Workforce migration and brain drain – A nationwide cross-sectional survey of early career psychiatrists in Nigeria

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Abstract

Background

Nigeria’s shortage of psychiatrists is exacerbated due to health worker migration.

Aim

This study explores migration experiences and tendencies among early-career psychiatrists in Nigeria.

Methods

We conducted a cross-sectional survey covering Nigeria’s six geopolitical zones, using a 61-item online questionnaire assessing short-term mobility, long-term migration experiences and migration attitudes. Data was analysed using IBM SPSS version 29.

Results

Of 228 early-career psychiatrists surveyed, 9.7% had short-term mobility and 8.0% had long-term migration experiences. However, 85.8% had ‘ever’ considered migration, 69.2% were planning to leave ‘now’, and 52.9% had taken ‘practical migration steps’. Over half (52.7%) said they would be working abroad in 5 years, with 25.2% indicating they would migrate within a year. The top reasons to leave were financial and academic, while personal and cultural factors were the key reasons to stay. Income dissatisfaction (OR = 2.27, 95%, CI = 1.05–4.88) predicted planning to leave ‘now’, while being in a relationship (OR = 3.46, 95%CI = 1.06–11.30) predicted taking ‘practical migration steps’. Attractive job features were good welfare (85.4%) and high salaries (80.3%). Improvements in finances (90.8%) and work conditions (86.8%) were requested.

Conclusions

Systemic changes to address psychiatrists’ migration from Nigeria are needed.

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Health systems context(s) for integrating mental health into primary health care in six Emerald countries: a situation analysis

James Mugisha, Jibril Abdulmalik, Charlotte Hanlon … (2017)

Background Mental, neurological and substance use disorders contribute to a significant proportion of the world’s disease burden, including in low and middle income countries (LMICs). In this study, we focused on the health systems required to support integration of mental health into primary health care (PHC) in Ethiopia, India, Nepal, Nigeria, South Africa and Uganda. Methods A checklist guided by the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) was developed and was used for data collection in each of the six countries participating in the Emerging mental health systems in low and middle-income countries (Emerald) research consortium. The documents reviewed were from the following domains: mental health legislation, health policies/plans and relevant country health programs. Data were analyzed using thematic content analysis. Results Three of the study countries (Ethiopia, Nepal, Nigeria, and Uganda) were working towards developing mental health legislation. South Africa and India were ahead of other countries, having enacted recent Mental Health Care Act in 2004 and 2016, respectively. Among all the 6 study countries, only Nepal, Nigeria and South Africa had a standalone mental health policy. However, other countries had related health policies where mental health was mentioned. The lack of fully fledged policies is likely to limit opportunities for resource mobilization for the mental health sector and efforts to integrate mental health into PHC. Most countries were found to be allocating inadequate budgets from the health budget for mental health, with South Africa (5%) and Nepal (0.17%) were the countries with the highest and lowest proportions of health budgets spent on mental health, respectively. Other vital resources that support integration such as human resources and health facilities for mental health services were found to be in adequate in all the study countries. Monitoring and evaluation systems to support the integration of mental health into PHC in all the study countries were also inadequate. Conclusion Integration of mental health into PHC will require addressing the resource limitations that have been identified in this study. There is a need for up to date mental health legislation and policies to engender commitment in allocating resources to mental health services. Electronic supplementary material The online version of this article (doi:10.1186/s13033-016-0114-2) contains supplementary material, which is available to authorized users.

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International Migration of Doctors, and Its Impact on Availability of Psychiatrists in Low and Middle Income Countries

Rachel Jenkins, Robert Kydd, Paul Mullen … (2010)

Background Migration of health professionals from low and middle income countries to rich countries is a large scale and long-standing phenomenon, which is detrimental to the health systems in the donor countries. We sought to explore the extent of psychiatric migration. Methods In our study, we use the respective professional databases in each country to establish the numbers of psychiatrists currently registered in the UK, US, New Zealand, and Australia who originate from other countries. We also estimate the impact of this migration on the psychiatrist population ratios in the donor countries. Findings We document large numbers of psychiatrists currently registered in the UK, US, New Zealand and Australia originating from India (4687 psychiatrists), Pakistan (1158), Bangladesh (149) , Nigeria (384) , Egypt (484), Sri Lanka (142), Philippines (1593). For some countries of origin, the numbers of psychiatrists currently registered within high-income countries' professional databases are very small (e.g., 5 psychiatrists of Tanzanian origin registered in the 4 high-income countries we studied), but this number is very significant compared to the 15 psychiatrists currently registered in Tanzania). Without such emigration, many countries would have more than double the number of psychiatrists per 100, 000 population (e.g. Bangladesh, Myanmar, Afghanistan, Egypt, Syria, Lebanon); and some countries would have had five to eight times more psychiatrists per 100,000 (e.g. Philippines, Pakistan, Sri Lanka, Liberia, Nigeria and Zambia). Conclusions Large numbers of psychiatrists originating from key low and middle income countries are currently registered in the UK, US, New Zealand and Australia, with concomitant impact on the psychiatrist/population ratio n the originating countries. We suggest that creative international policy approaches are needed to ensure the individual migration rights of health professionals do not compromise societal population rights to health, and that there are public and fair agreements between countries within an internationally agreed framework.

