The world has more nurses than it did five years ago, but they are in the wrong places. The WHO’s State of the World’s Nursing 2025 report confirms that the global shortage has narrowed, yet the gains are concentrated in wealthy countries that were already well-staffed. Africa and the Eastern Mediterranean are falling further behind. And Kenya, which has become Africa’s biggest supplier of nurses to the United States, is losing trained health workers to a system that contributes nothing to their education costs, offers no reciprocal investment in Kenyan health infrastructure, and returns little beyond remittances. 

The numbers tell the story plainly. The world has 29.8 million nurses but needs 5.8 million more. The shortage has narrowed from 6.2 million in 2020 and is projected to fall further to 4.1 million by 2030. 

But roughly 78 per cent of the world’s nurses work in countries that collectively serve fewer than half the global population, while 4.6 billion people lack access to essential health services. Europe’s nurse density is approximately five times that of Africa and the Eastern Mediterranean. By 2030, the African and Eastern Mediterranean regions are projected to see little to no growth in nurse density, even as the global aggregate improves. 

Kenya sits at the sharp end of this imbalance. According to TruMerit’s VisaScreen data for the financial year 2024, Kenya accounted for 6.5 per cent of US-bound VisaScreen applicants, the mandatory credential assessment for foreign-trained nurses and other health professionals seeking to work in the United States. That placed Kenya third globally, behind the Philippines at 51 per cent and Canada at 8 per cent, and made it the leading African nation in the pipeline.  

African nurses becoming central to the US healthcare supply chain despite political hostility  

Nigeria and India each held around five per cent. The TruMerit 2025 Nurse Migration Report, released in April 2026, indicates that Kenya’s share has continued to grow, though exact FY2025 country-level figures had not been independently published at the time of writing. 

Kenya’s rise reflects a broader shift in which African source countries are claiming a growing share of the US-bound nursing pipeline at precisely the moment US immigration policy is making that pipeline more treacherous to navigate. The US imposed immigrant visa pauses on 75 countries from January 2026, a list that includes Ghana, Nigeria, and significant portions of sub-Saharan Africa. The irony is pointed: African nurses are becoming more central to the US healthcare supply chain at the same moment the political environment is most hostile to their arrival. 

VisaScreen applications reached their all-time high in FY2023, at 25,935. By FY2025, that figure had fallen to 20,048, a 23 per cent drop over two years. Certificates issued also declined by 16 per cent between FY2024 and FY2025 alone, representing 3,959 fewer credentialled nurses entering the US system. 

The TruMerit report attributes this to compounding pressures rather than any single cause. Visa processing delays are pushing nurses to defer applications to avoid certificate expiry before they can use them. The US$100,000 H-1B fee, effective from September 2025, creates a prohibitive barrier for nurses who typically earn far less than the speciality occupations that fee was designed to filter for. The shift from random selection to a weighted H-1B lottery favouring higher-paid roles structurally disadvantages nursing as a profession. 

Yet despite all this, the FY2025 volume remains 2.4 times higher than the pre-pandemic baseline of FY2018. The pipeline has contracted but not collapsed, for now. The report also notes that 2026 numbers are likely to fall further still. 

As USA becomes a more difficult destination, other regions are absorbing a greater share of mobile nurses 

What this means in practical terms is that US healthcare facilities face a tightening supply of internationally educated nurses at precisely the moment domestic supply constraints remain unresolved. The shortfall does not disappear because the visa route becomes more difficult. It simply becomes a domestic staffing crisis instead of an immigration one. 

As the US becomes a more difficult destination, other regions are absorbing a greater share of mobile nurses. The foreign-educated share of Europe’s nursing workforce has risen from a ten-year average of 5.96 per cent to 8.01 per cent in recent years. Southeast Asia’s equivalent figure has climbed from 20.15 per cent to 24.87 per cent. Both regions are actively picking up nurses who might previously have pursued US routes. 

The Eastern Mediterranean and African regions, by contrast, have seen their proportions of foreign-educated nurses fall over the same period, deepening existing gaps in countries that can least afford them. 

The Gulf states present a particular case. Only 8 to 10 per cent of the Emirati nursing workforce consists of native-born Emiratis. The country has built a health tourism industry on the deliberate importation of foreign nursing labour, offering competitive salaries and a stepping-stone to eventual US entry for many. About three per cent of US-bound VisaScreen applicants between 2021 and 2024 took a mediated route through Gulf countries, typically waiting out US visa retrogression backlogs. Indian nurses face EB-2 and EB-3 waiting times of over twelve years under current figures, making Gulf transit an increasingly common strategy. 

About 28 per cent of internationally recruited nurses arrived in the US without knowing work locations 

Among nurses recruited through Alliance for Ethical International Recruitment Practices-certified agencies, 90 per cent reported a positive experience, 97 per cent received adequate contract review time, and 91 per cent knew their pay rate before arriving in the US. 

The troubling outlier: only 72 per cent knew their job location before boarding the plane. That means 28 per cent of internationally recruited nurses arrived in the United States without knowing where they would be working. 

The TruMerit report closes with eight policy recommendations covering bilateral agreements, portable credentials, standardised terminology, improved data sharing, AI-aware fraud detection, global certifications, and ethical recruitment tools. The WHO’s nursing report calls for low- and middle-income countries to raise domestic investment in nursing jobs and improve working conditions to reduce the push factors that make migration attractive in the first place. 

Both reports circle the same structural problem without yet solving it. The absence of a global forum dedicated to nurse migration workforce challenges is, in itself, a policy failure worth naming plainly. Until source countries like Kenya are compensated or supported for the nurses they train and export, the system will continue to function as a subsidy from the poor world to the rich one. 

Sources: WHO State of the World’s Nursing 2025, TruMerit 2025 Nurse Migration Report, TruMerit VisaScreen (FY2018–FY2025), Alliance for Ethical Intl Recruitment Survey 2025, US Dept of State Visa Bulletin 2025), USCIS. 

Data analytics & visualisation: Stanley Njihia  

Text: Yvonne Kawira