Supply before quotas

Executive summary

Every GCC state has made building a national health workforce a strategic priority, and the question now is how to do it. Eight years of published data from Saudi Arabia, the region's largest health system, point to one answer: localisation moves fastest where training supply, pay and career paths are built ahead of the quota. Quotas set the direction, but the pipeline is what delivers.

The stakes are high. Health systems across the region are expanding, populations are growing and ageing, and national visions commit to world-class care delivered increasingly by citizens. Getting the sequence right turns a target into a career that young nationals choose. Getting it wrong leaves training seats unfilled and produces a workforce that meets the ratio but not the need.

This paper draws six lessons from Saudi Arabia's experience, which is the most detailed and best-documented localisation effort in the region, and from Oman's long build in nursing. It ends with seven questions leaders can put to their own programmes.

A large, fast-growing workforce, built largely through international recruitment

The GCC had 413,200 nurses at the end of 2024, about 150,000 more than a decade earlier. Density is 67.5 nurses per 10,000 people, well above the global average of 37.7.¹ GCC nationals make up 30.3% of those nurses. The region has built capacity faster than any national education system could have supplied it, and international recruitment has filled the difference.

Recruiting internationally is not the problem. It has staffed the region's hospitals through rapid expansion and will remain part of the mix. It does carry three costs that grow over time:

• Continuity. A workforce that turns over every few years keeps restarting its institutional knowledge.
• Resilience. Supply depends on labour markets elsewhere. WHO projects a global shortfall of 4.1 million nurses by 2030.⁴
• Responsibility. WHO's Global Code of Practice asks recruiting countries to avoid active recruitment from countries with the most severe shortages.⁵

National visions answer these costs with the same ambition: more citizens in clinical careers. The rest of this paper is about how to deliver it.

The evidence

What eight years of Saudi data show

Between 2017 and 2024 the Saudi share rose in each of the three largest clinical professions, and the number of Saudi nationals grew faster still. In 2024 Saudis held 58.6% of the 681,914 posts in the Kingdom's health workforce.^{2, 6}

Three patterns stand out:

• Progress is fastest where the state trains and employs. In Ministry of Health facilities, Saudis are 64.7% of nurses, 53.3% of physicians and more than 97% of pharmacists and allied health staff.^{2, 7, 8}
• Quotas work when supply exists. Pharmacy localisation began in 2020 with a 20% first phase.⁹ Private-sector Saudi pharmacists rose from 1,130 to 12,988 as the pool of Saudi pharmacists grew.¹⁰
• The hardest work is in private care. Saudis are about 11% of private-sector nurses and physicians, where pay, shift patterns and graduate supply compete hardest with other careers.^{7, 8}

Allied health shows how far localisation can go: Saudis are 87.5% of allied health staff overall and 75.2% in the private sector.²

What works

Six lessons for health-workforce localisation

The wage floor is what turns a quota into a career.

International recruitment will stay part of the mix while national pipelines mature. Recruiting in line with the WHO Code keeps that supply ethical and sustainable.

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