Factors influencing the migration intention of health professionals in low and middle income countries: Critical review with a theoretical model

Abstract

Objective
 Migration of healthcare workers could result in shortage of human resources and rising inequalities in service provision in resource poor countries. The aim of this review was to determine the factors influencing the migration decisions of medical and dental graduates migrating from low- and middle-income countries as well as introducing a practical model for health professional’s migration.
 Methods
 Google Scholar and PubMed were searched together with relevant journals for English studies from January 2005 to January 2020. The original studies which evaluated the motivational factors of dental and medical graduates migrating from low or middle income countries were included. The migration model was developed by investigating the factors and frameworks of selected studies.
 Results
 Twenty-five articles were met the inclusion criteria. Push and pull theory was the most popular way to describe the driving factors of migration. These factors were classified into three macro-, meso- and micro-level with eight key domains. Poor income, unfavorable socio-economic situation, political instability, lack of professional and educational opportunities together with family and personal concerns found as strong common reasons perpetuating migration.
 Conclusion
 Despite the fact that health workers migrate for different reasons, they follow a same route for decision to stay or leave their home countries. Un-fulfillment of expectations in mother land in addition to media reconstructed reality of life in foreign land can develop a positive attitude for better quality of life improvement after migration. Once individuals could overpass their national identity and barriers of migration, the final decision toward migration would be more feasible.

Understanding the trends, and drivers of emigration, migration intention and non-migration of health workers from low-income and middle-income countries: protocol for a systematic review

“… 30 Based on a second conceptual framework of health professionals migration, the push and pull factors will be further categorised into three levels: macro-(national factors), meso-(professional factors) and micro-(personal factors) levels. 19 31 …”

“…The first framework is built on immigration theory of push and pull factors, which refer to factors that incentivise people to leave their home country and factors that attract them to a foreign country, respectively 30. Based on a second conceptual framework of health professionals migration, the push and pull factors will be further categorised into three levels: macro-(national factors), meso-(professional factors) and micro-(personal factors) levels 19 31…”

“…Previous reviews have limited their focus to specific cadre of HRH such as nurses, physicians or dentists. 19 Others have limited their scope to specific regions or countries, with no previous review exclusively studying all LMICs. 20 21 Importantly, the existing reviews have not considered factors driving the non-migration of those HWs who stay behind in source countries.…”

“…The existing reviews have a limited scope, hence the need for a more comprehensive and updated review. Previous reviews have limited their focus to specific cadre of HRH such as nurses, physicians or dentists 19. Others have limited their scope to specific regions or countries, with no previous review exclusively studying all LMICs 20 21.…”

Physician-Suggested Innovative Methods for Health System Resilience amidst Workforce Emigration and Sociopolitical Unrest in Nigeria: A Survey-Based Study

“…Specifically, of the international medical graduates from sub-Saharan African countries practicing in the US, 44.5% are from Nigeria [7]. Studies have listed unrest, safety, and security concerns as major push factors for the move to HICs, emphasizing that LMICs with broad-based unrest are more susceptible to the factors affecting the stability of health systems [12,13]. Furthermore, increasing unrest and national security concerns in Nigeria in the form of the Boko Haram insurgency, may further drive health workforce emigration [14].…”