Drivers of return migration of Ghanaian health professionals: perspectives from doctors and nurses in urban Ghana

Drivers of Global Health Care Worker Migration

The migration of health care workers on a global scale has emerged as a complex and critical issue, profoundly affecting the dynamics of health care systems worldwide. The authors delve into the multifaceted drivers behind the unprecedented migration of health care professionals, seeking to illuminate the interconnected factors that propel this phenomenon. The investigation encompasses economic, social, and professional dimensions, acknowledging the intricate interplay of factors influencing the decision of health care professionals to migrate. Economic disparities, inadequate working conditions, and limited career advancement opportunities in home countries are examined as primary push factors, while attractive employment prospects, higher remuneration, and improved quality of life in destination countries are explored as compelling pull factors. This study contributes to a deeper understanding of the intricate web of factors influencing global health care worker migration, providing insights that can inform evidence-based policies, strategic workforce planning, and international collaborations aimed at addressing the challenges posed by this phenomenon.

Experiences of Healthcare Worker Returnees in Their Home Countries: A Scoping Review

BACKGROUND

International migration of healthcare workers is a global phenomenon driven by growing demand in developed countries and expectations of healthcare workers from developing countries to have improved employment and lives. This migration has been understood to impact both the individuals and countries involved, with positive and negative consequences. However, little is known about returnees' experiences that could be used to address challenges and optimize benefits. The aim of this review was to understand what is known about experiences of migrant health workers after returning to their home countries.

METHODS

A scoping review of primary research addressing experiences of migrant health workers upon their return to their homelands. A range of database were searched including Career and Technical Education Database via ProQuest, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education database via ProQuest, Excerpta Medica Care (EMCare) via Ovid, Education Resources Information Center (ERIC), Excerpta Medica database (EMBASE) via Ovid, MEDLINE and Scopus. A systematic process was performed guided by the work of Arksey and O'Malley. Eight databases were searched and 226 articles were retrieved. After screening articles and abstracts, 15 full-texts were assessed for eligibility, and finally seven studies were further analyzed and synthesized.

RESULTS

Five qualitative studies, one quantitative study and one mixed methods study met inclusion criteria. Five themes emerged: (1) reasons to return, (2) upskilling and deskilling, (3) impact on human, financial, and social capital, (4) challenges and opportunities in the home country, and (5) facilitation supports.

CONCLUSION

Return migration is portrayed as a complex situation experienced by returnees. Structured policy and supports are required to help healthcare worker returnees prepare, and to adjust to life after their return. This study highlights the importance of comprehensive approach in return migration stage. Return migration policy should support healthcare worker returnees in their home country and facilitate utilization of their skills. Multi-stakeholder partnerships are vital to develop platforms for helping and facilitating returnees in the reintegration process at their home countries.

South African physician emigration and return migration, 1991-2017: a trend analysis

Although critical for understanding health labour market trends in low- and middle-income countries (LMICs), longitudinal LMIC health worker emigration and return migration trends are not routinely documented. This article seeks to better understand SA's trends in physician emigration and return migration and whether economic growth and related policies affect migration patterns. This study used physician registry data to analyse patterns of emigration and return migration only among SA-trained physicians registered to practice in top destination countries such as Australia, Canada, New Zealand, the USA or the UK between 1991 and 2017, which represent the top five emigration destinations for this group. A linear regression model analysed the relationship between migration trends (as dependent variables) and SA's economic growth, health financing and HIV prevalence (as independent variables). There has been a 6-fold decline in emigration rates from SA between 1991 and 2017 (from 1.8% to 0.3%/year), with declines in emigration to all five destination countries. About one in three (31.8% or 5095) SA physicians returned from destination countries as of 2017. Annual physician emigration fell by 0.16% for every $100 rise in SA GDP per capita (2011 international dollars) (95% confidence interval -0.60% to -0.086%). As of 2017, 21.6% (11 224) of all SA physicians had active registration in destination nations, down from a peak of 33.5% (16 366) in 2005, a decline largely due to return migration. Changes to the UK's licensing regulations likely affected migration patterns while the Global Code of Practice on International Recruitment contributed little to changes. A country's economic growth might influence physician emigration, with significant contribution from health workforce policy interventions. Return migration monitoring should be incorporated into health workforce planning.

A deskilling and challenging journey: the lived experience of Indonesian nurse returnees

AIM

To illuminate the lived experiences of Indonesian nurses who previously worked as caregivers in Japanese residential care facilities, by exploring the journey of becoming returnees.

BACKGROUND

The creation of bilateral agreements between Indonesia and Japan has facilitated the movement of Indonesian nurses to work as caregivers in Japan since 2008. While this decision raised concerns with regard to the degradation of nursing skills, little is known about this issue from the perspective of nurse returnees and how the experience affects their life.

METHOD

A hermeneutic phenomenological method was employed for this study. A purposive sample of 15 Indonesian nurse returnees participated in this study. Semi-structured interviews were conducted in four of Indonesia's provinces between August and October 2015. Data were analysed thematically, supported by QSR NVIVO 10 software.

FINDINGS

Four key themes emerged from the data analysis: (i) returning home; (ii) going back to zero; (iii) walking through a difficult journey; and (iv) overcoming barriers. These findings described the lived experiences of nurse returnees when they got back to the country of origin.

CONCLUSION

Indonesian nurse returnees experienced deskilling and struggled to re-enter the nursing profession or to find other non-nursing jobs. The significant impact of this migration on individual nurses with regard to maximizing the benefits of return migration deserves further investigation.

IMPLICATION FOR NURSING AND HEALTH POLICY

The Indonesian government, jointly with other stakeholders, should develop a brain gain strategy to align returnees' expertise with the needs of the national labour market. The public-private partnership should be strengthened to utilize returnees in healthcare services.