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了解迁徙：一项对尼日利亚医生和牙医移民模式及决定因素的 15 年回顾性队列研究。

Understanding the exodus: a 15-year retrospective cohort study on the pattern and determinants of migration among Nigerian doctors and dentists.

机构信息

Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.

Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia.

出版信息

Glob Health Action. 2024 Dec 31;17(1):2432754. doi: 10.1080/16549716.2024.2432754. Epub 2024 Nov 29.

DOI:10.1080/16549716.2024.2432754
PMID:39611329
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11610232/
Abstract

BACKGROUND

Nigeria faces a critical shortage of healthcare professionals yet experiences a significant annual exodus of doctors and dentists. This alarming trend threatens the country's ability to provide equitable healthcare.

OBJECTIVE

This study investigated the patterns and determinants of migration among doctors and dentists who graduated from the University of Benin, Nigeria, 15 years ago.

METHODS

We conducted a retrospective cohort study that tracked 274 of the 379 (72.3%) eligible cohort. We computed the migration incidence rate per person-year from 2008 to 2023, covering 3,455 person-years of follow-up and analysed migration drivers as push and pull factors across macro-, meso-, and micro-levels.

RESULTS

Fifteen years post-graduation, 48.9% (134/274) of the cohort had migrated. While the annual incidence rate of migration remained stable for the first 8 years, it spiked after 2016, reaching 11.4 per 100 person-years in 2023. Among those who migrated, the majority (96.3%, 129/134) relocated outside the African continent. The top three destination countries were the UK (48.5%, 65/134), Canada (20.9%, 28/134), and the USA (19.4%, 26/134). The leading push factors were insecurity of lives and property (57.8%), concerns about children's futures (50.3%), and limited career development opportunities (45.9%). The primary pull factors included security (56.3%), permanent residency (49.6%), and better pay in the destination country (46.7%). Significant predictors of migration included younger age, timing of marriage, and residency training status.

CONCLUSIONS

To avert an impending crisis, the Nigerian government must address the root causes driving the increasing migration of doctors and dentists.

摘要

背景

尼日利亚面临着医疗保健专业人员严重短缺的问题，但每年仍有大量医生和牙医流失。这种令人担忧的趋势威胁到该国提供公平医疗保健的能力。

目的

本研究调查了 15 年前毕业于尼日利亚贝宁大学的医生和牙医的移民模式和决定因素。

方法

我们进行了一项回顾性队列研究，跟踪了 379 名符合条件的队列中的 274 名（72.3%）。我们计算了 2008 年至 2023 年期间每人每年的移民发生率，共随访 3455 人年，并分析了宏观、中观和微观层面的移民驱动因素，包括推动因素和拉动因素。

结果

毕业后 15 年，274 名队列中有 48.9%（134/274）移民。虽然前 8 年的移民年发生率保持稳定，但在 2016 年后急剧上升，2023 年达到每 100 人年 11.4 人。在移民中，大多数（96.3%，129/134）迁移到非洲大陆以外。前三个目的地国家是英国（48.5%，65/134）、加拿大（20.9%，28/134）和美国（19.4%，26/134）。主要的推动因素是生命和财产安全无保障（57.8%）、对子女未来的担忧（50.3%）和职业发展机会有限（45.9%）。主要的拉动因素包括安全（56.3%）、永久居留权（49.6%）和目的地国家的更高薪酬（46.7%）。移民的显著预测因素包括年龄较小、结婚时间和居住培训状况。

结论

为了避免即将到来的危机，尼日利亚政府必须解决导致医生和牙医移民不断增加的根本原因。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0362/11610232/3a365c3a6359/ZGHA_A_2432754_F0005_OC.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0362/11610232/2ecbe5d98abf/ZGHA_A_2432754_F0001_B.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0362/11610232/04458375fc8a/ZGHA_A_2432754_F0002_OC.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0362/11610232/bda80045b4f9/ZGHA_A_2432754_F0003_OC.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0362/11610232/060a09bd04d1/ZGHA_A_2432754_F0004_OC.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0362/11610232/3a365c3a6359/ZGHA_A_2432754_F0005_OC.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0362/11610232/2ecbe5d98abf/ZGHA_A_2432754_F0001_B.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0362/11610232/04458375fc8a/ZGHA_A_2432754_F0002_OC.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0362/11610232/bda80045b4f9/ZGHA_A_2432754_F0003_OC.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0362/11610232/060a09bd04d1/ZGHA_A_2432754_F0004_OC.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0362/11610232/3a365c3a6359/ZGHA_A_2432754_F0005_OC.jpg

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本文引用的文献

1
Nigeria's new policy: solution for the health-care workforce crisis?尼日利亚的新政策：解决医疗劳动力危机的办法？
Lancet. 2024 Oct 5;404(10460):1303-1304. doi: 10.1016/S0140-6736(24)01766-5.
2
Market making and the production of nurses for export: a case study of India-UK health worker migration.做市和护士出口生产：以印英卫生工作者迁移为例。
BMJ Glob Health. 2024 Feb 28;9(2):e014096. doi: 10.1136/bmjgh-2023-014096.
3
Addressing Nigeria's proposed bill on the emigration of doctors.论尼日利亚关于医生移民的拟议法案
Lancet. 2024 Feb 3;403(10425):435. doi: 10.1016/S0140-6736(23)01559-3.
4
The negative impact of global health worker migration, and how it can be addressed.全球卫生工作者迁移的负面影响，以及如何解决这些问题。
Public Health. 2023 Dec;225:254-257. doi: 10.1016/j.puhe.2023.09.014. Epub 2023 Nov 8.
5
Drivers of health workers' migration, intention to migrate and non-migration from low/middle-income countries, 1970-2022: a systematic review.1970-2022 年，低/中收入国家卫生工作者移民、移民意向和非移民的驱动因素：系统评价。
BMJ Glob Health. 2023 May;8(5). doi: 10.1136/bmjgh-2023-012338.
6
Physician emigration from Nigeria and the associated factors: the implications to safeguarding the Nigeria health system.尼日利亚医生移民及其相关因素：对保障尼日利亚卫生系统的影响。
Hum Resour Health. 2022 Dec 20;20(1):85. doi: 10.1186/s12960-022-00788-z.
7
The Lancet Nigeria Commission: investing in health and the future of the nation.《柳叶刀》尼日利亚委员会：投资健康与国家的未来。
Lancet. 2022 Mar 19;399(10330):1155-1200. doi: 10.1016/S0140-6736(21)02488-0. Epub 2022 Mar 15.
8
Profile and determinants of intention to migrate by early career doctors in Nigeria: A report from CHARTING study.尼日利亚早期职业医生的移民意向概况及决定因素：CHARTING研究报告
Int J Health Plann Manage. 2022 May;37(3):1512-1525. doi: 10.1002/hpm.3422. Epub 2022 Jan 20.
9
"What Are You Really Doing in This Country?": Emigration Intentions of Nigerian Doctors and Their Policy Implications for Human Resource for Health Management.“你在这个国家究竟在做什么？”：尼日利亚医生的移民意向及其对卫生人力资源管理的政策影响
J Int Migr Integr. 2022;23(3):1377-1396. doi: 10.1007/s12134-021-00898-y. Epub 2021 Sep 15.
10
"If you are on duty, you may be afraid to come out to attend to a person": fear of crime and security challenges in maternal acute care in Nigeria from a realist perspective.“如果你值班，你可能害怕出来照顾病人”：从现实主义的角度看尼日利亚产妇急症护理中的犯罪和安全挑战。
BMC Health Serv Res. 2020 Sep 29;20(1):903. doi: 10.1186/s12913-020-05747-9.