LUSAKA – Zambia has been dropped from the World Health Organization’s 2026 Health Workforce Support and Safeguards List, marking a change in how the country is classified under the international framework designed to protect health systems facing severe workforce shortages.
The development is significant, but it needs to be understood in context. It does not mean Zambia has eliminated its shortage of doctors, nurses and midwives, nor does it establish that every province has enough health workers to meet the needs of its population.
In its March 2026 comparison of the previous and updated lists, the WHO identified Zambia among 10 African countries dropped from the 2023 list. The organisation said the overall reduction in countries on the list was primarily due to improvements in the Universal Health Coverage Service Coverage Index.
The updated technical list contains 36 countries globally, down from 55 in 2023.
For Zambia, the change raises three important questions: what does the WHO list actually measure, why has the country been removed, and what does the development mean for health workers and patients?
What is the WHO health workforce ‘red list’?
The list is officially called the WHO Health Workforce Support and Safeguards List. The term “red list” is commonly used informally, but it is not the WHO’s official name.
The list identifies countries facing particularly serious health workforce challenges in their efforts to achieve universal health coverage.
Its purpose is twofold: to prioritise vulnerable countries for support to strengthen their health systems and to discourage aggressive international recruitment that could worsen existing shortages.
The WHO’s assessment focuses on two principal indicators.
The first is the density of medical doctors, nursing personnel and midwifery personnel relative to the population. The second is the Universal Health Coverage Service Coverage Index, which measures access to essential health services across several areas of healthcare.
Under the 2026 technical criteria, countries are identified when their health workforce density falls below the global median used by the WHO and their UHC Service Coverage Index is below 50.
The 2023 list used a UHC service coverage threshold below 55, alongside the health workforce density criterion.
This difference is important. A country can fall outside the updated list because its service coverage indicator improves sufficiently or because the revised threshold changes how it is classified. Being outside the list is not, on its own, proof that the country has achieved an adequate health workforce.
Why has Zambia been removed?
The WHO’s March 2026 comparison provides the clearest explanation available.
The organisation said the reduction from 55 countries on the 2023 list to 36 in the 2026 technical update was primarily attributable to improvements in the UHC Service Coverage Index.
Zambia was among the African countries no longer included under the updated technical criteria.
The index measures coverage of essential health services using 14 sub-indicators grouped into four broad areas: reproductive, maternal, newborn and child health; infectious diseases; non-communicable diseases; and service capacity and access.
It is therefore broader than simply counting doctors or nurses. It seeks to capture how effectively essential health services reach the population.
An improvement in the index can reflect progress in access to or coverage of services. However, it does not automatically mean that the number of health workers has increased sufficiently, that vacancies have been filled or that shortages in rural and remote areas have been resolved.
The WHO has not presented Zambia’s removal as a declaration that the country no longer has health workforce challenges.
It is also important to distinguish between the reason for the overall change in the list and a specific explanation of every change in Zambia’s workforce. The published comparison identifies improvements in the UHC index as the main reason for the overall reduction, but does not establish that every aspect of Zambia’s health workforce has improved.
A change in the rules also matters
The 2026 update introduced another important change in the way the safeguards list is applied.
Following a resolution adopted by the World Health Assembly in May 2026, countries can indicate whether they wish to receive an exemption from the recommendations discouraging active international recruitment, or whether they want those safeguards extended to them even if they do not meet the technical criteria.
This means the updated framework is no longer based exclusively on the two technical indicators.
The WHO first identifies countries that meet the technical criteria, then gives Member States an opportunity to request an exemption or an extension of the safeguards. The final list is intended to reflect the technical assessment and countries’ positions.
As a result, a country’s technical classification and the application of recruitment safeguards are related but distinct questions.
The WHO’s published technical comparison confirms that Zambia was dropped from the 2023 list under the updated criteria. The public information reviewed for this article did not establish whether Zambia requested an extension of the safeguards or what the final country-specific determination was under the new process.
That distinction matters when interpreting claims that Zambia has been completely removed from every aspect of the WHO’s health workforce protection framework.
What does removal mean for health workers seeking jobs abroad?
The list is particularly relevant to international recruitment.
The WHO recommends that countries on the list receive priority for health workforce development support and that destination countries refrain from actively recruiting large numbers of health workers from those countries.
