Patterns, drivers and barriers of international migration of Nigerian health professionals: A mixed-methods analysis of policy documents and multi-stakeholder perspectives

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Over the years, there has been an increasing migration of health workers, especially from low- and middle-income countries, such as Nigeria, to developed regions in the quest for further education, higher remuneration, and an overall improvement in their quality of life. This study explored the patterns of health worker emigration, also known as Japa, from Nigeria and explores the driving factors and associated barriers from multi-disciplinary stakeholder perspectives. Methods This study adopted an exploratory mixed-method design, comprising of desk review of health workers migration data from 2013 - 2023, policy documents, and in-depth interviews of 20 multidisciplinary stakeholders in health, using semi-structured interviews as the data collection tool. The leaders of the health regulatory agencies and corresponding professional associations, most impacted by migration were interviewed. Data from desk and document reviews were presented in tables, while transcripts from the qualitative interviews were thematically analyzed. Results The year 2023 demonstrated the peak of health worker migration in all the professions, with the United Kingdom as the most common destination country. The in-depth interview of 20 stakeholders revealed three themes and thirteen subthemes. The themes were the push factors, pull factors, and barriers. The subthemes were characterized as economic factors, workplace conditions, poorly regulated practice environment, insecurity of all types, including job insecurity, and lack of job satisfaction, limited career growth, higher remuneration, better working conditions, job security and welfare benefits, research and training opportunities, financial constraints, system and regulatory factors, family and personal factors, overseas country policies, restrictions and discrimination. Conclusion This study identified the United Kingdom as the most common destination country. The key drivers of migration(japa) were economic factors, workplace conditions, a poorly regulated practice environment, insecurity of all types, lack of job satisfaction, limited career growth, and higher remuneration. Associated barriers from the multidisciplinary stakeholders included financial constraints, system and regulatory factors, family and personal factors, overseas country policies, restrictions, and discrimination. Evidence from this study can inform urgent and strategic actions toward practical migration and workforce retention policies of the Nigerian government. Patterns Health worker Migration Japa Drivers Barriers Policy Stakeholder Introduction The World Health Organization (WHO) defines health workers as “all people engaged in work actions whose primary intent is to improve health, including doctors, pharmacists, nurses, midwives, public health professionals, laboratory technologists and technicians, health technicians, medical and non-medical technicians, personal care workers, community health workers, healers, and traditional medicine practitioners” [ 1 ]. Effective health service coverage can only be achieved when health workers are fairly distributed and accessible to the public, and have sufficient support from the health system [ 2 ]. According to the WHO Health Workforce Support and Safeguards list, Nigeria is among the 37 countries with a critical health workforce shortage. The WHO recommendation of health workers for adequate health coverage is 4.45 healthcare workers per 1000 people [ 3 ]. Despite operating at 0.363 medical doctors per 1,000 people, the health system of Nigeria further deteriorated after the coronavirus pandemic [ 4 ]. Over the years, there has been an increasing migration of health workers, from low- and middle-income countries (LMICs) to developed regions, due to a quest for further education, higher remuneration, and a general improvement in their quality of lives [ 1 ]. Also, there was a dramatic and worrisome increase in the mass emigration(japa) of Nigerian healthcare workers to developed countries during the COVID- 19 pandemic [ 5 ]. The emigration was facilitated by the post-COVID shortage in Health Care Providers in developed countries, with a corresponding diminution of health workers in the emigrant countries [ 1 , 5 ]. Nigeria has been ranked the highest exporter of health worker brains and the United Kingdom (UK) as the major destination [ 5 , 6 ]. The UK welcomed up to 5543 nurses and 4880 doctors from Nigeria in 2021[ 7 ]. Nigerian-trained health professionals are also highly represented in other regions of the world such as South Africa, Saudi Arabia, Canada, Australia, and the United States [ 5 , 8 , 9 ]. International migration of healthcare workers is well established and has become a means of maintaining service quality in many high-income countries. The constant emigration causes a reduction in the strength of the health workforce, leading to an increase in the workload of the available staff, with consequent burnout, low work capacity, low quality of healthcare rendered to patients, and predisposing them to poorly achieved health outcomes [ 4 , 10 ]. In response, the Nigerian Government approved a new national policy on health workforce migration, aimed at mitigating brain drain and encouraging the return of health professionals from diaspora. The policy is expected to address the complex dynamics of health worker migration and ensure that the exodus of skilled healthcare professionals does not compromise the health system’s integrity and the well-being of the Nigerian citizens [ 11 ]. In addition to the reports in the National Policy on Health Workforce Migration of the federal Government of Nigeria, several studies have evaluated the reasons for this high rate of emigration. A lack of health-professional synergy, dissatisfaction with job and work-related policies, an almost non-existent feeling of being considerably compensated, poor work environment conditions, worsening economic conditions, deteriorating health system infrastructure, and insecurity were the most significant reasons [ 5 , 8 , 9 , 10 , 11 ]. However, many of these studies have focused on quantitative data and/or perspectives of individual healthcare workers, specifically physicians and nurses, and have ignored broader, systemic, policy, and multi-disciplinary stakeholders’ viewpoints. This study has identified, and qualitatively investigated the pull and push factors and barriers from multi-disciplinary stakeholders, including policy makers and professional bodies. It is hoped that the findings would provide scientific evidence to guide national retention strategies and policy reform in areas of migration governance and contribute to global dialogue in human resources for health, particularly in the LMICs. Methods Study Design An exploratory mixed-method design was utilized, comprising desk review of migration data from 2013 to 2023, and in-depth interviews (IDIs) of health professional stakeholders. The study was conducted between September 2024 and March 2025. Study Participants Six health professions most impacted by the challenges of international health worker migration in Nigeria were recruited for the study [ 11 ]. The professionals comprise of nurses, medical doctors, pharmacists, medical laboratory scientists, optometrists and radiographers. Table 1 shows the relevant information on the regulatory agencies and professional associations. Table 1 Regulatory agencies, professional associations, membership eligibility, and specific roles S/N Profession Agency/ Professional Organization Membership Eligibility/Role 1 Nursing Nursing and Midwifery Council of Nigeria (NMCN) The legal, administrative, corporate, and statutory body of the Federal Government of Nigeria that ensures the delivery of safe and effective Nursing and Midwifery care to the public through quality education and best practices. National Association of Nigerian Nurses and Midwives (NANNM) A non-governmental organization of all professional nurses and midwives who are trained, registered, and licensed to practice the Nursing Profession at all levels of the healthcare delivery system in Nigeria 2 Medicine and Dentistry Medical and Dental Council of Nigeria (MDCN) An agency of the Federal Government that regulates the education and practice of medicine, dentistry, and alternative medicine in Nigeria National Medical Association (NMA) A professional association for medical doctors who are Nigerians and trained to practice in Nigeria Guild of Medical Directors A body of medical doctors who own and run private hospitals and clinics and provide medical care to the public. Medical Women’s Association of Nigeria (MWAN) A women's health organization of female medical doctors in Nigeria that advocates for the health of women and children in Nigeria. 3 Pharmacy Pharmacy Council of Nigeria (PCN) An agency of the Federal Government of Nigeria that regulates pharmacy education, training, and practice, in all its aspects and ramifications. This includes licensing of pharmacists and pharmaceutical premises. Pharmaceutical Society of Nigeria (PSN) An organization of pharmacists trained to practice in Nigeria that instills discipline and maintains professional ethics among members of the pharmacy profession Association of Lady Pharmacists (ALPs) An interest group of the PSN consists of female pharmacists in Nigeria, who advocate for the health of women and children as well as female pharmacists in Nigeria. Association of Community Pharmacists of Nigeria (ACPN) A technical arm of the Pharmaceutical Society of Nigeria that promotes public health by providing quality pharmaceutical services and collaborating with other healthcare providers. Members are pharmacists practicing in the private and retail community pharmacy sector Association of Hospital and Administrative Pharmacists of Nigeria (AHAPN) A professional organization that provides pharmaceutical care, advocates for health workers, with a focus on public health. Members are pharmacists working in hospitals as clinical pharmacists and administrators in regulatory agencies. Clinical Pharmacists of Nigeria (CPAN) Promotes and practices clinical pharmacy within the Nigerian healthcare system, focusing on direct patient care and collaborating with other healthcare professionals to optimize drug use and patient outcomes. Members are pharmacists with specialization in clinical pharmacy in any health sector, including the academia Young Pharmacists’ Group (YPG) A forum of pharmacists aged 35 years and below, not more than 5 years post-qualification, and aimed at providing a platform for members to develop leadership skills, contribute to the pharmacy profession through innovative practices 4 Medical Laboratory Science Medical and Laboratory Science Council of Nigeria The federal government statutory agency that regulates the training and practice of medical laboratory scientists in Nigeria Guild of Medical Laboratory Directors (GMLD) Promotes medical laboratory science and the welfare of Medical Laboratory Scientists in Nigeria 5 Optometry Optometrists and Dispensing Opticians Registration Board (ODORBN) The regulatory body responsible for the registration, regulation, and control of the practice of optometry and dispensing optics in Nigeria. Nigerian Optometric Association (NOA) Acts as the primary organization representing all licensed optometrists in Nigeria, ensuring the welfare of its members, advocating for the profession, and promoting quality and affordable eye care services to the public 6 Radiography Radiographers Registration Board of Nigeria (RRBN) The RRBN regulates the practice of radiography in Nigeria Association of Radiographers of Nigeria (ARN) The primary professional body representing all certified radiographers in Nigeria, promoting the practice of medical imaging and radiation science, advocating for improved training standards, and elevating the status of radiographers within the country Study Sampling Purposive sampling of the chief executive officers of health regulatory agencies and members of health professional associations was carried out. A total of 20 participants were interviewed, which is line with Creswell’s guideline on sample size of about 18 to 30 participants being appropriate for qualitative study [ 12 ]. Instrument for Data Collection The migration data in the National Policy on Health workforce migration showing the magnitude and trend of migration of different cadres of health workers was adopted for the desk review [ 11 ]. We developed the interview guide for the in-depth interview from validated questionnaires previously used to assess migration intentions of health workers and their determinants in Nigeria, and from the National Policy on Health workforce migration for Nigeria [ 8 , 11 , 13 ]. Also, the questions in the interview guide were informed by the objectives of the study [ 14 ]. The interview guide sought both sociodemographic data, and the stakeholder perspectives on push and pull factors of, and barriers to, health worker migration in Nigeria. Data Collection The interviews were conducted by the researchers who are trained and experienced in qualitative research. The interviews were conducted virtually. using the Zoom platform and were recorded for analysis. The researchers ensured trustworthiness and validity of study findings Ethical Consideration Lagos University Teaching Hospital Health Research Ethics Committee approved the study, with assigned number: ADM/DSCST/HREC/APP/7155. Data collection was