臺灣博碩士論文加值系統

Background: The West African health sector is characterized by a human resource base lacking in numbers and specialized skills. Among the factors contributing to this lack of human resource for health include the migration of health professionals to rich countries. This study aims to explore some of the factors associated with migration of West African health professionals.
Methods: An online cross-sectional survey and in-depth interviews of 118 health professionals who participated in the Young Professional Internship Program (YPIP) of the West African Health Organization (WAHO) from (2005-2013), was conducted. The survey and in-depth interviews inquired about their work preference, characteristics of their work experience, migration intentions, and the factors predicting their decisions to migrate.
Results: Of the 118 health professionals, 100 responded to the online survey. The overwhelming majority (61%) indicated that they prefer to be posted in urban areas in their countries as opposed to (25%) who reported that their preference is to be posted in rural areas and (14%) who indicated semi-urban areas as their choice of posting. The overwhelmingly most important reason for their motivation to stay and work in their countries includes giving health professionals opportunities for career development (96%), which has also exerted the greatest influence on their intentions to migrate (93%), followed by desire to find a suitable job match (90%). The role of social capital and network was also noticeable in their characteristics of work experience. About (46%) reported that their first job position after they have graduated from the Young Professional Internship Program (YPIP) was obtained through informal channels such as family members, acquaintances or co-workers. The highest level of satisfaction expressed in their current job position were with their work itself (82%) and the significance of their task (80%), followed by collegial relations (77%) and the level of supervision they receive from their supervisors (74%). In only two categories was there less satisfaction: that is, with their pay (55%) and future prospects (61%). These two categories were also less favored by the larger majority in the qualitative findings. Multiple regression analysis shows that variables such as gender, marital status, working hours, previous job tenure, and country of previous job tenure and source of job information are all significant predictors in their decisions to migrate (p < 0.05).
Conclusions: This study has provided some understanding of some of the factors associated with migration of West African health professionals. The findings could be used by policymakers in health workforce planning and in modifying the migration pattern of health professionals in the West African health sector.

ACKNOWLEDGEMENTS ii
DECLARATION iii
ABSTRACT iv
LIST OF ABBREVIATIONS AND ACRONYMS ix
LIST OF FIGURES x
LIST OF TABLES xi
CHAPTER ONE 1
INTRODUCTION 1
1.1 Background of the Study 1
1.2 Study Context 3
1.3 Countries in the Study 4
1.4 Human Resource for Health Situation in the Study Countries 5
1.5 Rationale of the Study 6
1.6 Objectives of the Study 7
1.7 Operational Definitions of Terms used in the Study 7
CHAPTER TWO 9
LITERATURE REVIEW 9
2.1 Introduction 9
2.2 Crisis in Africa’s Health Workforce and Africa’s brain drain 9
2.3 Dimensions of impact assessment and causes of the brain drain 10
2.4 Critique of previous studies on migration of health professionals 11
CHAPTER THREE 15
METHODOLOGY 15
3.1 Introduction 15
3.2 Research Design and Rationale 15
3.3 Quantitative Component 16
3.3.1 Research Design 16
3.3.2 Conceptual Framework 16
3.3.3 Definitions of Variables used in the Study and their Roles 17
3.3.4 Study Participants 21
3.3.5 Questionnaire 22
3.3.6 Content Validity and reliability 23
3.3.7 Data Collection Procedure 23
3.3.8 Statistical Analysis 23
3.4 Qualitative Component 24
3.4.1 Research Design 24
3.4.2 Study Participants 24
3.4.3 Data Collection Procedure 25
3.4. 4 Data Quality Control 26
3.4. 5 Data Management and Analysis 27
3.4. 6 Ethical Considerations 27
CHAPTER FOUR 28
RESULTS 28
4.1 Introduction 28
4.2 Quantitative Results 28
4.2.1 Descriptive Statistics 28
4.2.2 Respondents’ socio-demographic characteristics 28
4.2.3 Work Preference 29
4.2.4 Characteristics of Work Experience 30
4.2.5 Migration Intentions 33
4.2.6 Multiple Regressions of Predictors of Migration Decisions 34
4.3 Qualitative Results 37
4.4 Reasons for intention not to stay 38
4.4.1 Lack of opportunity for career development 38
4.4.2 Low Pay 39
4.4.3 Poor working conditions in public health services 39
4.5 Reasons for intention to migrate 40
4.5.1 Better opportunities for career development 40
4.6 Reasons for motivation to stay 41
4.6.1 Competing social responsibilities 41
4.6.2 Relative political stability 42
CHAPTER FIVE 43
DISCUSSION 43
5.1 Introduction 43
5.2 Objective and Framework of the Study 43
5.3 Summary of the Quantitative and Qualitative Findings 43
5.4 Strengths and Limitations of the Study 51
5.5. Implications for policy/and or practice 51
5.6 Direction for Future Research 52
REFERENCES 53
APPENDICES 57
Appendix 1: Consent Form for Participation in the Study 57
Appendix 2: Questionnaires 59
Appendix 3: Research Letter of Institutional Support 67
Appendix 4: Letter of Collaboration from the West African Health Organization 68

Adams, O., & Stilwell, B. (2004). Health professionals and migration. Bull World Health Organ, 82(8), 560. doi: /S0042-96862004000800002
Adepoju, A. (1977). Migration and development in tropical Africa: Some research priorities. African Affairs, 76(303), 210-225.
