Retaining nurses in Sub-Saharan Africa: A systematic review and meta-analysis

This study aimed to determine the current prevalence of nurse retention in Sub-Saharan Africa (SSA), evaluate the strategies and interventions in SSA countries used to retain their nurses, and identify the key challenges impeding nurse retention.

A systematic review and meta-analysis were conducted. An electronic search was performed in August 2024 across multiple databases, including PubMed, Ovid Medline, Embase, CINAHL, Scopus, and grey literature sources. The studies were screened using Covidence, and quality assessments were conducted using the Mixed Methods Appraisal Tool.

A total of 31 articles were included in the review. Meta-analysis revealed that the pooled nurses' retention rate in SSA was 53 % (95 %CI: 38 %-67 %; I ² = 97 %), while the pooled intention to stay (ITS) rate at work was 57 % (95 %CI: 43 %-71 %; I ² = 99 %). Subgroup analysis by region showed that the ITS rate was highest in East Africa (65 %), followed by West Africa (63 %), and lowest in Southern Africa (35 %). Effective retention strategies included financial and non-financial incentives, increased production and training of nurses, steering students to shortage specialties, adequate rural housing, facility level improvements, availability of career and professional progression opportunities, nurses' recognition and involvement, employment terms, transparency and predictable management of human resources, supportive work environments, leadership, religious factors, and stakeholders' collaborations. Key challenges to nurses' retention include inadequate healthcare funding, governance issues, poor remuneration and working conditions, political interference, high unemployment rates, ineffective mobility management, unregulated international migration, and active recruitment by wealthier nations.

Nurse retention in SSA remains critically low. Interventions should be formulated for the above-mentioned effective improvement strategies to address these systemic challenges in order to retain nurses in SSA.