Exploring the migration decisions of health workers and trainees from Africa: a meta-ethnographic synthesis

The migration of healthcare workers from Africa depletes countries already suffering from substantial staffing shortages and considerable disease burdens. The recruitment of such individuals by high income countries has been condemned by the World Health Organisation. However, understanding the reasons why healthcare workers migrate is essential, in order to attempt to alter migration decisions. We aimed to systematically analyse factors influencing healthcare workers' decisions to migrate from Africa. We systematically searched CINAHL (1980-Nov 2010), Embase (1980-Nov 2010), Global Health (1973-Nov 2010) and Medline (1950-Nov 2010) for qualitative studies of healthcare workers from Africa which specifically explored views about migration. Two reviewers identified articles, extracted data and assessed quality of included studies. Meta-ethnography was used to synthesise new lines of understanding and meaning from the data. The search identified 1203 articles from which we included six studies of healthcare workers trained in seven African countries, namely doctors or medical students (two studies), nurses (three), and pharmacy students (one study). Using meta-ethnographic synthesis we produced six lines of argument relating to the migration decisions of healthcare workers: 1) Struggle to realise unmet material expectations of self, family and society, 2) Strain and emotion, interpersonal discord, and insecurity in workplace, 3) Fear from threats to personal or family safety, in and out of workplace, 4) Absence of adequate professional support and development, 5) Desire for professional prestige and respect, 6) Conviction that hopes and goals for the future will be fulfilled overseas. We conclude that a complex interaction of factors contribute to the migration decisions of healthcare workers from Africa. Some of the factors identified are more amenable to change than others, and addressing these may significantly affect migration decisions of African healthcare workers in the future.