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Cited by 167Global Health Workforce IssuesGlobal Health and SurgeryMigration and Labor Dynamics

Drivers of health workers’ migration, intention to migrate and non-migration from low/middle-income countries, 1970–2022: a systematic review

Open access
Toyin-Thomas, Patience, Ikhurionan, Paul, Omoyibo, Efe E, Iwegim, Chinelo, Ukueku, Avwebo O, Okpere, Jermaine, Nnawuihe, Ukachi C, Atat, Josephine +8 more·2023·BMJ Global Health
DOI 10.1136/bmjgh-2023-012338PMC PMC10174016
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Abstract

Background: The migration of healthcare workers (HWs) from low/middle-income countries (LMICs) is a pressing global health issue with implications for population-level health outcomes. We aimed to synthesise the drivers of HWs’ out-migration, intention to migrate and non-migration from LMICs. Methods: We searched Ovid MEDLINE, EMBASE, CINAHL, Global Health and Web of Science, as well as the reference lists of retrieved articles. We included studies (quantitative, qualitative or mixed-methods) on HWs’ migration or intention to migrate, published in either English or French between 1 January 1970 and 31 August 2022. The retrieved titles were deduplicated in EndNote before being exported to Rayyan for independent screening by three reviewers. Results: We screened 21 593 unique records and included 107 studies. Of the included studies, 82 were single-country studies focusing on 26 countries, while the remaining 25 included data from multiple LMICs. Most of the articles focused on either doctors 64.5% (69 of 107) and/or nurses 54.2% (58 of 107). The UK (44.9% (48 of 107)) and the USA (42% (45 of 107)) were the top destination countries. The LMICs with the highest number of studies were South Africa (15.9% (17 of 107)), India (12.1% (13 of 107)) and the Philippines (6.5% (7 of 107)). The major drivers of migration were macro-level and meso-level factors. Remuneration (83.2%) and security problems (58.9%) were the key macro-level factors driving HWs’ migration/intention to migrate. In comparison, career prospects (81.3%), good working environment (63.6%) and job satisfaction (57.9%) were the major meso-level drivers. These key drivers have remained relatively constant over the last five decades and did not differ among HWs who have migrated and those with intention to migrate or across geographical regions. Conclusion: Growing evidence suggests that the key drivers of HWs’ migration or intention to migrate are similar across geographical regions in LMICs. Opportunities exist to build collaborations to develop and implement strategies to halt this pressing global health problem.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review of 107 studies found that health workers’ migration or intention to migrate from low/middle-income countries is driven mainly by macro-level remuneration and security problems and meso-level career prospects, working environment and job satisfaction. These drivers were similar across migration status and geographical regions and remained relatively constant from 1970 to 2022.

Key findings

  • The review included 107 studies: 82 single-country studies covering 26 countries and 25 multi-LMIC studies. Most focused on doctors (64.5%, 69/107) and/or nurses (54.2%, 58/107). Top destination countries were the UK (44.9%, 48/107) and USA (42%, 45/107); top source countries were South Africa (15.9%, 17/107), India (12.1%, 13/107) and the Philippines (6.5%, 7/107).
  • Major macro-level drivers were remuneration (83.2%) and security problems (58.9%). Major meso-level drivers were career prospects (81.3%), good working environment (63.6%) and job satisfaction (57.9%). Micro-level drivers included improved quality of life (69.7%) and family ties (61.6%).
  • Local push factors mirrored foreign pull factors: poor pay, work environment, career development, infrastructure and job satisfaction were common local push factors, while financial incentives, good work environment and career development were top foreign pull factors. Local pull factors for non-migration were family ties, job satisfaction and advancing age; foreign push factors were sociocultural barriers and cost of migration.
  • Key drivers were similar for health workers who had migrated and those intending to migrate, and across regions. Financial incentives and career advancement were consistently reported from 1970–2022, with quality of life, working conditions, insecurity/security and unfavourable sociopolitical situations cited more frequently from the early 2000s onward.

Methods

  • PRISMA systematic review searching Ovid MEDLINE, EMBASE, CINAHL, Global Health and Web of Science, plus reference lists; included quantitative, qualitative or mixed-methods studies on health workers’ migration or intention to migrate from LMICs, published in English or French, with databases searched in August 2022.
  • Screening yielded 21,593 unique records and 107 included studies; three independent reviewers screened titles/abstracts in Rayyan, with consensus or a fourth arbiter resolving disagreements. Methodological quality was assessed with the Mixed Methods Appraisal Tool, and no studies were excluded based on quality.
  • Because of heterogeneity in study design, population and outcome, no meta-analysis was conducted; findings were narratively synthesised using push-pull migration theory and Young’s macro-level, meso-level and micro-level framework.