conducted while maintaining autonomy and non-maleficence [ 15 , 16 ]. Participants were assured of confidentiality as all the information were securely stored and de-identified. Informed consent was obtained before each interview process. . Data Analysis Data on the magnitude and trends of migration were presented in tables, while the transcribed scripts were thematically analyzed. Thematic analysis is one of the most recommended methods of analyzing qualitative data collected via interviews and was therefore employed in this study [ 17 , 18 ]. We employed a thematic analysis framework approach to analyze the transcripts [ 19 ]. This approach involves seven key stages: transcription, familiarization, open coding, developing a working analytical framework, indexing subsequent transcripts, charting, and interpretation. The recorded interviews were transcribed verbatim by the research team. Transcripts were de-identifed by giving each transcript a unique number for easy identification, anonymity, and subsequent peer coding. Thereafter, we used Artificial Intelligence to organize the transcript, and thereafter deleted all irrelevant information, and triangulated the organized responses with the original transcript to avoid loss of content. This is in line with the Ethics of using Artificial Intelligence in Qualitative Research [ 20 ]. For familiarization, we immersed ourselves with the data by reading and re-reading, to have an in-depth understanding of the data. Two of the researchers independently coded the first two transcripts using in vivo codes. The two coders met, discussed, resolved discrepancies through consensus, explored relationships between items, identified naturally emerging themes and recurrent patterns, and developed the codes and coding matrix, which were applied in indexing the remaining eighteen transcripts. This was followed by charting and interpreting the data. This rigorous procedure ensured inter-coder reliability, interpretive accuracy, and that the final report adequately captures the lived experiences of research participants [ 21 ]. Results Magnitude and Trend of Migration among Health Workers in Nigeria The data on the magnitude and trend of migration among health workers in Nigeria were collected from their respective regulatory bodies and national health workforce policy documents [ 11 ]. The data represents the health workers who requested letters of good standing or verification from the regulatory bodies, and are outlined in Table 2 . The year 2023 demonstrated the peak of migration for the health professionals, with 18028 nurses, 3419 medical doctors, 451 pharmacists, 420 radiographers, and 333 optometrists requesting letters of good standing. The most common destination country was the United Kingdom, followed by the United States of America, Canada, the United Arab Emirates, Australia, Ireland, and Saudi Arabia. Table 2 Table showing profession and magnitude of migration S/N Profession 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 1 Nursing ** ** ** ** ** ** ** ** ** 4943 18028 2 Radiography 90 130 210 320 250 310 280 320 411 205 420 3 Medicine and Dental Surgery 762 656 688 1010 1420 1553 1824 1242 2607 3047 3419 4 Pharmacy 124 131 159 145 180 448 550 300 783 472 451 5 Optometry ** ** ** ** ** 43 48 64 191 148 333 6 Medical Laboratory Science ** ** ** ** ** 78 166 140 1409 1553 ** **: Migration data for that year could not be accessed. Demographic characteristics of study participants According to Table 3 , there were significantly more males (17, 85.0%) than females (3, 15.0%), the majority (95%) of whom possess more than 20 years post-qualification experience. Out of the stakeholders, the most respondents (15, 75.0%) were from health professional associations, and 5 (15.0%) were regulators. Table 3 Socio-demographic characteristics of stakeholders Study Participants’ID Sex Years of practice Role in Health Workforce value chain Sector of practice IDI_1 Male 38 Professional Association Private IDI_2 Female 32 Professional Association Private IDI_3 Male 37 Professional Association Private IDI_4 Male 33 Regulatory Agency Public IDI_5 Male 27 Professional Association Private IDI_6 Female 34 Professional Association Private IDI_7 Male 35 Professional Association Private IDI_8 Male 25 Regulatory Agency Public IDI_9 Male 42 Professional Association Private IDI_10 Male 23 Professional Association Private IDI_11 Male 20 Professional Association Private IDI_12 Male 20 Professional Association Private IDI_13 Male 27 Professional Association Private IDI_14 Male 35 Regulatory Agency Public IDI_15 Male 28 Professional Association Private IDI_16 Male 26 Professional Association Private IDI_17 Male 4 Professional Association Private IDI_18 Female 26 Regulatory Agency Public IDI_19 Male 24 Professional Association Private IDI_20 Male 37 Regulatory Agency Public Findings from Thematic Analysis The presentation of the qualitative report was guided by the Standards for Reporting Qualitative Research (SRQR) Checklist [ 22 ]. Three major themes and thirteen subthemes emerged from the thematic analysis which described the drivers and barriers of international migration among health professionals in Nigeria. The themes were the push factors, pull factors and barriers. The subthemes for push factors were economic factors, workplace conditions, poorly regulated practice environment, insecurity of all types, including job insecurity, lack of job satisfaction, and limited career growth. Higher remuneration, better working conditions, job security/welfare benefits, and research and training opportunities were the subthemes for pull factors while financial constraints, system and regulatory factors, family and personal factors, overseas country policies, restrictions and discrimination were the barriers militating against health worker migration. Figure 1 (supplementary file): summary of the themes and sub-themes Theme 1: Push Factors Participants described the push factors as situations inherent in-country that encourage health professionals to emigrate: a. Economic factors. Poor salary package and remuneration, delayed salary payments, lack of financial incentives, poor country economy, lack of social amenities, and devaluation of Nigerian currency were critical factors facilitating the emigration of Nigerian health workers. According to a key stakeholder, “...One of the key driving forces is the economic disparity and financial incentives. I'll give you an example, I know of a country where they employed my colleague with accommodation incentives and tax-free salary and they pay him almost 20 times of his salary while he was in Nigeria…” (IDI_11, male, 20 years post qualification…private sector Workplace conditions A shared perspective from various stakeholders were issues of poor infrastructure, inadequate facilities, unsafe and poor working environments, work overload and health worker burn-out, as critical situations that compel health professionals to emigrate. Respondents stated that: “... We work in environments without basic facilities, yet we are expected to deliver quality care…” (IDI_8, male, 35 years post qualification…public sector). “...The few staff on ground are overused and come down with a lot of work induced hazards and stress induced fatigue. For example, they must work more than eight hours daily, because there's nobody to take over from them…” (IDI_2, female, 32 years post qualification…private sector). In contrast to belief that the quest for greener pastures is the major driver of emigration among the Nigerian health professionals, a stakeholder in a government employment affirmed that: “...For me, I don't think money is what pushes people away, but basically the lack of infrastructure. Some facilities don't have basic amenities for simple procedures…. and you see your patients dying…” (IDI_18, female, 26 years post qualification…public sector). b. Poorly regulated practice environment Existence of open drug markets, unregistered traditional healers, illegal health posts, medicines shops that treat all forms of ailments, unregistered traditional birth attendants, religious organizations that offer illegal health services with promises of miraculous healings, and massive infiltration of quacks in the health practice environments were reported. Participants stated that these unsatisfactory and poorly regulated practice environments adversely affect the viability of their professional practices and frustrate health professionals out of the country. As stated by a key stakeholder, “...I believe that what pushes people more is the practice environments, other people not obeying the rules and regulations, other people invading into our practice and nothing is done about it by government…” (IDI_12, male, 20 years post qualification…private sector). “...Quackery is one of the drivers of migration. When you set up a business and you are not making profit, and you see quacks all over the place, it seems as if nobody cares…” (IDI_7, male, 35 years post qualification…private sector). c. Insecurity of all types, including job insecurity, and lack of job satisfaction Participants expressed concerns about rising cases of kidnapping, killing of health workers, armed conflicts, hospital-related violence, political instability, poor work safety, lack of job satisfaction and job security, and reiterated that: “... We have seen kidnapping of health care workers in Cross Rivers and Delta States. Some were even killed. Some were attacked in Benue State, one doctor is still missing, until now she hasn't been released…” (IDI_6, female, 34 years post-qualification…private sector). d. Limited career growth Lack of funding for training, poor opportunities for specialization, stagnation of health workers, non-recognition of their expertise, and workplace discrimination against non-medical doctor health professionals, the healthcare industry crisis, were the key factors driving health professionals out of Nigeria. As highlighted by some stakeholders, “...The contest for who will lead the health sector and the quest for supremacy among healthcare providers has caused a lot of dissatisfaction in the system. We want to enhance our prestige, our earnings, and well-being, at the discretion of others…” (IDI_14, male, 35 years post-qualification…public sector). “...Many Health Care Providers leave because they feel unappreciated and lack access to professional growth opportunities…” (IDI_17, male, 4 years post qualification…private sector). Other reported push factors include spouse migration and increasing collaboration with institutions abroad. As stated by a stakeholder, “...Some of my staff can just come to work and say that they are moving, they don’t inform me when they are planning it…….Oh, my husband says we are moving, and that is how they resign…” (IDI_6, female, 34 years post-qualification…private sector). Theme 2: Pull Factors Further insights into the drivers of international migration were characterized as pull factors. These are factors inherent in destination countries that entice health professionals to emigrate to those countries, and they are higher salaries, better working conditions, job security and welfare benefits, and research and training opportunities. a. Higher remuneration Higher salaries in the destination countries were key factors that compel health professionals to emigrate, as they earn significantly more abroad, sometimes 5–10 times more than their current wages in Nigeria. “...So you can be paid up to 5000 pounds, that is motivating, and then the amenities are there, even though they're expensive. The security threat is not there……….., it's much more motivating, for people to migrate…” (IDI_4, male, 33 years post-qualification…private sector). b. Better working conditions Access to modern equipment, structured working hours, better prospects, and career progression pathways were reported as some of the critical factors that attract Nigerian health professionals to their destination countries. A participant stated that: “...my colleagues who left for Canada and UK say they now have access to better and digital healthcare facilities and career support…” (IDI_15, male, 28 years post-qualification…private sector). “...if you have the correct infrastructure, you will be happy to work. Exposure to risk and insecurity is low abroad, with better life-work balance…” (IDI_18, female, 26 years post-qualification…public sector c. Job security and welfare benefits Statements referring to the availability of health insurance, pensions, and well-defined employment contracts. “...Beyond money, the work culture abroad is more structured. There are clear career paths, and training is prioritized…” (IDI_13, male, 27 years post qualification…private sector). “...When you open your email, you see recruiters flaunting opportunities in Canada and the UK. These opportunities come with fantastic and well-defined employment contracts …” (IDI_11, male, 37 years post qualification…public sector). d. Research and training opportunities Stakeholders in this study indicated that there is better academic and practical exposure and greater opportunities for career advancement. “...In our climes, opportunities for professional development are not common, unless with out-of-pocket payments, but when you go abroad, it is compulsory, you must go for continued professional development. The white man doesn't joke with quality assurance…” (IDI_11, male, 20 years post-qualification…private sector). Other significant reasons associated with migration include demand for health work force abroad, little or no security threat, high level of interprofessional harmony and job satisfaction. “...Of course, there