Department of Primary Care Health Sciences, 2nd Floor, New Radcliffe House, Walton Street, Jericho, Oxford OX2 6NW, UK.
Department of Primary Care Health Sciences, 2nd Floor, New Radcliffe House, Walton Street, Jericho, Oxford OX2 6NW, UK.
Soc Sci Med. 2014 Jan;100:99-106. doi: 10.1016/j.socscimed.2013.10.032. Epub 2013 Nov 8.
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.
非洲的医疗工作者外流导致本已面临严重人员短缺和巨大疾病负担的国家更加匮乏人手。世界卫生组织谴责高收入国家招募这些人。然而，了解医疗工作者外流的原因至关重要，因为这有助于尝试改变移民决策。我们旨在系统地分析影响非洲医疗工作者移民的因素。我们系统地检索了 CINAHL（1980 年-2010 年 11 月）、Embase（1980 年-2010 年 11 月）、Global Health（1973 年-2010 年 11 月）和 Medline（1950 年-2010 年 11 月），以查找专门探讨移民问题的非洲医疗工作者的定性研究。两名评审员确定文章、提取数据并评估纳入研究的质量。元人种学用于从数据中综合出新的思路和意义。检索共确定了 1203 篇文章，其中纳入了来自七个非洲国家的 6 项医疗工作者研究，分别为医生或医学生（两项研究）、护士（三项）和药剂学生（一项研究）。通过元人种学综合，我们产生了与医疗工作者移民决策相关的 6 条论点：1）努力实现自我、家庭和社会未满足的物质期望；2）工作场所中的紧张和情绪、人际不和以及不安全；3）工作场所内外对个人或家庭安全的恐惧；4）缺乏足够的专业支持和发展；5）对专业声誉和尊重的渴望；6）坚信海外的未来希望和目标将会实现。我们得出结论，各种因素的复杂相互作用导致了非洲医疗工作者的移民决策。一些确定的因素比其他因素更易于改变，解决这些因素可能会显著影响未来非洲医疗工作者的移民决策。
