The migration of health workers to middle, and high, income countries is exacerbating existing inequities in the distribution in the global health workforce and further compromising health systems in some of the poorest countries in the world. The World Health Organization (WHO) global code process was preceded by a number of initiatives to address international health worker recruitment concerns on a country-by-country, multilateral, or transnational basis. The WHO Global Code is neither a perfect text nor a solution to the challenges associated with health worker migration. Recent developments in global health diplomacy have led to increasing calls for the negotiation and codification of international legal mechanisms to provide a framework for global health cooperation. African governments, underrepresented in global negotiations, played a key role in addressing an issue of significant concern to African health systems. Political leadership is a critical factor in international negotiations to broker deals and bring innovative thinking.