are issues of interprofessional harmony and job satisfaction in those developed countries. They build relationships among healthcare providers right from their level of training…” (IDI_3, male, 37 years post-qualification…private sector). Theme 3: Barriers Despite the mass exodus of Nigerian health professionals to other countries, the exploratory in-depth interview of stakeholders revealed multidimensional barriers to health worker emigration. These barriers were financial constraints, system and regulatory factors, family and personal factors, and overseas country restrictions. a. Financial constraints High cost of migration, described as exorbitant cost of application for qualifying exams and residency programs, professional licensure in the destination countries, cost of processing letters of good standing in home countries, air transportation for the health professional and dependents, and other sundry expenses. As remarked by some stakeholders, “...There are high financial costs associated with migration, such as cost of examinations, letters of good standing fees,……., these are difficult for some health professionals, especially those from poor families…” (IDI_10, male, 23 years post-qualification…private sector). “...There is a high cost of obtaining transcripts and applying for placements, the US charge up to $30 to submit one application for medical residency placement, and you may submit to up to sixty institutions to get a placement…” (IDI_7, male, 35 years post-qualification…private sector). b. System and Regulatory factors Participants expressed concerns on regulatory challenges experienced by colleagues when processing documents. They highlighted government policies, institutional barriers, delays and restrictions on travel documents as the critical factors posing barriers to health worker migration. “... Some professional regulatory councils have stopped processing letters of good standing for emigrating professionals…” (IDI_5, male, 27 years post qualification…private sector). A key stakeholder in a regulatory agency corroborated the above and stated that: “...Nurses are not eligible for verification to get letters of good standing until at least two years post registration…” (IDI_18, female, 26 years post qualification…public sector) “...There are unwritten visa restrictions for migration to preferred countries such as USA, UK, Canada, and Europe…” (IDI_1, male, 38 years post qualification…private sector). c. Family and Personal factors Family obligations and the fear of leaving the immediate or extended family members and aged parents, cultural ties, growing children, in-country financial investments and ‘fear of the unknown’ were the key barriers to health worker migration. “...There are family commitments and personal obligations in Nigeria & personal financial investments…” (IDI_11, male, 20 years post qualification…private sector) “... Some colleagues that have migrated face emotional and cultural challenges associated with relocation… ” (IDI_3, male, 37 years post qualification…private sector). d. Overseas country policies, restrictions and discrimination Outbound restrictions, migration policies in destination countries, difficulties in securing practice requirements, racial discrimination, language and practice barriers, and low digital proficiency were the challenges described by stakeholders. “... Yeah, there are barriers. It's not easy to get a placement as a professional; you have to write qualifying exams in another country outside Nigeria out -of - pocket, and sometimes you write more than once, and the exams are expensive…” (IDI_6, female, 34 years post qualification…private sector). “... I also know of some Nigerian medical doctors who became nurses in the United States because they could not pass the US medical examination, so when some of our colleagues hear such …..” (IDI_14, male, 35 years post qualification…public sector). Discussion The mixed-methods analysis of policy documents and exploratory in-depth interviews of multidisciplinary stakeholders provided unique insights into the patterns, drivers and barriers of international migration among Nigerian health workers, at the national, professional and personal levels. The significant greater number of males (17, 85.0%) than females (3, 15.0%), among the participants reaffirmed the under-representation of women in leadership positions, despite being the backbone of healthcare in Nigeria and constitutes 70% of the global health and social workforce [ 23 ]. Interestingly, two out of the three females among the participants were from female-only associations, while the third female was from a female-dominated association, implying that the study would have, otherwise, interviewed only males. This situation may have led to loss of diversity in the voices that reflects the views of the stakeholders in this study and limits women’s ability to influence policy and resource allocation. Nigeria, just like other LMICs, exports skilled labour to high-income countries. However, the massive exodus of health workers, as identified in this study implies an impending detrimental deficit of health workforce that would compromise the quality of healthcare in the country. This aligns with the predictions of a 2016 study, that by 2030, there will be a deficit of doctors and nurses by 33.45% and 29.25% respectively [ 24 ]. Similarly, a survey conducted by the Medical and Dental Consultants Association of Nigeria on its members in 2022 revealed that more than 500 medical consultants have left Nigeria to practice in developed countries, and 1 out of 10 consultants with fewer than five years had plans for emigration [ 9 ]. Findings from this study also corroborated previous data that among the Nigerian health workforce, job dissatisfaction and poor quality of work life are major reasons for emigration [ 25 , 26 , 27 ]. Another key driver of health worker emigration in Nigeria are poor remuneration, which was also found in previous studies [ 25 , 28 , 29 ]. Findings from our study were similar to those of a study conducted among Nepalese health workers, where the major reasons for migration were economic instability, insecurity, less opportunities for development, favouritism, and workplace stress [ 30 ]. These views were shared among health workers in India that reported notable key push factors responsible for migratory patterns among health workers as lack of opportunities for professional development, work overload, and poor working conditions [ 31 ]. Many of the key factors driving migration of Nigerian health workers to international labour markets were also factors driving migration in previous quantitative studies, existing policy documents and scoping review. This implies that the same factors driving health worker migration prevail in Nigeria and that the Nigerian government should take urgent steps in addressing health worker migration issues and protect the health of the Nigerian public. Lack of opportunities for training and development were one of the key factors that push Nigerian health workers to global labour markets. These findings corroborate with those of a comprehensive scoping review of quantitative, qualitative, mixed-methods literature reviews’ study [ 28 ], and reiterates the urgent need for the Nigerian government to prioritize training and professional development opportunities for health workers and put policies in place to ensure the high standards of practice. Practically, our research contributes to literature by providing a comprehensive qualitative data from the perspectives of regulatory agencies and professional associations on drivers of international health worker migration in Nigeria and the barriers that militate against it. These findings will inform migration and workforce retention policies of the Nigerian government. Limitations As opined by Mills et al., 2011, accurately estimating the movement of health workers is a particularly challenging task because reliable data is hard to obtain [ 32 ]. This, in addition to bureaucratic government protocols, compounded our challenges in accessing comprehensive data from some proposed stakeholders. For example, the study was unable to interview the Medical Laboratory Science Council and National Association of Nigeria Nurses and Midwives, but this would not compromise our findings as the Guild of Medical Laboratory Directors and Nursing and Midwifery Council participated in the study. The study reflected the association leaders’ and regulators’ perspectives and not the views of the direct health workers that emigrated from Nigeria or the health workers in Nigeria who may be planning to migrate. This would have helped in the triangulation of the results for robustness. Conclusion The study found that the year 2023 described the peak of Nigerian health worker migration, with United Kingdom as the most common country of destination. The migration crisis is driven by poor remuneration, limited career growth, insecurity, unfavorable work conditions, poorly regulated practice environment, insecurity job insecurity, and lack of job satisfaction, with lack of research and training opportunities, financial constraints, system and regulatory factors, family and personal factors, overseas country policies, restrictions and discrimination, as key barriers. While migration brings opportunities for global experience, its negative impact on Nigeria’s healthcare sector can be profound. Evidence from this study can inform urgent and strategic actions towards practical migration and workforce retention policies of the Nigerian government. The need for regulatory agencies to collect data on drivers of migration, while processing letters of good standing and further studies on the health workers who have migrated and who may be planning to migrate, are recommended. Declarations Ethics approval and consent to participate: The Lagos University Teaching Hospital Health Research Ethics Committee approved the study, with assigned number: ADM/DSCST/HREC/APP/7155. Consent for publication: Not applicable Availability of data and materials: All collected data are included as tables within the article and in the supplementary material, and are available from the corresponding author. Competing interests: The authors declare that there is no competing interest associated with this study. Funding: No external funding was obtained for this study. Authors' contributions: U. O.: Conceptualization, Research Proposal, Methodology - Data collection and analysis, writing of first manuscript draft, revising of draft after review and editing, Editing, Correspondence, project administration. O. E.: Research Proposal, Methodology - Data collection and analysis, Writing of first manuscript draft, Project administration. E. O.: Research Proposal, Methodology - Data collection and analysis, Review & Editing of first draft. Y.O.: Methodology - Data collection and analysis, Review & Editing of first draft. N. O.: Data analysis, writing of first manuscript draft, revising of draft after review and editing of first draft. All authors read and approved the final manuscript. Acknowledgements The research team is grateful to the regulatory agencies and professional associations that participated in the study. References World Health Organization. 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International Journal for Equity in Health. 2022 Dec 5;21(1):174. https://doi.org/10.1186/s12939-022-01789-z Toyin-Thomas P, Ikhurionan P, Omoyibo EE, Iwegim C, Ukueku AO, Okpere J, Nnawuihe UC, Atat J, Otakhoigbogie U, Orikpete EV, Erhiawarie F. Drivers of health workers’ migration, intention to migrate and non-migration from low/middle-income countries, 1970–2022: a systematic review. BMJ global health. 2023 May 1;8(5):e012338. Yakubu K, Shanthosh J, Adebayo KO, Peiris D, Joshi R. Scope of health worker migration governance and its impact on emigration intentions among skilled health workers in Nigeria. PLOS Global Public Health. 2023 Jan 6;3(1):e0000717. Akinwumi AF, Solomon OO, Ajayi PO, Ogunleye TS, Ilesanmi OA, Ajayi AO. Prevalence and pattern of migration intention of doctors undergoing training programmes in public tertiary hospitals in Ekiti State, Nigeria. Human Resources for Health. 2022 Oct 27;20(1):76. Onah CK, Azuogu BN, Ochie CN, Akpa CO, Okeke KC, Okpunwa AO, Bello HM, Ugwu GO. Physician emigration from Nigeria and the associated factors: the implications to safeguarding the Nigeria health system. Human Resources for Health. 2022 Dec 20;20(1):85. Yakubu K, Blacklock C, Adebayo KO, Peiris D, Joshi R, Mondal S. Social networks and skilled health worker migration in Nigeria: An ego network analysis. The International Journal of Health Planning and Management. 2023 Mar;38(2):457-72. Federal Government of Nigeria. National Policy on Health Workforce Migration. 2023 Creswell JW, Poth CN.. Qualitative inquiry and research design: Choosing among five traditions. 4th ed. Thousand Oaks, CA: Sage publications. 2016 Ojo TO, Oladejo BP, Afolabi BK, Osungbade AD, Anyanwu PC, Shaibu-Ekha I. Why move abroad? Factors influencing migration intentions of final year students of health-related disciplines in Nigeria. BMC Med Educ. 2023 Oct 10;23(1):742. doi: https://doi.org/10.1186/s12909-023-04683-6. PMID: 37817197; PMCID: PMC10563360. Lazar J, Feng JH, Hochheiser H. Research methods in human-computer interaction. Morgan Kaufmann; 2017 Apr 28. Nii Laryeafio M, Ogbewe OC. Ethical consideration dilemma: systematic review of ethics in qualitative data collection through interviews. Journal of Ethics in Entrepreneurship and Technology. 2023 Dec 14;3(2):94-110. Saunders B, Kitzinger J, Kitzinger C. Anonymising interview data: Challenges and compromise in practice. Qualitative research. 