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To ensure adequacy and efficiency in the health sector as recommended by the World Health Organization, governments of low-income countries should put measures in place to make medical practice in their countries more attractive to young doctors. Such measures include improved remuneration for services rendered and incorporation of more modern technology into the health care delivery system. Human resources for health remain a vital element of the healthcare system as the quality of health care services depends largely on the performance of skilled manpower [ 1 ].

The availability of skilled manpower at service locations is critical for effective health care system delivery in developing countries and is an important indicator of the strength of the healthcare system [ 2 - 4 ].

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Among the six regions of the WHO, Africa ranks the least with regard to the physician to population ratio of 2. According to the Medical and Dental Council of Nigeria, Nigeria, being the most populous African country, has about 72, registered medical doctors with only approximately 35, in practice within its shores [ 8 , 9 ]. The ratio of doctors per population in Nigeria is critically below the recommended standard at 4 per 10, population and emigration further places additional strain on the available workforce thereby compounding the already compromised health care deficiency in this region as this number is not sufficient to meet the significant health needs of the people [ 10 , 11 ].

The emigration of doctors reported in Africa over the years has tremendously increased in recent times [ 12 , 13 ].

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This steady emigration from the developing to developed settings has deleterious effects on both the health and economic sectors of these countries [ 12 - 14 ]. The health sector in this low-income region has registered a great setback in their health indices following a severe shortage of manpower [ 12 , 15 ]. Medical education around the globe is not cheap. Resources are lost after doctors trained by the government with tax-payers money in these low-income regions migrate to high-income regions without making a significant difference to health in their countries [ 5 , 12 , 13 ].

Though this emigration is not new, the current trend seems to be alarming. The poor economic situation in Nigeria has made the decisions to pursue better opportunities in developed countries [ 16 ]. Between and in Nigeria, about Using this projection, about 36, doctors would have migrated from the country from to The results of a survey on international medical graduates revealed that a total of US-based had their medical college in the SSA with Nigeria as the leading country [ 12 ].

In , Nigeria's polling agency, NOI Polls, in partnership with Nigerian Health Watch through an online survey revealed that about 9 out of 10 medical doctors in Nigeria were seeking work opportunities abroad [ 9 ]. This exodus widens the gap between demand and supply of health services available in this resource-deprived setting since the government is the main healthcare service provider in the country [ 12 ]. This further incapacitates health care delivery services in Nigeria.

Among factors influencing this migration, there is the push and pull theory of migration [ 17 , 18 ]. Push factors are the local components which deter the individual in his locality while the pull factors are the attractants in the developed settings.

Poor workers' motivation and perceived job risks are some of the push factors cited in some studies, while the pursuit of a better standard of living and better working conditions was among the pull factors recorded [ 16 , 18 ]. The objective of this study was to assess the willingness of clinical medical students to practice in Nigeria after their studies and identify associated factors.

Findings will provide possible directions for further research aimed at strengthening the healthcare system in order to avert brain-drain and improve retention of doctors. This study was conducted in Enugu, a southeastern state of Nigeria. It has a landmass of 7,km 2, with a population of 3,, based on the last national census in [ 19 ]. Enugu state has 17 local government councils [ 20 ].

The indigenes are predominantly Christians and are Igbo speaking. The state generally has about 4 doctors per 10, population [ 21 ]. It has four government tertiary institutions, including two medical students undergraduate teaching hospitals, and in which Enugu State University Teaching Hospital Parklane is also inclusive. The sample size was proportionally allocated to the classes. The total number of students in the clinical classes in August was and this was used as the sampling frame for the study.

The systematic sampling technique was used to select the study participants.

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The questionnaires were distributed in their classes during free lecture periods. Data were collected over 2 weeks using a pre-tested self-administered questionnaire. Though the Igbo language is the predominant language of the people in this region, the instruments were provided in English as the English language is the medium of instruction in all institutions of learning in Nigeria. The questionnaire was organized into sections; socio-demographics, willingness to practice in Nigeria and factors associated with willingness to practice in Nigeria.

Copies of the self-administered questionnaires were distributed and collected immediately.

Permission was obtained from the school authority. Written informed consents, giving a detailed account of the study objectives were obtained from the participants.

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Participation was voluntary and confidentiality was guaranteed by non- identification of individual questionnaires. Data entry and analysis were performed using Statistical Package for Social Sciences version 22 software. Descriptive statistics were used for data summarization and presentation. Table 1 illustrates the socio-demographic details of the respondents with a mean age of The majority of respondents in this study were males The highest number of respondents was L, with a proportion of The majority of the participants had their family footing their academic bills Table 2 shows the willingness to practice medicine in Nigeria, with about Among people that intend to leave, the USA Advanced technology Table 3 outlines the factors which influence willingness to practice in Nigeria; the respondents between the ages of Respondents whose families lived in urban areas were more willing to practice in Nigeria than those who lived in rural areas and this was found not to be statistically significant.

The mean age of respondents in this study was Another study in Egypt, North Africa, among medical students, showed a similar mean age of This similarity depicts the usual average age of students in medical schools. This may not be unrelated to the high unemployment rate, the heightened spate of insecurity and increasing poverty reported in Nigeria over time [ 16 ]. The similarity can be attributed to the common push factors found among medical practitioners in low-income countries [ 18 ].

