Scope of health worker migration governance and its impact on emigration intentions among skilled health workers in Nigeria

Abstract

The growing trends for skilled health worker (SHW) migration in Nigeria has led to increased concerns about achieving universal health coverage in the country. While a lot is known about drivers of SHW migration, including national/sub-national government’s inability to address them, not enough is known about its governance. Underpinning good governance systems is a commitment to human rights norms, that is, principles that enshrine non-discrimination, participation, accountability, and transparency. Hence, this study was aimed at deriving a conceptual framework that captures the scope of SHW migration governance in Nigeria and the extent to which it is human rights based. To describe the scope of SHW migration governance, we conducted an exploratory factor analysis and mapped our findings to themes derived from a qualitative analysis. We also did a multivariate analysis, examining how governance items are related to migration intentions of SHWs. The scope of SHW migration governance in Nigeria can be described across three levels: Constitutional—where policies about the economy and the health workforce are made and often poorly implemented; Collective—which responds to the governance vacuum at the constitutional level by promoting SHW migration or trying to mitigate its impact; Operational—individual SHWs who navigate the tension between the right to health, their right to fair remuneration, living/working conditions, and free movement. Examining these levels revealed opportunities for collaboration through stronger commitment to human right norms. In recognising their role as rights holders and duty bearers at various levels, citizens, health advocates, health workers, community groups and policy makers can work collaboratively towards addressing factors related to SHW migration. Further evidence is needed on how human rights norms can play a visible role in Nigeria’s governance system for SHW migration.

Promoting equitable health workforce distribution through improved migration governance: A mixed methods study of African health professionals' perceptions in Australia

“…Next, the lead author conducted a line‐by‐line, mixed deductive‐inductive coding of each transcript in NVivo 12 50 . For the deductive coding approach, we adapted a codebook used in a similar study which examined the scope of SHW migration governance in Nigeria 19 . The code book was based on a relational view of governance 13 and provided guidance for highlighting relevant rules related to migration drivers, migration oversight and health service access.…”

“…An institutional approach to governance provides a holistic framework for studying SHW migration by specifying what types of rules exist (formal and informal), and at what levels of influence within a country these rules are made, changed, monitored, and enforced 19 . In this study, we considered three levels of influence on SHW migration.…”

“…KY adapted a survey tool used in a similar study that elicited SHW's perceptions about the scope of migration governance in Nigeria. 19 The adapted survey tool had a list of 51 items representing key strategies employed by constitutional, collective and operational level-actors, including those that reflect the right to health and SHW's rights as migrants (see Supporting Information S1). One item elicited information about participant's return migration intentions.…”

“…Because migration involves sovereign states, formal rules and processes dictate what actions or outcomes are legally compatible with a country's interests, and thus determine the scope of its migration governance 8 . It is also important to understand how non‐state actors (e.g., citizen groups, civil society organisations) influence the supply and demand for SHWs, particularly in LMICs where formal organisational structures that provide policies, regulations, health services, and interventions are weak 13,17–19 . In this study we adopted an institutional approach to SHW migration governance, one that considers both the formal and informal roles of state and non‐state actors in determining what actions or outcomes are required or forbidden regarding SHW migration within a country 13 …”

“…An institutional approach to governance provides a holistic framework for studying SHW migration by specifying what types of rules exist (formal and informal), and at what levels of influence within a country these rules are made, changed, monitored, and enforced. 19 In this study, we considered three levels of influence on SHW migration. These are constitutional (where state actors make formal rules related to SHW migration), operational (SHWs who are the primary target of rules made by state actors), and collective (groups of stakeholders who do not have political appointments but can interact with actors at the constitutional and operational levels).…”