Hiding in plain sight: the absence of consideration of the gendered dimensions in 'source' country perspectives on health worker migration

Drivers of health workers' migration, intention to migrate and non-migration from low/middle-income countries, 1970-2022: a systematic review

BACKGROUND

The migration of healthcare workers (HWs) from low/middle-income countries (LMICs) is a pressing global health issue with implications for population-level health outcomes. We aimed to synthesise the drivers of HWs' out-migration, intention to migrate and non-migration from LMICs.

METHODS

We searched Ovid MEDLINE, EMBASE, CINAHL, Global Health and Web of Science, as well as the reference lists of retrieved articles. We included studies (quantitative, qualitative or mixed-methods) on HWs' migration or intention to migrate, published in either English or French between 1 January 1970 and 31 August 2022. The retrieved titles were deduplicated in EndNote before being exported to Rayyan for independent screening by three reviewers.

RESULTS

We screened 21 593 unique records and included 107 studies. Of the included studies, 82 were single-country studies focusing on 26 countries, while the remaining 25 included data from multiple LMICs. Most of the articles focused on either doctors 64.5% (69 of 107) and/or nurses 54.2% (58 of 107). The UK (44.9% (48 of 107)) and the USA (42% (45 of 107)) were the top destination countries. The LMICs with the highest number of studies were South Africa (15.9% (17 of 107)), India (12.1% (13 of 107)) and the Philippines (6.5% (7 of 107)). The major drivers of migration were macro-level and meso-level factors. Remuneration (83.2%) and security problems (58.9%) were the key macro-level factors driving HWs' migration/intention to migrate. In comparison, career prospects (81.3%), good working environment (63.6%) and job satisfaction (57.9%) were the major meso-level drivers. These key drivers have remained relatively constant over the last five decades and did not differ among HWs who have migrated and those with intention to migrate or across geographical regions.

CONCLUSION

Growing evidence suggests that the key drivers of HWs' migration or intention to migrate are similar across geographical regions in LMICs. Opportunities exist to build collaborations to develop and implement strategies to halt this pressing global health problem.

What do Health Workers say About Rural Practice?

Adequately staffed rural health services improve healthcare delivery and health outcomes, yet this is lacking in rural Ghana. We used a descriptive qualitative design to understand the contextual issues that affect rural practice, in the Upper East Region, Ghana. Sixty-eight in-depth interviews were conducted with healthcare workers and analysed thematically. Four themes were identified: types of postings to rural settings, healthcare workers’ perceptions of their rural postings, perceived enablers and motivators for rural practice, and perceived challenges and barriers to rural practice. While adequate supervision and family proximity are needed to improve the feelings of loneliness, isolation and neglect in rural areas, challenges and barriers such as inadequate security, unstable electricity supply, language barrier, lack of equipment and transport/ambulance have been identified to have negative influence on healthcare workers. The findings highlight the need for healthcare managers to improve fairness and transparency in the posting and reshuffling processes of healthcare workers.