This could be explained by the fact that this Pakistani study may have been conducted among students with probable zeal to serve their country, or the emotional attachment to friends and family, and possible bad experiences with recurring visa denials into the USA and other developed countries [ 29 ].

Similarly, religious and cultural values could have been a deterring factor. Among the countries of intended migration, the USA, Canada and the United Kingdom were distinctively the top choices of the participants of this study. This has also been reported in other studies where these countries topped the choice of practice for medical undergraduates after studies in their home country [ 9 , 29 ].

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The choice for these countries is probably due to pull factors such as better standard of living, opportunities, facilities and remuneration, among other factors [ 29 ]. Unlike European and American countries, the desire to migrate to Asia 0. This is consistent with findings from a report by the International Organization for Migration, where a diminished number of Nigerians, professionals inclusive, migrate to less developed regions of Africa and Asia [ 16 ].

This is attributed to the deteriorating economic realities, security and social disturbance in these countries. Though not statistically significant, there was a significant difference between the male and female gender that intended to emigrate, with the males This was also the case in a similar study in Nigeria, which showed more males intending to migrate to the developed countries more than females [ 16 ].

However, a variation was seen in Botswana, where there was an equal number of males and females with regard to emigration abroad [ 26 ]. This is probably because Respondents whose families reside in urban areas have more desire to practice in Nigeria than their counterparts residing in rural areas. This is also reflected in the location of their secondary schools as a greater number of respondents who schooled in urban areas desired to practice in Nigeria. The National Demographic and Health Survey reported that adult literacy level and access to media are higher in the urban than the rural areas [ 30 ].

There is a higher chance of those in the urban area of higher socioeconomic status than the rural residents; hence they may not be desirous to go through the rigorous examinations and re-certification exercises required in the western countries before they can practice. Moreover, those people whose families reside in rural areas could be desirous to have their lives and living conditions likened to those of their colleagues residing in the cities.

This is however, contrary to findings from other studies. A study about emigration conducted in Nigeria shows that people who reside in urban cities are more likely to be attracted by the economic opportunities of the developed world [ 16 ]. A systematic review of literature shows that growing up in rural areas has a great influence on the desire to practice in local settings [ 31 ]. Similarly, findings from an Iranian study reported that experience of residing in rural areas, in addition to poor parental education and professional network, could be associated with the reduced desire to practice in more sophisticated regions [ 28 ].

It is surprising to note that respondents who are sponsored by their families are more willing to practice in Nigeria than outside its shores. Contrary to this, in a similar Nigerian study, individuals who are dependent on their families in terms of finance and other welfare benefits have more migratory tendency [ 16 ]. Among the reasons cited for emigration, advanced technology, better learning opportunities and better remuneration have been cited as the most prevalent.

This low satisfaction resulted from the unavailability of equipment and medical supplies necessary for the management of patients, which in some cases could result in the death of these patients [ 9 ]. Better opportunities were also cited as a reason for emigration in this study. The dearth of job opportunities in the country has resorted to doctors paying for employment in some instances [ 9 ]. The majority of respondents in the survey are convinced that the government has no commitment to mitigating the challenges facing the health sector in its nation [ 9 ].

Addressing these challenges, more will change the perception of medical doctors towards emigration.

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This population growth will directly translate to an increase in the demand for healthcare in the country. If this gap is not closed, the number of doctors remaining left to practice in Nigeria will continue to decrease, resulting in the country having worse health outcome indices than currently reported. This study was conducted to assess the willingness of medical undergraduates to practice in Nigeria and some of the factors that influence this decision. The significantly higher proportion of medical students desirous to leave the shores of Nigeria after their studies is worrisome, with the United States of America and Europe coming on the top of the list of desired destinations.

From this study, it is obvious that this trend is still blooming and it poses a threat to the health sector in Nigeria. Given the poor health indices and the low doctor to population ratio, continued doctor emigration will produce even more worrisome health statistics. The urgent need for a reversal is recommended to prevent further deterioration of the economy. The government should put measures in place to make medical practice in their countries more attractive to young doctors.

Such measures should include improved remuneration, upgrade to modern hospital equipment and facilities, improved working conditions and increased funding of the healthcare system. Written informed consents, giving a detailed account of the study objectives, were obtained from the participants.

The data will be available and can be assessed at the Community Medicine departmental library of the institution. The questionnaires will, however, be destroyed seven years from the publication date.

We sincerely appreciate everyone who has in one way or the other contributed immensely to the success of this study, especially the students who participated, the administrative officers of both the ESUTH-P and that of ESUCOM, will be blessed beyond measures. Introduction: We are researchers from Community medicine department, Enugu state University Teaching hospital. Voluntary nature of participation: Participation in this project is completely voluntary. Thus, though you have been selected, you are free to participate in the programme or to decide otherwise.

Confidentiality: Information obtained from you will be treated as confidential and will not be used against you in any way. In addition, the data analysis and presentation from this study will be aggregate and will not in any way reveal your identity. I have read and understood the above or someone has read and explained to me and hereby consent to take part in it. Search Advanced Search. Toggle navigation.

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