2015 Oct;15(5):616-32. Dawadi S. Thematic analysis approach: A step by step guide for ELT research practitioners. Journal of NELTA. 2020 Dec 31;25(1-2):62-71. Gerritse K, Martens C, Bremmer MA, Kreukels BP, de Boer F, Molewijk BC. Sharing decisions amid uncertainties: a qualitative interview study of healthcare professionals’ ethical challenges and norms regarding decision-making in gender-affirming medical care. BMC Medical Ethics. 2022 Dec 27;23(1):139. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC medical research methodology. 2013 Dec;13:1-8. Marshall DT, Naff DB. The Ethics of Using Artificial Intelligence in Qualitative Research. J Empir Res Hum Res Ethics. 2024 Jul;19(3):92-102. doi: 10.1177/15562646241262659. Epub 2024 Jun 17. PMID: 38881315. Kiger ME, Varpio L. Thematic analysis of qualitative data: AMEE Guide No. 131. Medical teacher. 2020 Aug 2;42(8):846-54. O'Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA: Standards for reporting qualitative research: a synthesis of recommendations. Academic medicine : journal of the Association of American Medical Colleges 2014, 89(9):1245-1251. Doi: https://doi.org/10.1097/acm.0000000000000388. Nigeria Health Watch. Nigeria’s Health Migration Policy to Address Brain Drain Aims to Boost Local Expertise. 2024 Sep 16. https://articles.nigeriahealthwatch.com/nigerias-health-migration-policy-to-address-brain-drain-aims-to-boost-local-expertise/#:~:text=What%20is%20the%20policy%20is,and%20neglected%20areas%20in%20Nigeria. Adebayo O, Labiran A, Emerenini CF, Omoruyi L. Health workforce for 2016–2030: will Nigeria have enough. International Journal of Innovative Healthcare Research. 2016;4(1):9-16. Akinwale OE, George OJ. Personnel brain-drain syndrome and quality healthcare delivery among public healthcare workforce in Nigeria. Arab Gulf Journal of Scientific Research. 2023 Jan 4;41(1):18-39. https://doi.org/10.1108/AGJSR-04-2022-0022. Khalid B, Urbański M. Approaches to understanding migration: a mult-country analysis of the push and pull migration trend. Economics & Sociology. 2021 Oct 1;14(4):242-67. Adeniji A, Dansu E, Adeniyi M, Ale S, Ekum M, Shatalov M, Enoch O. Japa model: A mathematical framework for analyzing brain drain in Africa. Scientific African. 2024 Sep 1;25:e02329. Brennan N, Langdon N, Bryce M, Burns L, Humphries N, Knapton A, Gale T. Drivers and barriers of international migration of doctors to and from the United Kingdom: a scoping review. Hum Resour Health. 2023 Feb 14;21(1):11. doi: https://doi.org/10.1186/s12960-022-00789-y . PMID: 36788569; PMCID: PMC9927032. Nair M, Webster P. Health professionals' migration in emerging market economies: patterns, causes and possible solutions. Journal of public health. 2013 Mar 1;35(1):157-63. https://doi.org/10.1093/pubmed/fds087. Sapkota TN, van Teijlingen E, Simkhada PP. Nepalese health workers' migration to the United Kingdom: A qualitative study. Health Science Journal. 2014;8(1):57. Walton-Roberts M, Runnels V, Rajan SI, Sood A, Nair S, Thomas P, Packer C, MacKenzie A, Tomblin Murphy G, Labonté R, Bourgeault IL. Causes, consequences, and policy responses to the migration of health workers: key findings from India. Human resources for health. 2017 Dec;15:1-8. https://doi.org/10.1186/s12960-017-0199-y. Mills EJ, Kanters S, Hagopian A, Bansback N, Nachega J, Alberton M, Au-Yeung CG, Mtambo A, Bourgeault IL, Luboga S, Hogg RS. The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis. Bmj. 2011 Nov 24;343. https://doi.org/10.1136/bmj.d7031. Additional Declarations No competing interests reported. Supplementary Files ThemesIHWM.pdf Figure 1 (supplementary file): summary of the themes and sub-themes Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6667627","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":465863130,"identity":"bbfabdd0-c038-4852-aca5-d3cbf187a310","order_by":0,"name":"Ukamaka Gladys Okafor","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAElEQVRIie3PMWsCMRTA8RcidUm99W6pXyHBwQ5ynyXHgZ07F2oO4SbdT+iHsFuHDpEHveVaV8FJCp0c7rZuGk/cTK2bSP7Le5D8CAFwuS4xBlAC9MxGlWa72TxNSAbQNxsxZDcprQ/8EwRrAv8iHsOVqt7ndzyfJXotwzZH78Mnb71nGwnGqUiyn2WHF5GavchYTJHe+KToW1/hc+h+M72Mpgui8PaXSl6TFP8gzWrI9NegJkwODmRjJ58jYYiWfE/wQLSVBKPiMcl0LCb7v+RigrRzH6VxoCzEYw+vqtRhu5Ujlmv5ZJZktajS0LO9crSGL8+6b6LlucLlcrmuui0nN10t9a8yYAAAAABJRU5ErkJggg==","orcid":"","institution":"Euclid University","correspondingAuthor":true,"prefix":"","firstName":"Ukamaka","middleName":"Gladys","lastName":"Okafor","suffix":""},{"id":465863131,"identity":"9ec69ec9-0422-48bc-a40b-dce7e0e7d578","order_by":1,"name":"Oluebubechukwu Praise Eze","email":"","orcid":"","institution":"Pharmacy Council of Nigeria","correspondingAuthor":false,"prefix":"","firstName":"Oluebubechukwu","middleName":"Praise","lastName":"Eze","suffix":""},{"id":465863132,"identity":"b3c5c0f7-9606-4a3f-9f41-58fd8a1d089f","order_by":2,"name":"Ebele Eugenia Onwuchuluba","email":"","orcid":"","institution":"University of Lagos","correspondingAuthor":false,"prefix":"","firstName":"Ebele","middleName":"Eugenia","lastName":"Onwuchuluba","suffix":""},{"id":465863133,"identity":"faf52bb3-06b2-4a4a-a0b2-a5e9c773298a","order_by":3,"name":"Yejide Olukemi Oseni","email":"","orcid":"","institution":"Lead City University","correspondingAuthor":false,"prefix":"","firstName":"Yejide","middleName":"Olukemi","lastName":"Oseni","suffix":""},{"id":465863134,"identity":"7a93634c-b3f6-42e9-9785-97f9ffcba6a7","order_by":4,"name":"Nkem Mercy Obiakor","email":"","orcid":"","institution":"University of Lagos","correspondingAuthor":false,"prefix":"","firstName":"Nkem","middleName":"Mercy","lastName":"Obiakor","suffix":""}],"badges":[],"createdAt":"2025-05-15 00:23:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6667627/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6667627/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":92887929,"identity":"19eda9fd-64d3-4b21-9080-0a4124449cad","added_by":"auto","created_at":"2025-10-06 17:01:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1210921,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6667627/v1/8509be04-1195-4a50-bfb8-2a80a2ca0347.pdf"},{"id":83984477,"identity":"16a1ed0d-8d89-46ab-98c1-1f3432997fae","added_by":"auto","created_at":"2025-06-05 10:47:15","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":154985,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 1 (supplementary file): summary of the themes and sub-themes\u003c/p\u003e","description":"","filename":"ThemesIHWM.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6667627/v1/470076ce8fb77a933479db74.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Patterns, drivers and barriers of international migration of Nigerian health professionals: A mixed-methods analysis of policy documents and multi-stakeholder perspectives","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe World Health Organization (WHO) defines health workers as \u0026ldquo;all people engaged in work actions whose primary intent is to improve health, including doctors, pharmacists, nurses, midwives, public health professionals, laboratory technologists and technicians, health technicians, medical and non-medical technicians, personal care workers, community health workers, healers, and traditional medicine practitioners\u0026rdquo; [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Effective health service coverage can only be achieved when health workers are fairly distributed and accessible to the public, and have sufficient support from the health system [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. According to the WHO Health Workforce Support and Safeguards list, Nigeria is among the 37 countries with a critical health workforce shortage. The WHO recommendation of health workers for adequate health coverage is 4.45 healthcare workers per 1000 people [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Despite operating at 0.363 medical doctors per 1,000 people, the health system of Nigeria further deteriorated after the coronavirus pandemic [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOver the years, there has been an increasing migration of health workers, from low- and middle-income countries (LMICs) to developed regions, due to a quest for further education, higher remuneration, and a general improvement in their quality of lives [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Also, there was a dramatic and worrisome increase in the mass emigration(japa) of Nigerian healthcare workers to developed countries during the COVID- 19 pandemic [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The emigration was facilitated by the post-COVID shortage in Health Care Providers in developed countries, with a corresponding diminution of health workers in the emigrant countries [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNigeria has been ranked the highest exporter of health worker brains and the United Kingdom (UK) as the major destination [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The UK welcomed up to 5543 nurses and 4880 doctors from Nigeria in 2021[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Nigerian-trained health professionals are also highly represented in other regions of the world such as South Africa, Saudi Arabia, Canada, Australia, and the United States [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInternational migration of healthcare workers is well established and has become a means of maintaining service quality in many high-income countries. The constant emigration causes a reduction in the strength of the health workforce, leading to an increase in the workload of the available staff, with consequent burnout, low work capacity, low quality of healthcare rendered to patients, and predisposing them to poorly achieved health outcomes [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In response, the Nigerian Government approved a new national policy on health workforce migration, aimed at mitigating brain drain and encouraging the return of health professionals from diaspora. The policy is expected to address the complex dynamics of health worker migration and ensure that the exodus of skilled healthcare professionals does not compromise the health system\u0026rsquo;s integrity and the well-being of the Nigerian citizens [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn addition to the reports in the National Policy on Health Workforce Migration of the federal Government of Nigeria, several studies have evaluated the reasons for this high rate of emigration. A lack of health-professional synergy, dissatisfaction with job and work-related policies, an almost non-existent feeling of being considerably compensated, poor work environment conditions, worsening economic conditions, deteriorating health system infrastructure, and insecurity were the most significant reasons [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, many of these studies have focused on quantitative data and/or perspectives of individual healthcare workers, specifically physicians and nurses, and have ignored broader, systemic, policy, and multi-disciplinary stakeholders\u0026rsquo; viewpoints. This study has identified, and qualitatively investigated the pull and push factors and barriers from multi-disciplinary stakeholders, including policy makers and professional bodies. It is hoped that the findings would provide scientific evidence to guide national retention strategies and policy reform in areas of migration governance and contribute to global dialogue in human resources for health, particularly in the LMICs.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eAn exploratory mixed-method design was utilized, comprising desk review of migration data from 2013 to 2023, and in-depth interviews (IDIs) of health professional stakeholders. The study was conducted between September 2024 and March 2025.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Participants\u003c/h3\u003e\n\u003cp\u003eSix health professions most impacted by the challenges of international health worker migration in Nigeria were recruited for the study [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The professionals comprise of nurses, medical doctors, pharmacists, medical laboratory scientists, optometrists and radiographers. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the relevant information on the regulatory agencies and professional associations.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRegulatory agencies, professional associations, membership eligibility, and specific roles\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS/N\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProfession\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAgency/ Professional Organization\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMembership Eligibility/Role\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNursing and Midwifery Council of Nigeria (NMCN)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe legal, administrative, corporate, and statutory body of the Federal Government of Nigeria that ensures the delivery of safe and effective Nursing and Midwifery care to the public through quality education and best practices.