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Strengthening mental health systems in low- and middle-income countries: the Emerald programme

Maya Semrau, Sara Evans-Lacko, Atalay Alem … (2015)

There is a large treatment gap for mental health care in low- and middle-income countries (LMICs), with the majority of people with mental, neurological, and substance use (MNS) disorders receiving no or inadequate care. Health system factors are known to play a crucial role in determining the coverage and effectiveness of health service interventions, but the study of mental health systems in LMICs has been neglected. The ‘Emerging mental health systems in LMICs’ (Emerald) programme aims to improve outcomes of people with MNS disorders in six LMICs (Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda) by generating evidence and capacity to enhance health system performance in delivering mental health care. A mixed-methods approach is being applied to generate evidence on: adequate, fair, and sustainable resourcing for mental health (health system inputs); integrated provision of mental health services (health system processes); and improved coverage and goal attainment in mental health (health system outputs). Emerald has a strong focus on capacity-building of researchers, policymakers, and planners, and on increasing service user and caregiver involvement to support mental health systems strengthening. Emerald also addresses stigma and discrimination as one of the key barriers for access to and successful delivery of mental health services.

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Author and article information

Journal

Journal ID (nlm-ta): Glob Ment Health (Camb)

Journal ID (iso-abbrev): Glob Ment Health (Camb)

Journal ID (publisher-id): GMH

Title: Cambridge Prisms: Global Mental Health

Publisher: Cambridge University Press (Cambridge, UK )

ISSN (Electronic): 2054-4251

Publication date (Electronic, collection): 2024

Publication date (Electronic): 29 February 2024

Volume: 11

Electronic Location Identifier: e30

Affiliations

[ 1 ]Department of Clinical Services, Federal Neuropsychiatric Hospital , Calabar, Nigeria

[ 2 ]Department of Clinical Services, Federal Neuropsychiatric Hospital , Maiduguri, Nigeria

[ 3 ]Department of Mental Health, University of Port Harcourt , Choba, Rivers State, Nigeria

[ 4 ]Directorate of Clinical Services, Neuropsychiatric Hospital, Aro , Abeokuta, Nigeria

[ 5 ]Department of Clinical Services, Federal Neuropsychiatric Hospital , Kaduna, Nigeria

[ 6 ]Department of Psychiatry, Jos University Teaching Hospital , Plateau, Nigeria

[ 7 ]Department of Behavioural Sciences, University of Ilorin Teaching Hospital , Ilorin, Nigeria

[ 8 ]Institute of Psychiatry, Psychology & Neuroscience, King’s College London , London, UK

Centre for Rural Health, University of KwaZulu-Natal , South Africa

London School of Hygiene & Tropical Medicine , United Kingdom of Great Britain and Northern Ireland

Centre for Rural Health, University of KwaZulu-Natal , South Africa

London School of Hygiene & Tropical Medicine , United Kingdom of Great Britain and Northern Ireland

Author notes

Corresponding author: Mariana Pinto da Costa; Email: mariana.pintodacosta@ 123456kcl.ac.uk

Author information

Emmanuel Aniekan Essien https://orcid.org/0000-0002-9920-9159

Mohammed Yusuf Mahmood https://orcid.org/0000-0001-6599-4067

Frances Adiukwu https://orcid.org/0000-0001-5543-1746

Yesiru Adeyemi Kareem https://orcid.org/0000-0001-5569-6592

Nafisatu Hayatudeen https://orcid.org/0000-0002-9502-3971

Margaret Isioma Ojeahere https://orcid.org/0000-0002-0593-2400

Mumeen Olaitan Salihu https://orcid.org/0000-0003-2174-6488

Kamaldeen Adeyinka Sanni https://orcid.org/0009-0001-9426-9187

Ayotunde Bolatito Omotoso https://orcid.org/0000-0002-1344-1898

Mariana Pinto da Costa https://orcid.org/0000-0002-5966-5723

Article

Publisher Item ID: S2054425124000256

DOI: 10.1017/gmh.2024.25

PMC ID: 10988168

PubMed ID: 38572258

SO-VID: 7c3f93d9-c5af-40a7-8d0f-97f3dfe54f6f

License:

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.

History

Date received : 05 December 2023

Date revision received : 07 January 2024

Date accepted : 14 February 2024

Page count

Figures: 3, Tables: 2, References: 37, Pages: 9

Funding

Funded by: Medical Research Foundation, doi http://dx.doi.org/10.13039/501100009187;

Award ID: MRF-SF-MCTG-2022-100047

Workforce migration and brain drain – A nationwide cross-sectional survey of early career psychiatrists in Nigeria

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Most cited references 33

Health systems context(s) for integrating mental health into primary health care in six Emerald countries: a situation analysis

International Migration of Doctors, and Its Impact on Availability of Psychiatrists in Low and Middle Income Countries

Strengthening mental health systems in low- and middle-income countries: the Emerald programme

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