# `This is our country and somehow, we have to make it work’: a sequential explanatory mixed-methods study of the enablers of non-migration and return migration in a cohort of Nigerian medical doctors and dentists

## TL;DR

This study explores why Nigerian doctors and dentists choose to stay in Nigeria or return after migrating, identifying factors like security, remuneration, and patriotism.

## Contribution

The study provides new insights into the enablers of non-migration and return migration among Nigerian health professionals using a mixed-methods approach.

## Key findings

- Macro-level factors like insecurity and poor remuneration drive emigration among Nigerian doctors.
- Micro-level factors such as patriotism and family responsibilities encourage non-migration.
- Improved security and healthcare infrastructure could encourage return migration among those who have already emigrated.

## Abstract

While many studies have explored the drivers of health-worker emigration, there is limited understanding of the factors that potentially encourage them to remain or return after migration.

We explored three interrelated questions: what factors encouraged some members of the study population to remain in Nigeria?; what circumstances might encourage those intending to migrate to reconsider their plans?; and what conditions could encourage those who have already emigrated to consider returning?

We conducted a sequential explanatory mixed-methods study among a cohort of Nigerian-trained doctors and dentists. In the quantitative phase, 274 cohort members completed a structured survey assessing drivers of migration. In the qualitative phase, 50 participants across three migration status groups (emigrated, intending to migrate, and not intending to migrate) were interviewed. Thematic analysis was conducted.

Overall, 49.3% (135/274) of the cohort had already migrated within 15 years of qualifying, while 63.6% (82/139) of those still in Nigeria expressed an intention to migrate. Qualitative findings reinforced the quantitative results, highlighting shared potential enablers of staying (among those intending to migrate) or returning (among already migrated), including improved security, economic stability, better remuneration, stronger healthcare infrastructure, and enhanced training opportunities. Most of those who had already migrated expressed a willingness to return, though often as a long-term plan. Those with no intention to migrate cited a sense of duty and patriotism, family responsibilities, thriving businesses, and professional or age-related factors as reasons for staying back.

This study offers actionable insights to inform policies on health-worker migration.

Main findings: The main drivers of emigration among doctors who have migrated or intend to do so, are largely macro-level factors such as insecurity, concerns about children’s future, poor remuneration, and high cost of living. On the other hand, micro-level factors such as patriotism, and family responsibilities are the main reasons for non-migration among those who have chosen not to emigrate from the country.Added knowledge: This mixed-methods study examine the deeper motivations behind non-migration of doctors, the triggers for considering migration, and the potential enablers of return migration, providing a comprehensive comparison of perspectives across three distinct groups of doctors.Global health impact for policy and action: The results of this study offer timely and policy-relevant evidence to inform national and regional strategies to support the return migration and improve non-migration of skilled health professionals.

Main findings: The main drivers of emigration among doctors who have migrated or intend to do so, are largely macro-level factors such as insecurity, concerns about children’s future, poor remuneration, and high cost of living. On the other hand, micro-level factors such as patriotism, and family responsibilities are the main reasons for non-migration among those who have chosen not to emigrate from the country.

Added knowledge: This mixed-methods study examine the deeper motivations behind non-migration of doctors, the triggers for considering migration, and the potential enablers of return migration, providing a comprehensive comparison of perspectives across three distinct groups of doctors.

Global health impact for policy and action: The results of this study offer timely and policy-relevant evidence to inform national and regional strategies to support the return migration and improve non-migration of skilled health professionals.