Active recruitment includes targeted efforts by employers or recruitment agencies to attract health workers from countries facing serious shortages.
The objective is to reduce the risk that wealthy destination countries fill their own vacancies by drawing large numbers of health professionals away from health systems that already struggle to provide essential services.
The safeguards are not a blanket ban on migration.
The WHO makes clear that the list does not prevent individual health workers from applying for jobs abroad or pursuing employment opportunities in countries willing to recruit them. Individual migration, passive recruitment in response to advertised vacancies and recruitment under appropriate bilateral agreements can still take place.
For Zambian nurses, doctors and midwives, therefore, being dropped from the technical list does not mean that they have suddenly acquired an unrestricted right to work in every destination country, nor does it mean that their qualifications or professional registration requirements have changed.
Recruitment remains subject to the laws, licensing requirements and immigration rules of the destination country.
The change may, however, affect how destination countries and recruiters apply the WHO’s specific recommendations on active recruitment from countries classified as having the most pressing workforce vulnerabilities.
Does this mean Zambia has enough doctors and nurses?
The WHO itself cautions that the workforce density threshold used in the list is a comparative tool, not a recommended staffing level for every country. Appropriate workforce levels depend on factors such as population needs, disease burden, demographics, skills mix and how health services are organised.
A national average can also conceal substantial differences within a country.
A province with a concentration of hospitals and health professionals may have a very different staffing situation from a rural district where patients travel long distances to reach a health facility.
The number of trained health workers is only one part of the equation. Their distribution, employment status, working conditions, availability of equipment and medicines, and ability to provide services also affect the quality and accessibility of healthcare.
For that reason, the more useful question for Zambia is not simply whether it appears on an international list. It is whether the country has enough appropriately trained and supported health workers, in the right places, to meet the needs of its population.
Zambia has also improved health workforce data reporting
There is another development relevant to the wider picture.
In August 2026, the WHO Regional Office for Africa recognised Zambia for progress in strengthening its health workforce data.
The country ranked first in the African Region and third globally in the 2024 National Health Workforce Accounts data-reporting cycle, with a data availability score of 94%.
Zambia had ranked 10th in the region in the 2023 reporting cycle, when its score was 81%.
The National Health Workforce Accounts provide a standardised system for monitoring workforce information. Better data can help authorities understand staffing levels, identify shortages and distribution gaps, and make decisions about education, recruitment, deployment and retention.
The WHO’s recognition is evidence of progress in the availability and reporting of health workforce information. It is not, by itself, proof that Zambia has eliminated shortages or that staffing levels are now adequate across the country.
The value of improved data will ultimately depend on how effectively the information is used to guide policy and investment.
What should happen next?
Zambia’s change in status provides an opportunity to focus on the underlying workforce challenges rather than treating removal from the list as an end in itself.
The WHO recommends that countries strengthen health workforce planning, invest in training and employment, improve working conditions and develop retention strategies suited to their circumstances.
For Zambia, the practical priorities include determining where health workers are most urgently needed, ensuring that training produces the skills required by the health system, and creating conditions that enable qualified professionals to work and build careers in the country.
The country also needs to ensure that the benefits of international recruitment are balanced against domestic needs. Where health worker mobility is pursued through government-to-government agreements, the WHO recommends arrangements that protect adequate domestic supply and deliver proportionate benefits to the source country’s health system.
For patients, the ultimate measure of progress will be whether they can obtain timely care, whether facilities have the staff required to operate effectively and whether access to essential services improves across urban and rural communities.
The real measure is what happens in health facilities
Zambia’s removal from the WHO’s 2023 health workforce safeguards list under the 2026 technical update is a documented change in its international classification. The WHO says improvements in the UHC Service Coverage Index were the primary reason for the overall reduction in countries on the list.
But the development should not be confused with a declaration that Zambia has solved its health workforce challenges.
The list is a tool for identifying vulnerability and guiding support and recruitment safeguards. It is not a complete assessment of every hospital, clinic, profession or district.
The more important test is whether improvements in service coverage are sustained, whether workforce planning translates into adequate staffing and whether patients experience better access to care.
Zambian Eye will continue examining the country’s health workforce, the policies affecting recruitment and retention, and the gap between national indicators and the realities faced by patients and health professionals.