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

Background Health 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. 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.