Limitations

  • The paper states that some source countries were disproportionately represented—South Africa, India and the Philippines accounted for over one-third (34.5%) of included studies—which may have skewed findings.
  • The paper states that most included studies focused only on doctors (64.5%) and nurses (54.2%), with limited focus on other essential cadres, and many did not differentiate drivers by cadre, so the review could not examine whether drivers differed across cadres as originally proposed.
  • The paper states that included studies were mainly cross-sectional, so they did not examine changing trends within a particular cohort over time; evident from the text, the review also relied on narrative synthesis rather than meta-analysis because of heterogeneity, and 12 full texts were inaccessible.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1136/bmjgh-2023-012338

Cites

125 of 125 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 14 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Some source countries such as South Africa, India and the Philippines were disproportionately represented, accounting for over one-third (34.5%) of all included studies.

    “some source countries such as South Africa, India and the Philippines were disproportionately represented, accounting for over one-third (34.5%) of all the included studies”
    Quote in the paperNot a substantial claim
  • Findingown data

    The LMICs with the highest number of studies were South Africa (15.9%), India (12.1%) and the Philippines (6.5%).

    “The LMICs with the highest number of studies were South Africa (15.9% (17 of 107)), India (12.1% (13 of 107)) and the Philippines (6.5% (7 of 107)).”
    • Also stated in: § Publication trend, the cadres of HRH studied, the source and the destination countries · plain
      “The top source countries, as determined by studies with single-country data, are South Africa (15.9% (17 of 107) of articles), India (12.1% (13 of 107)) and the Philippines (6.5% (7 of 107)).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Financial incentives, a good work environment and career development were the topmost foreign pull factors.

    “In contrast, financial incentives, a good work environment and career development were the topmost foreign pull factors”
    Quote in the paperNot a substantial claim
  • Findingown data

    The majority of included studies (64.5%) focused solely on doctors.

    “the majority of included studies (64.5%) focused solely on doctors”
    Quote in the paperSubstantial claim
  • Findingown data

    The key drivers did not differ across geographical regions.

    “or across geographical regions”
    • Also stated in: § Evaluating drivers of migration by migration status and geographical regions · plain
      “the key drivers were consistent across geographical regions, as the same drivers were consistently reported in articles from different regions, particularly in Africa, the Eastern Mediterranean and Southeast Asia”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The 107 included studies are representative of health workers in LMICs.
    • Rests on an assumption: The drivers reported in the included studies accurately reflect the actual drivers of health worker migration.
    • Rests on an assumption: The search strategy and databases captured all relevant studies on HRH migration from LMICs.
    • Rests on an assumption: The English/French language restriction did not bias the findings.
    • Rests on an assumption: The 2020 World Bank classification of LMICs is appropriate for studies spanning 1970–2022.
  • May combine two claims. 23
  • Classified as probably not a substantial claim. 9

  • May combine two claims.

    Findingown data

    Local push factors were the most reported and mirrored foreign pull factors.

    “The local push factors were the most reported and mirrored the foreign pull factors.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Remuneration (83.2%) and security problems (58.9%) were the key macro-level factors driving HWs' migration/intention to migrate.

    “Remuneration (83.2%) and security problems (58.9%) were the key macro-level factors driving HWs’ migration/intention to migrate.”
    • Also stated in: § Drivers of out-migration, intention to migrate and non-migration · plain
      “Remuneration and security were the most common macro-level factors driving HRH migration from LMICs, with 83.2% and 58.9% of studies, respectively, identifying these factors”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The review screened 21,593 unique records and included 107 studies.

    “We screened 21 593 unique records and included 107 studies.”
    • Also stated in: § Results · plain
      “In the end, 107 articles11 29–134 were eligible for the final analysis”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The UK (44.9%) and the USA (42%) were the top destination countries.

    “The UK (44.9% (48 of 107)) and the USA (42% (45 of 107)) were the top destination countries.”
    • Also stated in: § Publication trend, the cadres of HRH studied, the source and the destination countries · plain
      “The UK is the leading destination country, with 44.9% (48 of 107) of the articles studied, followed closely by the USA at 42% (45 of 107)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the early 2000s, there was a surge in research on HRH migration that peaked in 2014 and covered a wider range of healthcare workers.