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNational Association of Nigerian Nurses and Midwives (NANNM)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA non-governmental organization of all professional nurses and midwives who are trained, registered, and licensed to practice the Nursing Profession at all levels of the healthcare delivery system in Nigeria\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMedicine and Dentistry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedical and Dental Council of Nigeria (MDCN)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAn agency of the Federal Government that regulates the education and practice of medicine, dentistry, and alternative medicine in Nigeria\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNational Medical Association (NMA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA professional association for medical doctors who are Nigerians and trained to practice in Nigeria\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGuild of Medical Directors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA body of medical doctors who own and run private hospitals and clinics and provide medical care to the public.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedical Women\u0026rsquo;s Association of Nigeria (MWAN)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA women's health organization of female medical doctors in Nigeria that\u0026nbsp;advocates for the health of women and children in Nigeria.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003ePharmacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePharmacy Council of Nigeria (PCN)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAn agency of the Federal Government of Nigeria that regulates pharmacy education, training, and practice, in all its aspects and ramifications. This includes licensing of pharmacists and pharmaceutical premises.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePharmaceutical Society of Nigeria (PSN)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAn organization of pharmacists trained to practice in Nigeria that instills discipline and maintains professional ethics among members of the pharmacy profession\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssociation of Lady Pharmacists (ALPs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAn interest group of the PSN consists of female pharmacists in Nigeria, who advocate for the health of women and children as well as female pharmacists in Nigeria.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssociation of Community Pharmacists of Nigeria (ACPN)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA technical arm of the Pharmaceutical Society of Nigeria that promotes public health by providing quality pharmaceutical services and collaborating with other healthcare providers. Members are pharmacists practicing in the private and retail community pharmacy sector\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssociation of Hospital and Administrative Pharmacists of Nigeria (AHAPN)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA professional organization that\u0026nbsp;provides pharmaceutical care, advocates for health workers, with a focus on public health. Members are pharmacists working in hospitals as clinical pharmacists and administrators in regulatory agencies.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClinical Pharmacists of Nigeria (CPAN)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePromotes and practices clinical pharmacy within the Nigerian healthcare system, focusing on direct patient care and collaborating with other healthcare professionals to optimize drug use and patient outcomes. Members are pharmacists with specialization in clinical pharmacy in any health sector, including the academia\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYoung Pharmacists\u0026rsquo; Group (YPG)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA forum of pharmacists aged 35 years and below, not more than 5 years post-qualification, and aimed at\u0026nbsp;providing a platform for members to develop leadership skills, contribute to the pharmacy profession through innovative practices\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical Laboratory Science\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedical and Laboratory Science Council of Nigeria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe federal government statutory agency that regulates the training and practice of medical laboratory scientists in Nigeria\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGuild of Medical Laboratory Directors (GMLD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePromotes medical laboratory science and the welfare of Medical Laboratory Scientists in Nigeria\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOptometry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOptometrists and Dispensing Opticians Registration Board (ODORBN)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe regulatory body responsible for the registration, regulation, and control of the practice of optometry and dispensing optics in Nigeria.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNigerian Optometric Association (NOA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eActs as the primary organization representing all licensed optometrists in Nigeria, ensuring the welfare of its members, advocating for the profession, and promoting quality and affordable eye care services to the public\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRadiography\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRadiographers Registration Board of Nigeria (RRBN)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe RRBN regulates the practice of radiography in Nigeria\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssociation of Radiographers of Nigeria (ARN)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe primary professional body representing all certified radiographers in Nigeria, promoting the practice of medical imaging and radiation science, advocating for improved training standards, and elevating the status of radiographers within the country\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eStudy Sampling\u003c/h3\u003e\n\u003cp\u003ePurposive sampling of the chief executive officers of health regulatory agencies and members of health professional associations was carried out. A total of 20 participants were interviewed, which is line with Creswell\u0026rsquo;s guideline on sample size of about 18 to 30 participants being appropriate for qualitative study [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eInstrument for Data Collection\u003c/h3\u003e\n\u003cp\u003eThe migration data in the National Policy on Health workforce migration showing the magnitude and trend of migration of different cadres of health workers was adopted for the desk review [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. We developed the interview guide for the in-depth interview from validated questionnaires previously used to assess migration intentions of health workers and their determinants in Nigeria, and from the National Policy on Health workforce migration for Nigeria [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Also, the questions in the interview guide were informed by the objectives of the study [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The interview guide sought both sociodemographic data, and the stakeholder perspectives on push and pull factors of, and barriers to, health worker migration in Nigeria.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eThe interviews were conducted by the researchers who are trained and experienced in qualitative research. The interviews were conducted virtually. using the Zoom platform and were recorded for analysis. The researchers ensured trustworthiness and validity of study findings\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical Consideration\u003c/h2\u003e \u003cp\u003e Lagos University Teaching Hospital Health Research Ethics Committee approved the study, with assigned number: ADM/DSCST/HREC/APP/7155. Data collection was conducted while maintaining autonomy and non-maleficence [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Participants were assured of confidentiality as all the information were securely stored and de-identified. Informed consent was obtained before each interview process.\u003c/p\u003e \u003cp\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData on the magnitude and trends of migration were presented in tables, while the transcribed scripts were thematically analyzed. Thematic analysis is one of the most recommended methods of analyzing qualitative data collected via interviews and was therefore employed in this study [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe employed a thematic analysis framework approach to analyze the transcripts [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This approach involves seven key stages: transcription, familiarization, open coding, developing a working analytical framework, indexing subsequent transcripts, charting, and interpretation. The recorded interviews were transcribed verbatim by the research team. Transcripts were de-identifed by giving each transcript a unique number for easy identification, anonymity, and subsequent peer coding. Thereafter, we used Artificial Intelligence to organize the transcript, and thereafter deleted all irrelevant information, and triangulated the organized responses with the original transcript to avoid loss of content. This is in line with the Ethics of using Artificial Intelligence in Qualitative Research [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor familiarization, we immersed ourselves with the data by reading and re-reading, to have an in-depth understanding of the data. Two of the researchers independently coded the first two transcripts using in vivo codes. The two coders met, discussed, resolved discrepancies through consensus, explored relationships between items, identified naturally emerging themes and recurrent patterns, and developed the codes and coding matrix, which were applied in indexing the remaining eighteen transcripts. This was followed by charting and interpreting the data. This rigorous procedure ensured inter-coder reliability, interpretive accuracy, and that the final report adequately captures the lived experiences of research participants [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eMagnitude and Trend of Migration among Health Workers in Nigeria\u003c/h2\u003e\n \u003cp\u003eThe data on the magnitude and trend of migration among health workers in Nigeria were collected from their respective regulatory bodies and national health workforce policy documents [\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]. The data represents the health workers who requested letters of good standing or verification from the regulatory bodies, and are outlined in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. The year 2023 demonstrated the peak of migration for the health professionals, with 18028 nurses, 3419 medical doctors, 451 pharmacists, 420 radiographers, and 333 optometrists requesting letters of good standing. The most common destination country was the United Kingdom, followed by the United States of America, Canada, the United Arab Emirates, Australia, Ireland, and Saudi Arabia.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eTable showing profession and magnitude of migration\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"13\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eS/N\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eProfession\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2013\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2014\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2015\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2016\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNursing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4943\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRadiography\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e411\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e420\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedicine and Dental Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e762\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e656\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e688\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1420\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1553\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1824\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2607\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3419\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePharmacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e448\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e550\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e783\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e472\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e451\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOptometry\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e333\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedical Laboratory Science\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1409\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1553\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e**: Migration data for that year could not be accessed.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eDemographic characteristics of study participants\u003c/h2\u003e\n \u003cp\u003eAccording to Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, there were significantly more males (17, 85.0%) than females (3, 15.0%), the majority (95%) of whom possess more than 20 years post-qualification experience. Out of the stakeholders, the most respondents (15, 75.0%) were from health professional associations, and 5 (15.0%) were regulators.