Ahmad, O. B. (2005). Managing medical migration from poor countries. Bmj, 331(7507), 43-45. doi: 10.1136/bmj.331.7507.43
Akl, E. A., Maroun, N., Major, S., Afif, C., Abdo, A., Choucair, J., . . . Schunemann, H. J. (2008). Post-graduation migration intentions of students of Lebanese medical schools: a survey study. BMC Public Health, 8, 191. doi: 10.1186/1471-2458-8-191
Akl, E. A., Maroun, N., Major, S., Afif, C., Chahoud, B., Choucair, J., . . . Schunemann, H. J. (2007). Why are you draining your brain? Factors underlying decisions of graduating Lebanese medical students to migrate. Soc Sci Med, 64(6), 1278-1284. doi: 10.1016/j.socscimed.2006.10.021
Akl, E. A., Maroun, N., Major, S., Afif, C., Chahoud, B., Choucair, J., . . . Schunemann, H. J. (2007). Why are you draining your brain? Factors underlying decisions of graduating Lebanese medical students to migrate. Social Science & Medicine, 64(6), 1278-1284.
Albaugh, J. A. (2003). Keeping nurses in nursing: the profession''s challenge for today. Urologic Nursing, 23(3), 193.
Anarfi, J., Quartey, P., & Agyei, J. (2010). Key determinants of migration among health professionals in Ghana. Development Research Centre on Migration, Globalisation and Poverty.
Asegid, A., Belachew, T., & Yimam, E. (2014). Factors influencing job satisfaction and anticipated turnover among nurses in Sidama Zone Public Health Facilities, South Ethiopia. Nursing research and practice, 2014.
Bailey, A. J., & Cooke, T. J. (1998). Family migration and employment: the importance of migration history and gender. Int Reg Sci Rev, 21(2), 99-118.
Bailey, A. J., & Cooke, T. J. (1998). Family migration and employment: the importance of migration history and gender. International Regional Science Review, 21(2), 99-118.
Beekhan, A. (2008). Work-family conflict, job satisfaction and spousal support: An exploratory study of nurses’ experience. Curationis.
Bigsten, A. (1996). The circular migration of smallholders in Kenya. J Afr Econ, 5(1), 1-20.
Bilsborrow, R. E., McDevitt, T. M., Kossoudji, S., & Fuller, R. (1987). The impact of origin community characteristics on rural-urban out-migration in a developing country. Demography, 24(2), 191-210.
Bonenberger, M., Aikins, M., Akweongo, P., & Wyss, K. (2014). The effects of health worker motivation and job satisfaction on turnover intention in Ghana: a cross-sectional study. Hum Resour Health, 12, 43. doi: 10.1186/1478-4491-12-43
Bourdieu, P. (2006). 1. Le capital social. Notes provisoires Le capital social (pp. 29-34): La Decouverte.
Boyle, P., Cooke, T., Halfacree, K., & Smith, D. (1999). Gender inequality in employment status following family migration in GB and the US: the effect of relative occupational status. International Journal of Sociology and Social Policy, 19(9/10/11), 109-143.
Branden, M. (2013). Gendered Migration Patterns within a Sex Segregated Labor Market.
Buchan, J. (2001). Nurse migration and international recruitment. Nursing inquiry, 8(4), 203-204.