    “However, in the early 2000s, we found a surge in research on HRH migration that peaked in 2014 and covered a wider range of healthcare workers, including those who had already migrated and those planning to do so.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The most common foreign push factors were sociocultural barriers and the cost of migration.

    “In contrast, the most common foreign push factors were sociocultural barriers and the cost of migration.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    At the micro-level, family ties in the destination country and the quest for improved quality of life were the major drivers of migration.

    “At the micro-level, family ties in the destination country and the quest for improved quality of life were the major drivers of migration.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Career prospects (81.3%), good working environment (63.6%) and job satisfaction (57.9%) were the major meso-level drivers.

    “In comparison, career prospects (81.3%), good working environment (63.6%) and job satisfaction (57.9%) were the major meso-level drivers.”
    • Also stated in: § Drivers of out-migration, intention to migrate and non-migration · plain
      “The main drivers at the meso-level were career prospects (81.3%), a good working environment (63.6%) and job satisfaction (57.9%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The review included a large number (107) of studies, most of which were of medium quality.

    “we included a large number (107) of studies, most of which were of medium quality”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The most cited micro-level factors were family ties (61.6%) and improved quality of life (69.7%).

    “The most cited micro-level factors (ie, personal factors) were family ties (61.6%) and improved quality of life (69.7%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Of the 107 included studies, 82 were single-country studies focusing on 26 countries, and 25 included data from multiple LMICs.

    “Of the included studies, 82 were single-country studies focusing on 26 countries, while the remaining 25 included data from multiple LMICs.”
    • Also stated in: § Results · plain
      “Out of the included articles, 82 were single-country studies that focused on 26 countries. The remaining 25 articles were based on data collected from multiple LMICs.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Few studies on HRH migration were published before 2004; publication gained momentum in 2004, peaking in 2014 with 13 articles.

    “Few studies on HRH migration were published before 2004 (figure 2A). However, the publication of articles on the topic gained momentum in 2004, peaking in 2014 with 13 articles”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The review's findings may largely be representative because it included 107 studies, most of medium quality.

    “means that our findings may largely be representative”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The similarity across regions suggests that effective strategies implemented in one LMIC may be applicable to others.

    “as their similarity across regions suggests that effective strategies implemented in one LMIC may be applicable to others.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 107 included studies are representative of health workers in LMICs.
    • Rests on an assumption: The drivers reported in the included studies accurately reflect the actual drivers of health worker migration.
    • Rests on an assumption: The search strategy and databases captured all relevant studies on HRH migration from LMICs.
    • Rests on an assumption: The English/French language restriction did not bias the findings.
    • Rests on an assumption: The 2020 World Bank classification of LMICs is appropriate for studies spanning 1970–2022.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationcitation

    Policies that improve the overall quality of life in LMICs would have a positive spillover effect in reducing the migration of HRH.

    “In addition, policies that improve the overall quality of life in LMICs would have a positive spillover effect in reducing the migration of HRH.144”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [144] Witt, 2009, Addressing the migration of health professionals: the role of working conditions and educational placements, BMC Public Health source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In 2010, the WHO World Health Assembly adopted the Code of Practice on the international recruitment of health personnel.

    “In 2010, another global call to action was made during the WHO World Health Assembly when the Code of Practice on the international recruitment of health personnel was adopted.136”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [136] World Health Organization . The who global code of practice on the International recruitment of health personnel. Geneva, Switzerland: World Health Organization, 2010.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In 2006, the WHO World Health Report was dedicated to HRH, launching a Decade of Human Resources for Health.

    “In 2006, the WHO World Health Report was dedicated to HRH—launching a Decade of Human Resources for Health.135”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [135] World Health Organization . Working together for health: the World Health Report 2006. Geneva, Switzerland: World Health Organization, 2006.

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    National health scheme implementation, ageing populations and a shortage of trained HRH in these countries may have created a demand for foreign-trained HRH to fill gaps in the local workforce.

    “National health scheme implementation, ageing populations and a shortage of trained HRH in these countries may have created a demand for foreign-trained HRH to fill gaps in the local workforce.135”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [135] World Health Organization . Working together for health: the World Health Report 2006. Geneva, Switzerland: World Health Organization, 2006.

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    The relative stability of family structures, the communal nature of societies in many LMIC contexts and the relative lack of additional benefit to older persons who migrate partly explain the non-migration finding.

    “It is likely that the relative stability of family structures, the communal nature of societies in many LMIC contexts and the relative lack of additional benefit to older persons who migrate partly explain this finding.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    These events may have contributed to increased publications that sought to understand the drivers of HRH migration and intention to migrate.