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSocio-demographic characteristics of stakeholders\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStudy Participants\u0026rsquo;ID\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eYears of practice\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRole in Health Workforce value chain\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSector of practice\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIDI_1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessional Association\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIDI_2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessional Association\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIDI_3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessional Association\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIDI_4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRegulatory Agency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePublic\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIDI_5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessional Association\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIDI_6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessional Association\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIDI_7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessional Association\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIDI_8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRegulatory Agency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePublic\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIDI_9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessional Association\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIDI_10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessional Association\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIDI_11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessional Association\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIDI_12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessional Association\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIDI_13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessional Association\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIDI_14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRegulatory Agency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePublic\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIDI_15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessional Association\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIDI_16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessional Association\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIDI_17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessional Association\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIDI_18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRegulatory Agency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePublic\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIDI_19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessional Association\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIDI_20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRegulatory Agency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePublic\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eFindings from Thematic Analysis\u003c/h2\u003e\n \u003cp\u003eThe presentation of the qualitative report was guided by the Standards for Reporting Qualitative Research (SRQR) Checklist [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003eThree major themes and thirteen subthemes emerged from the thematic analysis which described the drivers and barriers of international migration among health professionals in Nigeria. The themes were the push factors, pull factors and barriers. The subthemes for push factors were economic factors, workplace conditions, poorly regulated practice environment, insecurity of all types, including job insecurity, lack of job satisfaction, and limited career growth. Higher remuneration, better working conditions, job security/welfare benefits, and research and training opportunities were the subthemes for pull factors while financial constraints, system and regulatory factors, family and personal factors, overseas country policies, restrictions and discrimination were the barriers militating against health worker migration.\u003c/p\u003e\n \u003cp\u003eFigure 1 (supplementary file): summary of the themes and sub-themes\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eTheme 1: Push Factors\u003c/h2\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eParticipants described the push factors as situations inherent in-country that encourage health professionals to emigrate:\u003c/p\u003e\n \u003c/div\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003ea. Economic factors.\u003c/strong\u003e\u003c/p\u003e\n \u003c/span\u003e\n \u003cp\u003ePoor salary package and remuneration, delayed salary payments, lack of financial incentives, poor country economy, lack of social amenities, and devaluation of Nigerian currency were critical factors facilitating the emigration of Nigerian health workers. According to a key stakeholder,\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;...One of the key driving forces is the economic disparity and financial incentives. I\u0026apos;ll give you an example, I know of a country where they employed my colleague with accommodation incentives and tax-free salary and they pay him almost 20 times of his salary while he was in Nigeria\u0026hellip;\u0026rdquo;\u003c/em\u003e (IDI_11, male, 20 years post qualification\u0026hellip;private sector\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003eWorkplace conditions\u003c/h2\u003e\n \u003cp\u003eA shared perspective from various stakeholders were issues of poor infrastructure, inadequate facilities, unsafe and poor working environments, work overload and health worker burn-out, as critical situations that compel health professionals to emigrate. Respondents stated that:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;... We work in environments without basic facilities, yet we are expected to deliver quality care\u0026hellip;\u0026rdquo;\u003c/em\u003e (IDI_8, male, 35 years post qualification\u0026hellip;public sector).\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;...The few staff on ground are overused and come down with a lot of work induced hazards and stress induced fatigue. For example, they must work more than eight hours daily, because there\u0026apos;s nobody to take over from them\u0026hellip;\u0026rdquo;\u003c/em\u003e (IDI_2, female, 32 years post qualification\u0026hellip;private sector).\u003c/p\u003e\n \u003cp\u003eIn contrast to belief that the quest for greener pastures is the major driver of emigration among the Nigerian health professionals, a stakeholder in a government employment affirmed that:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;...For me, I don\u0026apos;t think money is what pushes people away, but basically the lack of infrastructure. Some facilities don\u0026apos;t have basic amenities for simple procedures\u0026hellip;. and you see your patients dying\u0026hellip;\u0026rdquo;\u003c/em\u003e (IDI_18, female, 26 years post qualification\u0026hellip;public sector).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003eb. Poorly regulated practice environment\u003c/h2\u003e\n \u003cp\u003eExistence of open drug markets, unregistered traditional healers, illegal health posts, medicines shops that treat all forms of ailments, unregistered traditional birth attendants, religious organizations that offer illegal health services with promises of miraculous healings, and massive infiltration of quacks in the health practice environments were reported. Participants stated that these unsatisfactory and poorly regulated practice environments adversely affect the viability of their professional practices and frustrate health professionals out of the country. As stated by a key stakeholder,\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;...I believe that what pushes people more is the practice environments, other people not obeying the rules and regulations, other people invading into our practice and nothing is done about it by government\u0026hellip;\u0026rdquo;\u003c/em\u003e (IDI_12, male, 20 years post qualification\u0026hellip;private sector).\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;...Quackery is one of the drivers of migration. When you set up a business and you are not making profit, and you see quacks all over the place, it seems as if nobody cares\u0026hellip;\u0026rdquo;\u003c/em\u003e (IDI_7, male, 35 years post qualification\u0026hellip;private sector).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003ec. Insecurity of all types, including job insecurity, and lack of job satisfaction\u003c/h2\u003e\n \u003cp\u003eParticipants expressed concerns about rising cases of kidnapping, killing of health workers, armed conflicts, hospital-related violence, political instability, poor work safety, lack of job satisfaction and job security, and reiterated that:\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ldquo;...\u003c/strong\u003e \u003cem\u003eWe have seen kidnapping of health care workers in Cross Rivers and Delta States. Some were even killed. Some were attacked in Benue State, one doctor is still missing, until now she hasn\u0026apos;t been released\u0026hellip;\u0026rdquo;\u003c/em\u003e (IDI_6, female, 34 years post-qualification\u0026hellip;private sector).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003ed. Limited career growth\u003c/h2\u003e\n \u003cp\u003eLack of funding for training, poor opportunities for specialization, stagnation of health workers, non-recognition of their expertise, and workplace discrimination against non-medical doctor health professionals, the healthcare industry crisis, were the key factors driving health professionals out of Nigeria. As highlighted by some stakeholders,\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;...The contest for who will lead the health sector and the quest for supremacy among healthcare providers has caused a lot of dissatisfaction in the system. We want to enhance our prestige, our earnings, and well-being, at the discretion of others\u0026hellip;\u0026rdquo;\u003c/em\u003e (IDI_14, male, 35 years post-qualification\u0026hellip;public sector).\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;...Many Health Care Providers leave because they feel unappreciated and lack access to professional growth opportunities\u0026hellip;\u0026rdquo;\u003c/em\u003e (IDI_17, male, 4 years post qualification\u0026hellip;private sector).\u003c/p\u003e\n \u003cp\u003eOther reported push factors include spouse migration and increasing collaboration with institutions abroad. As stated by a stakeholder,\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;...Some of my staff can just come to work and say that they are moving, they don\u0026rsquo;t inform me when they are planning it\u0026hellip;\u0026hellip;.Oh, my husband says we are moving, and that is how they resign\u0026hellip;\u0026rdquo;\u003c/em\u003e (IDI_6, female, 34 years post-qualification\u0026hellip;private sector).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ch2\u003eTheme 2: Pull Factors\u003c/h2\u003e\n \u003cp\u003eFurther insights into the drivers of international migration were characterized as pull factors. These are factors inherent in destination countries that entice health professionals to emigrate to those countries, and they are higher salaries, better working conditions, job security and welfare benefits, and research and training opportunities.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n \u003ch2\u003ea. Higher remuneration\u003c/h2\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eHigher salaries in the destination countries were key factors that compel health professionals to emigrate, as they earn significantly more abroad, sometimes 5\u0026ndash;10 times more than their current wages in Nigeria.\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;...So you can be paid up to 5000 pounds, that is motivating, and then the amenities are there, even though they\u0026apos;re expensive. The security threat is not there\u0026hellip;\u0026hellip;\u0026hellip;.., it\u0026apos;s much more motivating, for people to migrate\u0026hellip;\u0026rdquo;\u003c/em\u003e (IDI_4, male, 33 years post-qualification\u0026hellip;private sector).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\n \u003ch2\u003eb. Better working conditions\u003c/h2\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eAccess to modern equipment, structured working hours, better prospects, and career progression pathways were reported as some of the critical factors that attract Nigerian health professionals to their destination countries. A participant stated that:\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;...my colleagues who left for Canada and UK say they now have access to better and digital healthcare facilities and career support\u0026hellip;\u0026rdquo;\u003c/em\u003e (IDI_15, male, 28 years post-qualification\u0026hellip;private sector).\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;...if you have the correct infrastructure, you will be happy to work. Exposure to risk and insecurity is low abroad, with better life-work balance\u0026hellip;\u0026rdquo;\u003c/em\u003e (IDI_18, female, 26 years post-qualification\u0026hellip;public sector\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\n \u003ch2\u003ec. Job security and welfare benefits\u003c/h2\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eStatements referring to the availability of health insurance, pensions, and well-defined employment contracts.