Canosa, C. A., Lue, H.-C., Vaughan, V. C., Kahssay, H. M., Taylor, P. A., & Mary, E. (2004). Human resources for health: overcoming the crisis: Harvard College.
Chen, L., Evans, T., Anand, S., Boufford, J. I., Brown, H., Chowdhury, M., . . . Wibulpolprasert, S. (2004). Human resources for health: overcoming the crisis. Lancet, 364(9449), 1984-1990. doi: 10.1016/s0140-6736(04)17482-5
Chikanda, A. (2005). Nurse migration from Zimbabwe: analysis of recent trends and impacts. Nurs Inq, 12(3), 162-174. doi: 10.1111/j.1440-1800.2005.00273.x
Coleman, J. S. (1988). Social capital in the creation of human capital. American journal of sociology, S95-S120.
Crisp , N., & Chen , L. (2014). Global Supply of Health Professionals. New England Journal of Medicine, 370(10), 950-957. doi: doi:10.1056/NEJMra1111610
Crush, J., & Pendleton, W. (2012). The brain drain potential of students in the African health and nonhealth sectors. International Journal of Population Research, 2012.
Darboe, A., Lin, I.-F., & Kuo, H.-W. (2016). Effort-reward imbalance and self-rated health among Gambian healthcare professionals. BMC health services research, 16(1), 1.
DaVanzo, J. S. (1981). Microeconomic approaches to studying migration decisions.
Degli Antoni, G. (2009). Getting a Job through Voluntary Associations: the Role of Network and Human Capital Creation: Econometica.
Di Stasio, V., & Gerxhani, K. (2015). Employers’ social contacts and their hiring behavior in a factorial survey. Social Science Research, 51, 93-107. doi: http://dx.doi.org/10.1016/j.ssresearch.2014.12.015
Dodani, S., & LaPorte, R. E. (2005). Brain drain from developing countries: how can brain drain be converted into wisdom gain? Journal of the Royal Society of Medicine, 98(11), 487-491.
Dovlo, D., & Nyonator, F. (1999). Migration by graduates of the University of Ghana Medical School: a preliminary rapid appraisal. Human Resources for Health Development Journal, 3(1), 40-51.
Eastwood, J. B., Conroy, R. E., Naicker, S., West, P. A., Tutt, R. C., & Plange-Rhule, J. (2005). Loss of health professionals from sub-Saharan Africa: the pivotal role of the UK. Lancet, 365(9474), 1893-1900. doi: 10.1016/s0140-6736(05)66623-8
El-Jardali, F., Dimassi, H., Dumit, N., Jamal, D., & Mouro, G. (2009). A national cross-sectional study on nurses'' intent to leave and job satisfaction in Lebanon: implications for policy and practice. BMC Nurs, 8, 3. doi: 10.1186/1472-6955-8-3
Eliason, S., Tuoyire, D., Awusi-Nti, C., & Bockarie, A. (2014). Migration Intentions of Ghanaian Medical Students: The Influence of existing Funding Mechanisms of Medical Education (" The Fee Factor"). Ghana medical journal, 48(2), 78-84.
Fox, R. (2005). African labour market matters. Economic Affairs, 25(4), 71-73.
Gargiulo, M., & Benassi, M. (1999). The dark side of social capital Corporate social capital and liability (pp. 298-322): Springer.
Garip, F. (2008). Social capital and migration: how do similar resources lead to divergent outcomes? Demography, 45(3), 591-617.
George, G., & Reardon, C. (2013). Preparing for export? Medical and nursing student migration intentions post-qualification in South Africa. African Journal of Primary Health Care & Family Medicine, 5(1).
Goldstein, S. (1954). Repeated migration as a factor in high mobility rates. American Sociological Review, 19(5), 536-541.
Goss, E. P., & Paul, C. (1986). Age and work experience in the decision to migrate. Journal of Human Resources, 397-405.
Gouda, P., Kitt, K., Evans, D. S., Goggin, D., McGrath, D., Last, J., . . . O''Donovan, D. (2015). Ireland''s medical brain drain: migration intentions of Irish medical students. Hum Resour Health, 13, 11. doi: 10.1186/s12960-015-0003-9
Gupta, M. R. (1984). Migration, unemployment and development: a dynamic two-sector analysis. Econ Lett, 16(1-2), 177-184.
