Factors contributing to the emigration and retention of health workers in Bhutan

Background Bhutan faces challenges maintaining an adequate health workforce, exacerbated by a post-COVID-19 exodus. Little is known about the reasons for emigration from Bhutan, known for its happiness and stable governance, and about mitigation strategies. This study aims to identify drivers of emigration and explore potential strategies for improving health worker retention.

A narrative literature review was conducted in the context of Bhutan and similar settings, complemented by seven semi-structured interviews with researchers, policymakers, and health managers. Findings Bhutan has witnessed a surge in health worker departure post-COVID-19, particularly young professionals. Data from various sources underscore its gravity. Better financial opportunities, career prospects and a shift towards a materialistic mindset in Bhutanese community drive emigration. Societal pressure and family are both push and pull factors for health workers. Existing retention policies encompass financial incentives and bonds, but their impact remains to be evaluated. Drawing inspiration from global practices, strategies like circular/return migration, bilateral agreements, task shifting, and community engagement present promising avenues to mitigate emigration and fortify retention initiatives in Bhutan.

The study highlights the inevitability of emigration in a globalised world. While financial incentives and career opportunities are crucial, addressing societal factors and social values in retaining health workers is equally essential. By upholding the “right to move” while safeguarding the “right to health,” Bhutan can foster a sustainable and resilient health workforce. Competing Interest Statement The authors have declared no competing interest. Funding Statement The author(s) received no specific funding for this work. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Research Ethics Committee, Royal Tropical Institute (KIT) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable Data Availability All relevant data are within the manuscript and its Supporting Information files.