    “These events may have contributed to the increased publications that sought to understand the drivers of HRH migration and intention to migrate.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Some of these countries struggle with corruption, unemployment, rising xenophobia attacks, and murder targeting migrants and minority groups.

    “Furthermore, some of these countries also struggle with other issues such as corruption, unemployment, rising xenophobia attacks, and murder targeting migrants and minority groups.139 140”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [139] Kumar, 2019, Violent-acts against doctors and healthcare professionals in India: call for action, J Family Med Prim Care source

      Not checked in the free run.

    • cites [140] Njaka, 2020, Work place violence (wpv) against healthcare workers in Africa: a systematic review, Heliyon source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Security and poor working environment were key drivers of migration/intention to migrate reported among HRH from these countries.

    “Thus, it is unsurprising that security and poor working environment were key drivers of migration/intention to migrate reported among HRH from these countries.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Most included studies focused on doctors and nurses, which is unsurprising since these cadres are the largest and disproportionately represented in the health workforce of many countries globally.

    “This review shows that most of the included studies focused on doctors and nurses, which is unsurprising since these cadres are the largest and disproportionately represented in the health workforce of many countries globally.5 6”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [5] Scheffler RCG , Tulenko K , Bruckner T . Health workforce requirements for universal health coverage and the Sustainable Development Goals – Background paper N.1 to the WHO Global Strategy on Human Resources for Health: Workforce 2030. Human Resources for Health Observer Series No 17. Geneva, Switzerland: WHO, 2016.

      Not checked in the free run.

    • cites [6] World Health Organization . Global strategy on human resources for health: Workforce 2030. Geneva, Switzerland: WHO, 2016.

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Our findings are consistent with prior research demonstrating that financial safety needs, opportunities for professional development through training and research, and the desire for improved quality of life for HRH and their families are critical drivers of HRH emigration.

    “Our findings are consistent with prior research demonstrating that financial safety needs, opportunities for professional development through training and research, and the desire for improved quality of life for HRH and their families are critical drivers of HRH emigration.19 141–143”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [19] Davda, 2018, Migration motives and integration of international human resources of health in the United Kingdom: systematic review and meta-synthesis of qualitative studies using framework analysis, Hum Resour Health source

      Not checked in the free run.

    • cites [141] Dohlman, 2019, Global brain drain: how can the maslow theory of motivation improve our understanding of physician migration?, Int J Environ Res Public Health source

      Not checked in the free run.

    • cites [142] Humphries, 2017, The consequences of Ireland’s culture of medical migration, Hum Resour Health source

      Not checked in the free run.

    • cites [143] Clarke, 2017, Factors influencing trainee doctor emigration in a high income country: a mixed methods study, Hum Resour Health source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    This shift coincided with growing global concern about the adverse effects of a chronic global shortage of well-trained HRH.

    “This shift coincided with the growing global concern about the adverse effects of a chronic global shortage of well-trained HRH, which was most acutely felt in the countries that need them most.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Personal issues of advancing age and family ties are not affected by policies aimed at halting HRH emigration from LMICs.

    “Nevertheless, personal issues of advancing age and family ties are not affected by policies aimed at halting HRH emigration from LMICs.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The prospect of a safer environment, opportunities for career advancement and conducive immigration policies with a promise of improved quality of life motivated HRH to leave their home countries.

    “We found that the prospect of a safer environment, opportunities for career advancement and conducive immigration policies with a promise of improved quality of life motivated HRH to leave their home countries.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Remuneration-related issues and future career prospects are critical drivers of HRH emigration or intention to migrate, operating at macro-level and meso-level, respectively.

    “This review identified remuneration-related issues and future career prospects as critical drivers of HRH emigration or intention to migrate, operating at macro-level and meso-level, respectively.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    The health workforce may not be immune from these dangers, so they often leave these countries entirely for their safety.

    “Sadly, as the health workforce may not be immune from these dangers, they often leave these countries entirely for their safety.”
    Quote in the paperNot a substantial claim
29 of 29

  • The paper relies on this without support.

    The 107 included studies are representative of health workers in LMICs.

    “In the end, 107 articles11 29–134 were eligible for the final analysis”

  • The paper relies on this without support.

    The drivers reported in the included studies accurately reflect the actual drivers of health worker migration.

    “Overall, the most common drivers were the macro-level (global and national) and meso-level (professional) factors.”

  • The paper relies on this without support.

    The search strategy and databases captured all relevant studies on HRH migration from LMICs.

    “We systematically searched five electronic databases: Ovid MEDLINE, EMBASE, CINAHL, Global Health and Web of Science.”