Hagopian, A., Ofosu, A., Fatusi, A., Biritwum, R., Essel, A., Gary Hart, L., & Watts, C. (2005). The flight of physicians from West Africa: views of African physicians and implications for policy. Soc Sci Med, 61(8), 1750-1760. doi: 10.1016/j.socscimed.2005.03.027
Haug, S. (2008). Migration networks and migration decision-making. Journal of Ethnic and Migration Studies, 34(4), 585-605.
Humphries, N., McAleese, S., Matthews, A., & Brugha, R. (2015). ''Emigration is a matter of self-preservation. The working conditions . . . are killing us slowly'': qualitative insights into health professional emigration from Ireland. Hum Resour Health, 13, 35. doi: 10.1186/s12960-015-0022-6
Jurges, H. (2006). Gender ideology, division of housework, and the geographic mobility of families. Review of Economics of the Household, 4(4), 299-323.
Kalipeni, E., Semu, L. L., & Mbilizi, M. A. (2012). The brain drain of health care professionals from sub-Saharan Africa: A geographic perspective. Progress in Development Studies, 12(2-3), 153-171.
Kennedy, P. (2013). Key themes in social policy: Routledge.
Kerry, V. B., Ndung''u, T., Walensky, R. P., Lee, P. T., Kayanja, V. F., & Bangsberg, D. R. (2011). Managing the demand for global health education. PLoS Med, 8(11), e1001118. doi: 10.1371/journal.pmed.1001118
Kinfu, Y., Dal Poz, M. R., Mercer, H., & Evans, D. B. (2009). The health worker shortage in Africa: are enough physicians and nurses being trained? Bulletin of the World Health Organization, 87(3), 225-230.
Kingma, M. (2007). Nurses on the Move: A Global Overview. Health Services Research, 42(3 Pt 2), 1281-1298. doi: 10.1111/j.1475-6773.2007.00711.x
Kinyanyi, H. (2014). Migration decision making: A case study of Kibera, Nairobi. University Of Nairobi.
Kirigia, J. M., Gbary, A. R., Muthuri, L. K., Nyoni, J., & Seddoh, A. (2006). The cost of health professionals'' brain drain in Kenya. BMC health services research, 6(1), 1.
Kirigia, J. M., Gbary, A. R., Muthuri, L. K., Nyoni, J., & Seddoh, A. (2006). The cost of health professionals'' brain drain in Kenya. BMC Health Serv Res, 6, 89. doi: 10.1186/1472-6963-6-89
Martineau, T., Decker, K., & Bundred, P. (2004). “Brain drain” of health professionals: from rhetoric to responsible action. Health policy, 70(1), 1-10.
Massey, D. S. (1990). Social structure, household strategies, and the cumulative causation of migration. Population index, 3-26.
Massey, D. S., Arango, J., Hugo, G., Kouaouci, A., & Pellegrino, A. (1999). Worlds in Motion: Understanding International Migration at the End of the Millennium: Understanding International Migration at the End of the Millennium: Clarendon Press.
Massey, D. S., Arango, J., Hugo, G., Kouaouci, A., Pellegrino, A., & Taylor, J. E. (1993). Theories of international migration: A review and appraisal. Population and development review, 431-466.
Mbaye, L. M. (2014). “Barcelona or die”: understanding illegal migration from Senegal. IZA Journal of Migration, 3(1), 1.
Morokvasic, M. (1984). Birds of Passage are also Women. Int Migr Rev, 18(4), 886-907.
Naicker, S., Plange-Rhule, J., Tutt, R. C., & Eastwood, J. B. (2009). Shortage of healthcare workers in developing countries--Africa. Ethn Dis, 19(1 Suppl 1), S1-60-64.
Nguyen, L., Ropers, S., Nderitu, E., Zuyderduin, A., Luboga, S., & Hagopian, A. (2008). Intent to migrate among nursing students in Uganda: Measures of the brain drain in the next generation of health professionals. Hum Resour Health, 6(1), 1-11. doi: 10.1186/1478-4491-6-5
Numerato, D., & Baglioni, S. (2012). The dark side of social capital: An ethnography of sport governance. International Review for the Sociology of Sport, 47(5), 594-611.
Oberoi, S. S., & Lin, V. (2006). Brain drain of doctors from southern Africa: brain gain for Australia. Aust Health Rev, 30(1), 25-33.