\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;...Beyond money, the work culture abroad is more structured. There are clear career paths, and training is prioritized\u0026hellip;\u0026rdquo;\u003c/em\u003e (IDI_13, male, 27 years post qualification\u0026hellip;private sector).\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;...When you open your email, you see recruiters flaunting opportunities in Canada and the UK. These opportunities come with fantastic and well-defined employment contracts \u0026hellip;\u0026rdquo;\u003c/em\u003e (IDI_11, male, 37 years post qualification\u0026hellip;public sector).\u003c/p\u003e\n \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\n \u003ch2\u003ed. Research and training opportunities\u003c/h2\u003e\n \u003cp\u003eStakeholders in this study indicated that there is better academic and practical exposure and greater opportunities for career advancement.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;...In our climes, opportunities for professional development are not common, unless with out-of-pocket payments, but when you go abroad, it is compulsory, you must go for continued professional development. The white man doesn\u0026apos;t joke with quality assurance\u0026hellip;\u0026rdquo;\u003c/em\u003e (IDI_11, male, 20 years post-qualification\u0026hellip;private sector).\u003c/p\u003e\n \u003cp\u003eOther significant reasons associated with migration include demand for health work force abroad, little or no security threat, high level of interprofessional harmony and job satisfaction.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;...Of course, there are issues of interprofessional harmony and job satisfaction in those developed countries. They build relationships among healthcare providers right from their level of training\u0026hellip;\u0026rdquo;\u003c/em\u003e (IDI_3, male, 37 years post-qualification\u0026hellip;private sector).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\n \u003ch2\u003eTheme 3: Barriers\u003c/h2\u003e\n \u003cp\u003eDespite the mass exodus of Nigerian health professionals to other countries, the exploratory in-depth interview of stakeholders revealed multidimensional barriers to health worker emigration. These barriers were financial constraints, system and regulatory factors, family and personal factors, and overseas country restrictions.\u003c/p\u003e\n \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\n \u003ch2\u003ea. Financial constraints\u003c/h2\u003e\n \u003cp\u003eHigh cost of migration, described as exorbitant cost of application for qualifying exams and residency programs, professional licensure in the destination countries, cost of processing letters of good standing in home countries, air transportation for the health professional and dependents, and other sundry expenses. As remarked by some stakeholders,\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;...There are high financial costs associated with migration, such as cost of examinations, letters of good standing fees,\u0026hellip;\u0026hellip;., these are difficult for some health professionals, especially those from poor families\u0026hellip;\u0026rdquo;\u003c/em\u003e (IDI_10, male, 23 years post-qualification\u0026hellip;private sector).\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;...There is a high cost of obtaining transcripts and applying for placements, the US charge up to $30 to submit one application for medical residency placement, and you may submit to up to sixty institutions to get a placement\u0026hellip;\u0026rdquo;\u003c/em\u003e (IDI_7, male, 35 years post-qualification\u0026hellip;private sector).\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\n \u003ch2\u003eb. System and Regulatory factors\u003c/h2\u003e\n \u003cp\u003eParticipants expressed concerns on regulatory challenges experienced by colleagues when processing documents. They highlighted government policies, institutional barriers, delays and restrictions on travel documents as the critical factors posing barriers to health worker migration.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;...\u003cem\u003eSome professional regulatory councils have stopped processing letters of good standing for emigrating professionals\u0026hellip;\u0026rdquo;\u003c/em\u003e (IDI_5, male, 27 years post qualification\u0026hellip;private sector).\u003c/p\u003e\n \u003cp\u003eA key stakeholder in a regulatory agency corroborated the above and stated that:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;...Nurses are not eligible for verification to get letters of good standing until at least two years post registration\u0026hellip;\u0026rdquo;\u003c/em\u003e (IDI_18, female, 26 years post qualification\u0026hellip;public sector)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;...There are unwritten visa restrictions for migration to preferred countries such as USA, UK, Canada, and Europe\u0026hellip;\u0026rdquo;\u003c/em\u003e (IDI_1, male, 38 years post qualification\u0026hellip;private sector).\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\n \u003ch2\u003ec. Family and Personal factors\u003c/h2\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eFamily obligations and the fear of leaving the immediate or extended family members and aged parents, cultural ties, growing children, in-country financial investments and \u0026lsquo;fear of the unknown\u0026rsquo; were the key barriers to health worker migration.\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;...There are family commitments and personal obligations in Nigeria \u0026amp; personal financial investments\u0026hellip;\u0026rdquo;\u003c/em\u003e (IDI_11, male, 20 years post qualification\u0026hellip;private sector)\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;...\u003cem\u003eSome colleagues that have migrated face emotional and cultural challenges associated with relocation\u0026hellip;\u003c/em\u003e\u0026rdquo; (IDI_3, male, 37 years post qualification\u0026hellip;private sector).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\n \u003ch2\u003ed. Overseas country policies, restrictions and discrimination\u003c/h2\u003e\n \u003cp\u003eOutbound restrictions, migration policies in destination countries, difficulties in securing practice requirements, racial discrimination, language and practice barriers, and low digital proficiency were the challenges described by stakeholders.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;...\u003cem\u003eYeah, there are barriers. It\u0026apos;s not easy to get a placement as a professional; you have to write qualifying exams in another country outside Nigeria out -of - pocket, and sometimes you write more than once, and the exams are expensive\u0026hellip;\u0026rdquo;\u003c/em\u003e (IDI_6, female, 34 years post qualification\u0026hellip;private sector).\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;...\u003cem\u003eI also know of some Nigerian medical doctors who became nurses in the United States because they could not pass the US medical examination, so when some of our colleagues hear such\u003c/em\u003e \u0026hellip;..\u0026rdquo; (IDI_14, male, 35 years post qualification\u0026hellip;public sector).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe mixed-methods analysis of policy documents and exploratory in-depth interviews of multidisciplinary stakeholders provided unique insights into the patterns, drivers and barriers of international migration among Nigerian health workers, at the national, professional and personal levels.\u003c/p\u003e \u003cp\u003eThe significant greater number of males (17, 85.0%) than females (3, 15.0%), among the participants reaffirmed the under-representation of women in leadership positions, despite being the backbone of healthcare in Nigeria and constitutes 70% of the global health and social workforce [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Interestingly, two out of the three females among the participants were from female-only associations, while the third female was from a female-dominated association, implying that the study would have, otherwise, interviewed only males. This situation may have led to loss of diversity in the voices that reflects the views of the stakeholders in this study and limits women\u0026rsquo;s ability to influence policy and resource allocation.\u003c/p\u003e \u003cp\u003eNigeria, just like other LMICs, exports skilled labour to high-income countries. However, the massive exodus of health workers, as identified in this study implies an impending detrimental deficit of health workforce that would compromise the quality of healthcare in the country. This aligns with the predictions of a 2016 study, that by 2030, there will be a deficit of doctors and nurses by 33.45% and 29.25% respectively [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Similarly, a survey conducted by the Medical and Dental Consultants Association of Nigeria on its members in 2022 revealed that more than 500 medical consultants have left Nigeria to practice in developed countries, and 1 out of 10 consultants with fewer than five years had plans for emigration [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Findings from this study also corroborated previous data that among the Nigerian health workforce, job dissatisfaction and poor quality of work life are major reasons for emigration [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother key driver of health worker emigration in Nigeria are poor remuneration, which was also found in previous studies [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Findings from our study were similar to those of a study conducted among Nepalese health workers, where the major reasons for migration were economic instability, insecurity, less opportunities for development, favouritism, and workplace stress [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. These views were shared among health workers in India that reported notable key push factors responsible for migratory patterns among health workers as lack of opportunities for professional development, work overload, and poor working conditions [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Many of the key factors driving migration of Nigerian health workers to international labour markets were also factors driving migration in previous quantitative studies, existing policy documents and scoping review. This implies that the same factors driving health worker migration prevail in Nigeria and that the Nigerian government should take urgent steps in addressing health worker migration issues and protect the health of the Nigerian public.\u003c/p\u003e \u003cp\u003eLack of opportunities for training and development were one of the key factors that push Nigerian health workers to global labour markets. These findings corroborate with those of a comprehensive scoping review of quantitative, qualitative, mixed-methods literature reviews\u0026rsquo; study [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], and reiterates the urgent need for the Nigerian government to prioritize training and professional development opportunities for health workers and put policies in place to ensure the high standards of practice.\u003c/p\u003e \u003cp\u003ePractically, our research contributes to literature by providing a comprehensive qualitative data from the perspectives of regulatory agencies and professional associations on drivers of international health worker migration in Nigeria and the barriers that militate against it. These findings will inform migration and workforce retention policies of the Nigerian government.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eAs opined by Mills et al., 2011, accurately estimating the movement of health workers is a particularly challenging task because reliable data is hard to obtain [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. This, in addition to bureaucratic government protocols, compounded our challenges in accessing comprehensive data from some proposed stakeholders. For example, the study was unable to interview the Medical Laboratory Science Council and National Association of Nigeria Nurses and Midwives, but this would not compromise our findings as the Guild of Medical Laboratory Directors and Nursing and Midwifery Council participated in the study.\u003c/p\u003e \u003cp\u003eThe study reflected the association leaders\u0026rsquo; and regulators\u0026rsquo; perspectives and not the views of the direct health workers that emigrated from Nigeria or the health workers in Nigeria who may be planning to migrate. This would have helped in the triangulation of the results for robustness.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study found that the year 2023 described the peak of Nigerian health worker migration, with United Kingdom as the most common country of destination. The migration crisis is driven by poor remuneration, limited career growth, insecurity, unfavorable work conditions, poorly regulated practice environment, insecurity job insecurity, and lack of job satisfaction, with lack of research and training opportunities, financial constraints, system and regulatory factors, family and personal factors, overseas country policies, restrictions and discrimination, as key barriers. While migration brings opportunities for global experience, its negative impact on Nigeria\u0026rsquo;s healthcare sector can be profound. Evidence from this study can inform urgent and strategic actions towards practical migration and workforce retention policies of the Nigerian government.