  • The paper relies on this without support.

    The English/French language restriction did not bias the findings.

    “published in either English or French between 1 January 1970 and 31 August 2022”

  • The paper relies on this without support.

    The 2020 World Bank classification of LMICs is appropriate for studies spanning 1970–2022.

    “based on the 2020 World Bank classification24”

  • The paper relies on this without support.

    Migration intention is a valid proxy for actual migration when comparing drivers.

    “Overall, the key factors driving migration were similar for HRH who have already migrated and those who plan to migrate”
6 of 6

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Doctor studies cannot all have focused solely on doctors

    Minor

    Calling 64.5% of the 107 studies doctor-only and an additional 54.2% nurse-focused would require more than 107 distinct studies. Some studies must have covered both cadres, as the abstract's "and/or" wording allows.

  • Emigrated-study percentage is overstated

    Minor

    The table reports 49 emigrated studies among 107 included studies, which is 45.8%, not 47.8%.

    Reported 47.8 · recomputed 45.794393

  • Qualitative-study percentage is overstated

    Minor

    The table reports 31 qualitative studies out of 107, which is 29.0%, not 30.0%.

    Reported 30 · recomputed 28.971963

3 of 3

Cites

Flagged first, then by citations

5 of the 130 references couldn’t be matched to a known paper.

Research works printed but not linked: 6

  1. Dovlo D . The brain drain and retention of health professionals in Africa; a case study prepared for a regional training conference on improving tertiary education in sub-Saharan Africa: things that work. Accra 2003.
  2. Imran, 2012, Original article brain drain: a harsh reality. International migration of Pakistani medical graduates, J Postgraduate Med Institute, 26, 67
  3. Bidwell, 2014, Security and skills: the two key issues in health worker migration, Glob Health Action, 7, 10.3402/gha.v7.24194 · DOI
  4. 10.1176/appi.ajp.126.9.1318 · DOI
  5. 10.1186/s12960-015-0093-4 · DOI · Paper page
  6. Aggarwal, 2014, Migratory trends of medical graduates in India, J Pioneering Med Sci, 4, 155

Cited by

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Related

Authors
Toyin-Thomas, P., Ikhurionan, P., Omoyibo, E. E., Iwegim, C., Ukueku, A. O., Okpere, J., Nnawuihe, U. C., Atat, J., Otakhoigbogie, U., Orikpete, E. V., Erhiawarie, F., Gbejewoh, E. O., Odogu, U., Akhirevbulu, I. C. G., Kwarshak, Y. K., & Wariri, O.
Affiliations
  • Dartmouth College (US)
  • University of Benin Teaching Hospital (NG)
  • Department of Paediatrics, Federal Medical Centre, Asaba, Nigeria
  • Fraser Health (CA)
  • University of Port Harcourt Teaching Hospital (NG)
  • Department of Clinical Research, Alpha Research Clinic, Edmonton, Alberta, Canada
  • Department of Clinical Services, Intercountry Centre for Oral Health for Africa, Jos, Nigeria
  • University of Nigeria (NG)
  • University of Port Harcourt (NG)
  • Baylor College of Medicine (US)
  • International Organization for Migration (CH)
  • Lagos University Teaching Hospital (NG)
  • Department of Surgery, Edo Specialist Hospital, Benin City, Nigeria
  • Jos University Teaching Hospital (NG)
  • London School of Hygiene & Tropical Medicine (GB)
Corresponding author
Wariri, Oghenebrume
ORCID
Venue
BMJ Global Health
Publisher
BMJ
Published
2023-05
Volume
8
Issue
5
Pages
e012338
ISSN
2059-7908 (ISSN-L)
DOI
10.1136/bmjgh-2023-012338
PMC
PMC10174016
OpenAlex
W4375955799
Semantic Scholar
ca8562f6c1bc1b81211318be53108fa06bb6eb07
Cited by
160
References
130
Citations by year
2026: 54 · 2025: 56 · 2024: 40 · 2023: 10
FWCI
10.18
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ Global Health (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion, cc-by-nc)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Surgery
  • Social Sciences › Sociology and Political Science › Migration and Labor Dynamics
Keywords
non-migration, low-middle income countries, physicians, nurses, remuneration, career prospects, work environment, job satisfaction, security, migration determinants, healthcare workers
MeSH terms
Developing Countries, Emigration and Immigration, Health Personnel, Humans, Physicians, Intention

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-07.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-07.

Statistics and arithmetic are recomputed, not judged.

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