Power Asymmetries and the Limitations of the WHO Global Code: A Stakeholder Analysis of Health Worker Migration Governance in Sub-Saharan Africa

Abstract

This paper examines the implementation challenges of the WHO Global Code of Practice on the International Recruitment of Health Personnel, focusing on health worker migration from Sub-Saharan African countries. While the Code serves as a normative framework encouraging ethical recruitment and cooperation between source and destination countries, its non-binding nature and reliance on voluntary compliance significantly limit its effectiveness. Applying stakeholder theory as an analytical framework, this study analyzes the asymmetric power relations among the WHO, source countries, and destination countries. It argues that these structural power imbalances combined with limited institutional capacity and the absence of enforceable mechanisms constrain the Code’s practical implementation. The analysis shows that although the Code has been institutionalized as a global ethical standard, it remains insufficient in addressing the deeper structural drivers of medical brain drain in Sub-Saharan Africa.