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Brain drain in neurosurgery: migration intentions and retention determinants in the Tanzanian neurosurgical workforce
Francisco Rivera1, Chibueze I Agwu1, April Mabie2
1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America; Barrow Global, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America.
Background:
Sub-Saharan Africa carries a disproportionate burden of neurosurgical disease amid a severe neurosurgical workforce shortage. Tanzania has achieved high retention of neurosurgical graduates; however, increasing dissatisfaction among early-career neurosurgeons raises concerns about long-term workforce sustainability. Migration intention is a sensitive early indicator of "brain drain" but remains understudied in this context.
Methods:
A national cross-sectional mixed-methods survey was conducted of practicing neurosurgeons, fellows, and residents in Tanzania. The survey evaluated demographics, practice characteristics, migration intentions, retention factors, and proposed system-level interventions. Quantitative data were analyzed descriptively, and qualitative responses underwent thematic analysis.
Results:
Twenty-six of 40 (65%) eligible participants responded. Most neurosurgeons (17 of 26; 65%) intended to remain in Tanzania. For those who were actively considering migration, financial pressure was the predominant driver (7 of 9; 78%), followed by work-related and academic constraints. Sixteen respondents earned ≤ 5 million TZS (US $1890) monthly, and only 4 of 26 (15%) reported satisfaction with their income. Retention was primarily influenced by personal, financial, and sociocultural factors. Over 80% (21 of 26; 81%) of participants identified the need for systemic reforms, prioritizing salary restructuring, improved work environments, expanded subspecialty training, and increased healthcare investment.
Conclusions:
Despite Tanzania having one of the highest regional retentions of neurosurgical trainees, a substantial proportion of the Tanzanian neurosurgeons surveyed were considering migration due to modifiable economic and structural factors. Targeted financial, training, and infrastructure reforms are critical to sustaining the neurosurgical workforce and reducing future migration risk in Tanzania and similar low- and middle-income settings.
