How do social networks influence Nigerian health workers’ intentions to migrate?

The emigration of skilled health workers (SHWs) from low- and middle-income countries (LMICs) to high-income ones has been on the rise. In 2000, an estimated 415,936 doctors migrated from LMICs to countries belonging to the Organisation for Economic Development (OECD). By 2015, this number had risen to 716,432 – an increase of over 70 percent in 15 years.

This trend has led to a spike in the clinical workload of those who choose to remain, decreasing the quality of health services, and negatively impacting their job satisfaction and wellbeing. Migration of SHWs has also negatively impacted LMIC health systems by reducing the pool of health educators available to train future SHWs, limiting the ability to respond to future health workforce needs.

Like many other LMICs, Nigeria’s health system has been affected by SHW migration. Our new study finds that the social networks of skilled health workers (SHWs) in Nigeria can have considerable influence on their intentions to migrate to other countries. These networks – including policy makers, colleagues, peers, friends, family, and others that share common ties – can be leveraged to improve the country’s response to health worker migration.

“Our paper does not recommend preventing SHWs from migrating. But there is a need to improve migration governance,” explains lead author Dr. Kenneth Yakubu, Co-Lead of The George Institute’s Initiative for Partnerships in Africa.

Migration governance refers to how norms, laws, procedures, and organisational structures regulate or facilitate a state’s response to migration.

“Governments respond to SHW migration based on expert advice or formal regulatory systems that they are conversant with, but there are informal systems of thinking and behaviour that impact migration behaviour too,” he adds.

“Our paper aims to provide evidence on one such informal system - health workers’ social connections - on moulding migration intentions.”

Yakubu interviewed 22 SHWs living or working in Nigeria on their interactions within networks regarding migration and their intent on moving out of the country. Half the participants wanted to migrate, while half intended to stay and practice in Nigeria. Those looking to move had larger social networks and their discussions centred on information on migration opportunities and support from social networks (family, friends) to aid decision-making. While those planning to stay also participated in conversations about migration opportunities, they were also interested in engaging their networks in improving health services in the country and mitigating the negative effect of migration.

“Health worker migration is a complex issue requiring collaboration among multiple stakeholders. Our study shows SHWs can serve as links across various networks, raising awareness about SHW migration,” adds Dr Yakubu.

“It also highlights the agency and leadership potential of health workers to influence how their colleagues and other stakeholders perceive factors related to SHW migration.”