Ojakaa, D., Olango, S., & Jarvis, J. (2014). Factors affecting motivation and retention of primary health care workers in three disparate regions in Kenya. Hum Resour Health, 12, 33-33. doi: 10.1186/1478-4491-12-33
Okeke, E. N. (2014). Do higher salaries lower physician migration? Health Policy Plan, 29(5), 603-614. doi: 10.1093/heapol/czt046
Organization, W. H. (2003). Migration of health professionals in six countries: a synthesis report. Brazzaville: World Health Organization Regional Office for Africa.
Organization, W. H. (2010a). Increasing access to health workers in remote and rural areas through improved retention: global policy recommendations: World Health Organization.
Organization, W. H. (2010b). World health statistics 2010: World Health Organization.
Organization, W. H. (2011). The Abuja Declaration: Ten years on. 2011. Online at: http://www. who. int/healthsystems/publications/abuja_10. pdf, accessed, 25.
Pendleton, W. C., Crush, J., Olsen, K. R., & Lefko-Everett, K. (2007). The haemorrhage of health professionals from South Africa: Medical opinions: Southern African Migration Project.
Poppe, A., Jirovsky, E., Blacklock, C., Laxmikanth, P., Moosa, S., De Maeseneer, J., . . . Peersman, W. (2014). Why sub-Saharan African health workers migrate to European countries that do not actively recruit: a qualitative study post-migration. Glob Health Action, 7, 24071. doi: 10.3402/gha.v7.24071
Portes, A. (1995). The economic sociology of immigration. New York: Russell Sage Foundation, 29, 11-12.
Putman, R. Bowling alone: The collapse and revival of American community. 2000: New York: Simon and Schuster.
Rockers, P. C., Jaskiewicz, W., Wurts, L., Kruk, M. E., Mgomella, G. S., Ntalazi, F., & Tulenko, K. (2012). Preferences for working in rural clinics among trainee health professionals in Uganda: a discrete choice experiment. BMC Health Services Research, 12(1), 1-13. doi: 10.1186/1472-6963-12-212
Salami, B., Nelson, S., Hawthorne, L., Muntaner, C., & McGillis Hall, L. (2014). Motivations of nurses who migrate to Canada as domestic workers. Int Nurs Rev, 61(4), 479-486. doi: 10.1111/inr.12125
Sanou, A. S., Awoyale, F. A., & Diallo, A. (2014). An interventional model to develop health professionals in West Africa. Pan Afr Med J, 18, 152. doi: 10.11604/pamj.2014.18.152.3283
Shauman, K. A., & Noonan, M. C. (2007). Family migration and labor force outcomes: sex differences in occupational context. Social Forces, 85(4), 1735-1764.
Shields, G. M., & Shields, M. P. (1989). The emergence of migration theory and a suggested new direction. Journal of Economic Surveys, 3(4), 277-304.
Sjaastad, L. A. (1962). The Costs and Returns of Human Migration. Journal of Political Economy, 70(5, Part 2), 80-93. doi: doi:10.1086/258726
Smetana, J. G., & Adler, N. E. (1979). Decision-making regarding abortion: A value x expectancy analysis. Population & Environment, 2(4), 338-357.
Stark, O., & Bloom, D. E. (1985). The new economics of labor migration. The american Economic review, 75(2), 173-178.
Stewart, J., Clark, D., & Clark, P. F. (2007). Migration and recruitment of healthcare professionals: causes, consequences and policy responses. Policy Brief, 7(1), 1-10.
Trimble, L. B., & Kmec, J. A. (2011). The Role of Social Networks in Getting a Job. Sociology Compass, 5(2), 165-178. doi: 10.1111/j.1751-9020.2010.00353.x
Ullah, A. K. M. A. (2010). Population migration and Asia : theories and practice. Hauppauge, N.Y.: Nova Science Publishers.
Vork, A., Kallaste, E., & Priinits, M. (2004). Migration intentions of health care professionals: the case of Estonia. Public Policy Center, Cluj Napoca.
Wao, H. O. (2008). A mixed methods approach to examining factors related to time to attainment of the Doctorate in Education: ProQuest.
Warr, P., Cook, J., & Wall, T. (1979). Scales for the measurement of some work attitudes and aspects of psychological well‐being. Journal of occupational psychology, 52(2), 129-148.
Winkleby, M. A., Jatulis, D. E., Frank, E., & Fortmann, S. P. (1992). Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. American journal of public health, 82(6), 816-820.
Wolpert, J. (1965). Behavioral aspects of the decision to migrate. Papers in Regional Science, 15(1), 159-169.