in the US. This places Kenya third globally in terms of nurses applying for US work visas, behind only the Philippines ((51.3 per cent) and Canada (8 per cent). Nigeria and Ghana follow closely, at five per cent and four per cent respectively.
“The composition of top source countries for nurse migration continues to evolve. The Philippines remains the leading provider of foreign-educated healthcare professionals. However, Kenya has emerged as a key player, surpassing the United States to become the third most common country of education for VisaScreen applicants,” says the report.
According to the report, 86 per cent of VisaScreen certificates were issued to registered nurses, 12 per cent to clinical laboratory scientists, while seven other allied health professions, including audiologists, clinical laboratory technicians, licensed practical or vocational nurses, occupational therapists, physical therapists, physician therapists and speech language pathologists accounted for the remaining two per cent.
This significant outflow of nurses occurs against a backdrop of considerable healthcare workforce challenges within Kenya . Health experts have highlighted a healthcare system at a crossroads, facing issues such as the inequitable distribution of healthcare professionals, limited training and employment opportunities, poor working conditions, and a growing brain drain.
The World Health Organisation reported in 2024 that nurse emigration continues to be a significant issue in the African Region. Many nurses leave their home countries due to inadequate working conditions, lack of jobs, or the pursuit of better pay and career prospects elsewhere. This has resulted in the region having the lowest nurse-to-population ratio globally, with only 11.3 nurses per 10,000 people in 2022, significantly lower than the global median of 49 per 10,000.
The report shows that in 2024, there were 24,733 new VisaScreen applications. Out of these, 24,236 VS certificates were issued to individuals educated in 106 countries or territories.
While this represents a 4.6 per cent decrease from the previous year, the application numbers are still remarkably high, sitting at nearly 200 per cent higher than figures that were recorded before the pre-pandemic levels of 2018.
There has, however, been a steady increase in the number of certificates issued between 2020 and 2023. In 2020, 7,822 visa certificates were issued, increasing to 10, 822 in 2021, to the 12, 134 in 2022, before doubling in 2023, when 26, 972 were issued. Some 6,842 certificates were issued in 2018, and 9,464 in 2019.
Despite Africa having a surplus of trained nurses, many remain unemployed or underemployed because public healthcare systems lack sufficient funding, while those who are employed face poor working conditions— long working hours, low pay and unfavourable work environments.
The surge in nurse migration has created a booming consultancy industry that capitalises on nurses' aspirations to work abroad. A social media deep dive reveals services such as resume polishing and trainings to improve English language proficiency and get familiar with the format and requirements of the International English Language Testing System. Other consultants offer to book English proficiency exams.
It is common to find this phrase: “Are you a Kenyan nurse seeking international experience?... Embrace a rewarding career abroad. 500K Jobs Abroad. Apply Kazi Majuu.”
The posts also carry a sense of urgency, suggesting that these jobs are readily available and need quick action.
But beyond social media posts, political leaders, including President William Ruto, may further encourage the migration. The President has more than once mentioned that he has visited other countries seeking job opportunities for Kenyan nurses. This, said the President, will not only address unemployment, but also enhance foreign exchange.
This is in contrast to other countries that have ramped up efforts to retain their skilled nurses within their healthcare systems. Zimbabwe and Ghana have temporarily stopped issuing emigration certificates to nurses, while Nigeria has implemented mandatory in-country service periods for nurses before they can migrate.
Other governments are trying to encourage nurses to stay by offering incentives such as Namibia's provision of car and home ownership benefits for nursing students and registered nurses. Some nations are also actively trying to attract nurses from diaspora to go back home through return incentives or by establishing mentorship and collaboration programs to facilitate knowledge exchange between nurses working abroad and those in African countries.