\u003c/p\u003e \u003cp\u003eThe need for regulatory agencies to collect data on drivers of migration, while processing letters of good standing and further studies on the health workers who have migrated and who may be planning to migrate, are recommended.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e The Lagos University Teaching Hospital Health Research Ethics Committee approved the study, with assigned number: ADM/DSCST/HREC/APP/7155.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e All collected data are included as tables within the article and in the supplementary material, and are available from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare that there is no competing interest associated with this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e No external funding was obtained for this study.\u003c/p\u003e\n\u003cp\u003eAuthors' contributions: U.\u0026nbsp;O.: Conceptualization, Research Proposal, Methodology - Data collection and analysis, writing of first manuscript draft, revising of draft after review and editing, Editing, Correspondence, project administration.\u003c/p\u003e\n\u003cp\u003eO. E.: Research Proposal, Methodology - Data collection and analysis, Writing of first manuscript draft, Project administration.\u003c/p\u003e\n\u003cp\u003eE.\u0026nbsp;O.: Research Proposal, Methodology - Data collection and analysis, Review \u0026amp; Editing of first draft.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eY.O.: Methodology - Data collection and analysis, Review \u0026amp; Editing of first draft.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eN. O.: Data analysis, writing of first manuscript draft, revising of draft after review and editing of first draft.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research team is grateful to the regulatory agencies and professional associations that participated in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Health workforce: medical doctors. https://www.who.int/data/gho/data/themes/topics/indicator-groups/indicator-group-details/GHO/medical-doctors. Accessed 27th November, 2024.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Global Strategy on Human Resources for Health: Workforce 2030. Geneva: World Health Organization, 2016. https://iris.who.int/handle/10665/250368. Accessed 27th November,2024\u003c/li\u003e\n\u003cli\u003eWHO, 2020. World Health Organization (WHO). Addressing the international migration of health workers. Internet. 2020. www.who.int.2020.Available:https://www.who.int/activities/ad dressing-theinternational-migration-of-health-workers. Last accessed 2nd May, 2025\u003c/li\u003e\n\u003cli\u003eAderinto N, Olatunji G. Addressing Nigeria\u0026apos;s proposed bill on the emigration of doctors. The Lancet. 2024 Feb 3;403(10425):435.\u003c/li\u003e\n\u003cli\u003eLawal L, Lawal AO, Amosu OP, Muhammad-Olodo AO, Abdulrasheed N, Abdullah KU, Kuza PB, Aborode AT, Adebisi YA, Kareem AA, Aliu A. The COVID-19 pandemic and health workforce brain drain in Nigeria. International Journal for Equity in Health. 2022 Dec 5;21(1):174. https://doi.org/10.1186/s12939-022-01789-z\u003c/li\u003e\n\u003cli\u003eToyin-Thomas P, Ikhurionan P, Omoyibo EE, Iwegim C, Ukueku AO, Okpere J, Nnawuihe UC, Atat J, Otakhoigbogie U, Orikpete EV, Erhiawarie F. Drivers of health workers\u0026rsquo; migration, intention to migrate and non-migration from low/middle-income countries, 1970\u0026ndash;2022: a systematic review. BMJ global health. 2023 May 1;8(5):e012338.\u003c/li\u003e\n\u003cli\u003eYakubu K, Shanthosh J, Adebayo KO, Peiris D, Joshi R. Scope of health worker migration governance and its impact on emigration intentions among skilled health workers in Nigeria. PLOS Global Public Health. 2023 Jan 6;3(1):e0000717.\u003c/li\u003e\n\u003cli\u003eAkinwumi AF, Solomon OO, Ajayi PO, Ogunleye TS, Ilesanmi OA, Ajayi AO. Prevalence and pattern of migration intention of doctors undergoing training programmes in public tertiary hospitals in Ekiti State, Nigeria. Human Resources for Health. 2022 Oct 27;20(1):76.\u003c/li\u003e\n\u003cli\u003eOnah CK, Azuogu BN, Ochie CN, Akpa CO, Okeke KC, Okpunwa AO, Bello HM, Ugwu GO. Physician emigration from Nigeria and the associated factors: the implications to safeguarding the Nigeria health system. Human Resources for Health. 2022 Dec 20;20(1):85.\u003c/li\u003e\n\u003cli\u003eYakubu K, Blacklock C, Adebayo KO, Peiris D, Joshi R, Mondal S. Social networks and skilled health worker migration in Nigeria: An ego network analysis. The International Journal of Health Planning and Management. 2023 Mar;38(2):457-72.\u003c/li\u003e\n\u003cli\u003eFederal Government of Nigeria. National Policy on Health Workforce Migration. 2023\u003c/li\u003e\n\u003cli\u003eCreswell JW, Poth CN.. Qualitative inquiry and research design: Choosing among five traditions. 4th ed. Thousand Oaks, CA: Sage publications. 2016\u003c/li\u003e\n\u003cli\u003eOjo TO, Oladejo BP, Afolabi BK, Osungbade AD, Anyanwu PC, Shaibu-Ekha I. Why move abroad? Factors influencing migration intentions of final year students of health-related disciplines in Nigeria. BMC Med Educ. 2023 Oct 10;23(1):742. doi: https://doi.org/10.1186/s12909-023-04683-6. PMID: 37817197; PMCID: PMC10563360.\u003c/li\u003e\n\u003cli\u003eLazar J, Feng JH, Hochheiser H. Research methods in human-computer interaction. Morgan Kaufmann; 2017 Apr 28.\u003c/li\u003e\n\u003cli\u003eNii Laryeafio M, Ogbewe OC. Ethical consideration dilemma: systematic review of ethics in qualitative data collection through interviews. Journal of Ethics in Entrepreneurship and Technology. 2023 Dec 14;3(2):94-110.\u003c/li\u003e\n\u003cli\u003eSaunders B, Kitzinger J, Kitzinger C. Anonymising interview data: Challenges and compromise in practice. Qualitative research. 2015 Oct;15(5):616-32.\u003c/li\u003e\n\u003cli\u003eDawadi S. Thematic analysis approach: A step by step guide for ELT research practitioners. Journal of NELTA. 2020 Dec 31;25(1-2):62-71.\u003c/li\u003e\n\u003cli\u003eGerritse K, Martens C, Bremmer MA, Kreukels BP, de Boer F, Molewijk BC. Sharing decisions amid uncertainties: a qualitative interview study of healthcare professionals\u0026rsquo; ethical challenges and norms regarding decision-making in gender-affirming medical care. BMC Medical Ethics. 2022 Dec 27;23(1):139.\u003c/li\u003e\n\u003cli\u003eGale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC medical research methodology. 2013 Dec;13:1-8.\u003c/li\u003e\n\u003cli\u003eMarshall DT, Naff DB. The Ethics of Using Artificial Intelligence in Qualitative Research. J Empir Res Hum Res Ethics. 2024 Jul;19(3):92-102. doi: 10.1177/15562646241262659. Epub 2024 Jun 17. PMID: 38881315.\u003c/li\u003e\n\u003cli\u003eKiger ME, Varpio L. Thematic analysis of qualitative data: AMEE Guide No. 131. Medical teacher. 2020 Aug 2;42(8):846-54.\u003c/li\u003e\n\u003cli\u003eO\u0026apos;Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA: Standards for reporting qualitative research: a synthesis of recommendations. Academic medicine : journal of the Association of American Medical Colleges 2014, 89(9):1245-1251. Doi: https://doi.org/10.1097/acm.0000000000000388.\u003c/li\u003e\n\u003cli\u003eNigeria Health Watch. Nigeria\u0026rsquo;s Health Migration Policy to Address Brain Drain Aims to Boost Local Expertise. 2024 Sep 16. https://articles.nigeriahealthwatch.com/nigerias-health-migration-policy-to-address-brain-drain-aims-to-boost-local-expertise/#:~:text=What%20is%20the%20policy%20is,and%20neglected%20areas%20in%20Nigeria. \u003c/li\u003e\n\u003cli\u003eAdebayo O, Labiran A, Emerenini CF, Omoruyi L. Health workforce for 2016\u0026ndash;2030: will Nigeria have enough. International Journal of Innovative Healthcare Research. 2016;4(1):9-16.\u003c/li\u003e\n\u003cli\u003eAkinwale OE, George OJ. Personnel brain-drain syndrome and quality healthcare delivery among public healthcare workforce in Nigeria. Arab Gulf Journal of Scientific Research. 2023 Jan 4;41(1):18-39. https://doi.org/10.1108/AGJSR-04-2022-0022.\u003c/li\u003e\n\u003cli\u003eKhalid B, Urbański M. Approaches to understanding migration: a mult-country analysis of the push and pull migration trend. Economics \u0026amp; Sociology. 2021 Oct 1;14(4):242-67.\u003c/li\u003e\n\u003cli\u003eAdeniji A, Dansu E, Adeniyi M, Ale S, Ekum M, Shatalov M, Enoch O. Japa model: A mathematical framework for analyzing brain drain in Africa. Scientific African. 2024 Sep 1;25:e02329.\u003c/li\u003e\n\u003cli\u003eBrennan N, Langdon N, Bryce M, Burns L, Humphries N, Knapton A, Gale T. Drivers and barriers of international migration of doctors to and from the United Kingdom: a scoping review. Hum Resour Health. 2023 Feb 14;21(1):11. doi: https://doi.org/10.1186/s12960-022-00789-y . PMID: 36788569; PMCID: PMC9927032.\u003c/li\u003e\n\u003cli\u003eNair M, Webster P. Health professionals\u0026apos; migration in emerging market economies: patterns, causes and possible solutions. Journal of public health. 2013 Mar 1;35(1):157-63. https://doi.org/10.1093/pubmed/fds087.\u003c/li\u003e\n\u003cli\u003eSapkota TN, van Teijlingen E, Simkhada PP. Nepalese health workers\u0026apos; migration to the United Kingdom: A qualitative study. Health Science Journal. 2014;8(1):57.\u003c/li\u003e\n\u003cli\u003eWalton-Roberts M, Runnels V, Rajan SI, Sood A, Nair S, Thomas P, Packer C, MacKenzie A, Tomblin Murphy G, Labont\u0026eacute; R, Bourgeault IL. Causes, consequences, and policy responses to the migration of health workers: key findings from India. Human resources for health. 2017 Dec;15:1-8. https://doi.org/10.1186/s12960-017-0199-y.\u003c/li\u003e\n\u003cli\u003eMills EJ, Kanters S, Hagopian A, Bansback N, Nachega J, Alberton M, Au-Yeung CG, Mtambo A, Bourgeault IL, Luboga S, Hogg RS. The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis. Bmj. 2011 Nov 24;343. https://doi.org/10.1136/bmj.d7031.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Patterns, Health worker, Migration, Japa, Drivers, Barriers, Policy, Stakeholder","lastPublishedDoi":"10.21203/rs.3.rs-6667627/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6667627/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHealth workers are an integral part of any functioning health system. Over the years, there has been an increasing migration of health workers, especially from low- and middle-income countries, such as Nigeria, to developed regions in the quest for further education, higher remuneration, and an overall improvement in their quality of life. This study explored the patterns of health worker emigration, also known as Japa, from Nigeria and explores the driving factors and associated barriers from multi-disciplinary stakeholder perspectives.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study adopted an exploratory mixed-method design, comprising of desk review of health workers migration data from 2013 - 2023, policy documents, and in-depth interviews of 20 multidisciplinary stakeholders in health, using semi-structured interviews as the data collection tool. The leaders of the health regulatory agencies and corresponding professional associations, most impacted by migration were interviewed. Data from desk and document reviews were presented in tables, while transcripts from the qualitative interviews were thematically analyzed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe year 2023 demonstrated the peak of health worker migration in all the professions, with the United Kingdom as the most common destination country. The in-depth interview of 20 stakeholders revealed three themes and thirteen subthemes. The themes were the push factors, pull factors, and barriers. The subthemes were characterized as economic factors, workplace conditions, poorly regulated practice environment, insecurity of all types, including job insecurity, and lack of job satisfaction, limited career growth, higher remuneration, better working conditions, job security and welfare benefits, research and training opportunities, financial constraints, system and regulatory factors, family and personal factors, overseas country policies, restrictions and discrimination.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study identified the United Kingdom as the most common destination country. The key drivers of migration(japa) were economic factors, workplace conditions, a poorly regulated practice environment, insecurity of all types, lack of job satisfaction, limited career growth, and higher remuneration. Associated barriers from the multidisciplinary stakeholders included financial constraints, system and regulatory factors, family and personal factors, overseas country policies, restrictions, and discrimination. Evidence from this study can inform urgent and strategic actions toward practical migration and workforce retention policies of the Nigerian government.\u003c/p\u003e","manuscriptTitle":"Patterns, drivers and barriers of international migration of Nigerian health professionals: A mixed-methods analysis of policy documents and multi-stakeholder perspectives","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-05 10:47:10","doi":"10.21203/rs.3.rs-6667627/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"893e4da8-5359-4476-bca1-1d7f906d64ce","owner":[],"postedDate":"June 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-06T16:53:33+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-05 10:47:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6667627","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6667627","identity":"rs-6667627","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}