Social and structural factors affecting the culture of medical migration in Nigeria: insights from four public medical schools
Background: The loss of doctors from low income countries through migration is a major concern. In Nigeria, one of several ’push’ factors implicated in the migration of doctors is a ‘culture of migration’ prevalent in medical schools. This culture has policy implications; retention schemes and policies are less likely to be effective if the targets of such schemes are being prepared for export during their medical school training. Little is known about the drivers of a ‘culture of migration’ in Nigeria and their influence on the aspirations of medical students to emigrate after graduation. Aim and Objectives: The aim of the thesis is to define and assess the scope of a ‘culture of migration’ in Nigerian medical schools. Objectives are: (1) To examine attitudes and intentions to migrate among medical students in Nigerian medical schools (2) To examine medical education in Nigeria and its influence on medical students’ aspirations to migrate after graduation, (3) To understand the influence of social networks on medical students’ aspirations and intentions to migrate after graduation in Nigeria. Methods: A two-phased mixed methods design was employed. In the first phase of the study, a structured questionnaire survey was conducted to assess the defining features and extent of a ‘culture of migration’ in four medical schools in Nigeria. In the second phase, a flexible, embedded multiple case study of two schools was employed to explore in-depth the reasons and the mechanisms through which a ‘culture of migration’ is propagated. Results: 211 out of a total of 580 final year students in six medical schools participated in the survey, aged between 20 and 45 years. Almost two-thirds (63.5%) of respondents had positive views on medical migration, while close to half (41.7%) showed a positive aspiration to migrate after graduation. Respondents’ ‘views on migration’, ‘gender’, and ‘family migration history’ were found to be the predictors of respondents’ aspirations to migrate after graduation. This study found evidence of factors characteristic of the existence of a culture of migration in the medical schools studied: a long history of migration, positive attitudes towards migration, and high aspirations to migrate. However, the strength of this evidence varies across the schools depending on the availability of support structures for migration; one school showed compelling evidence, another showed little, while the other two showed characteristics that were between those two extremes. Students’ dissatisfaction with the general situation in Nigeria, and a dysfunctional medical education system, leaves them feeling inadequate, and in need of further training abroad. These aspirations are furthered by students’ day-to-day interactions with the medical school faculty, and by the backing they receive from social institutions. Students and young medical graduates prepare for their migration projects by taking advantage of the support provided by their family, social networks, and support of their training institutions. Discussion/Conclusion: Medical students and medical graduates will continue to migrate from Nigeria because the culture in their training institutions encourages them to do so; the stronger the institutional support for migration the stronger the evidence of a culture of migration. Retention schemes aimed at keeping doctors in Nigeria must therefore include concerted efforts to change the institutional support for migration and the resulting ’culture of migration’. This will require policies that introduce exit requirements for medical school graduates, as well as improvements in funding for both medical education and the healthcare systems and revamping of the national social infrastructure in Nigeria. Better training facilities, better treatment of resident doctors, and greater availability of residency training places might encourage medical students and graduates to consider a professional future in Nigeria.