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ISSN 2278-2540 | DOI: 10.51583/IJLTEMAS | Volume XIII, Issue VII, July 2024

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Brain-Drain in Health Sector: Towards Sustainable Healthcare

Development in Nigeria: A Study of Selected State Hospitals in

Ogun State.

Latifat I. Akindele &

Rashidat O. Olabimtan

Department of Business Administration and Management,

Department of Maritime Transportation and Business Studies,

1&2

The Federal Polytechnic Ilaro, Ogun State, Nigeria.

DOI: https://doi.org/10.51583/IJLTEMAS.2024.130712

Received: 10 July 2024; Accepted: 27 July 2024; Published: 07 August 2024

Abstract: This study investigates the impact of brain drain in the health sector on sustainable healthcare development in Ogun

State, Nigeria, focusing specifically on selected state hospitals. The research was conducted across several state hospitals with the

entire medical staff forming the target population. Utilizing a random sampling strategy, data were collected from a sample of 278

healthcare professionals, determined through Taro Yamane sampling techniques from a population of 912. Data collection was

facilitated through a systematically designed containing 26-item questionnaire employing a four-point Likert scale. The reliability

instrument was confirmed with a Cronbach alpha statistic, while its validity was assessed using component factor analysis.

Descriptive statistics summarized the data, and inferential statistics were derived using simple linear regression analysis. The

findings reveal a significant brain drain phenomenon, driven by factors such as inadequate remuneration, subpar working

conditions, and limited professional growth opportunities. This has resulted in a critical shortage of healthcare providers,

negatively impacting the quality and accessibility of healthcare services in Ogun state. The regression analysis further illustrates a

strong correlation between brain drain and the deterioration of healthcare service delivery, which in turn hampers the region's

progress towards sustainable healthcare development. The study recommends that the level of poverty must be reduce in the

country; high pay incentives must be adequately provided by the government; initiatives that support youth in realizing their full

potential must be developed; and a sound macroeconomic plan must be Implemented.

Keywords: Brain Drain, Sustainable Development, Healthcare Delivery

I Introduction

The brain drain of trained healthcare workforce is one of the main issues emerging countries are facing. Developing countries like

Nigeria are not immune to this misfortune, particularly in the domains of health and education sectors. Over 50% of Nigerian

physicians were employed and resided overseas.

A trained and stable workforce is essential to the delivery of high-quality healthcare, which is why the healthcare industry is so

important to a country's general well-being. But Nigeria, like many other developing nations, has to deal with the ongoing issue

of "brain drain" in the health sector. This phenomenon is the exodus of highly qualified healthcare workers to other nations,

frequently in search of better possibilities.

The global migration of health professionals has led to an uneven distribution of medical personnel worldwide. "Brain drain," the

term used to describe the exodus of medical professionals from some developing nations, has an impact on the health care system

on several levels, affecting all health personnels. Both push and pull factors are causing medical professionals to leave their home

nations. Better pay and working conditions, job satisfaction, and opportunities for additional education are pull factors. Push

factors include lack of education opportunities, poor working environment, poor infrastructure, insufficient enumeration, and lack

of diagnostic equipment. In addition to push and pull considerations, medical professionals' relationships to the receiving nations

have an impact on their movement. Along with a scarcity of medical personnel, the exporting country has higher rates of

morbidity and mortality as a result of this medical professional exodus. In the event of an illness, prompt diagnosis and

intervention are impossible without medical personnel. The presence of competent healthcare workers is critical to the efficient

operation of the global health system, especially in Nigeria. [1]

The country is losing a large number of skilled medical personnel and other vital healthcare workers. This depletion has resulted

in a substantial healthcare personnel deficit, decreased access to excellent healthcare services, and impeded attempts toward

sustainable development [2]. Poor infrastructure and inadequate resources for our health system have also increased brain drain

among Nigerian medical staff. This study aims to produce findings that will help to alleviate the distressing crisis and improve the

stability of the health-care system.

One of the most major barriers to upgrading Nigeria's and other African countries' health-care systems is a shortage of health

workers. The global workforce issue can be addressed if there is global responsibility, political will, financial commitment, and

public-private partnerships to support country-led and country-specific actions that look outside the health sector. Only by

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training, sustaining, and retaining enough health workers in underdeveloped nations will the area be able to meet the Millennium

Development Goals [3].

This research is critical for policy makers, healthcare administrators, and stakeholders when developing focused interventions to

address the difficulties caused by brain drain in the health sector. This project intends to improve healthcare services and overall

well-being in Ogun state, and by extension, Nigeria, by establishing long-term strategies for maintaining and attracting qualified

healthcare personnel.

The main objective of this study was to examine the effect of brain drain in health sector on sustainable development of health

care delivery in Ogun state. The specific objectives were the following: (i) to investigate the effect of brain drain in health sector

on environmental sustainability in Ogun state hospitals; (ii) to examine the effect of brain drain in health sector on economic

sustainability in Ogun state hospitals; (iii) to determine the effect of brain drain in health sector on social sustainability in Ogun

state hospitals.

II Conceptual Review

Brain Drain

Global trade and investment opportunities have been fuelled by the emergence of the globalized economy, the information

explosion, social networking, and technological advancement. This has led to an acceleration of the brain drain from developing

to developed countries worldwide [4]. This circumstance heightened the aspirations of developed countries worldwide to raise

their standards of living and draw in more foreign workers, especially medical professionals with training from developing

nations, to augment their human resources. Most industrialized nations worldwide have enacted robust policies associated with

reforms pertaining to ethical democratization of society, openness in the development of their economies and infrastructure, and

strong autonomous institutions that strengthen good governance inside their country [4].

The topic of brain drain in the healthcare sector has posed a persistent challenge for many developing countries, including

Nigeria. Brain drain refers to the emigration of qualified healthcare personnel, which has a significant influence on the country's

ability to provide healthcare services.

[5] characterized brain drain as a migration of employees or professionals seeking better living conditions, higher salaries, access

to modern technology, and stable political situations in a variety of locations around the world. This is a continuing occurrence

that has an impact on the quality and quantity of the labor force, as well as the quality of human capital development.

[6] defined brain drain as the preponderance of the migration of highly skilled and educated persons from poor, developing and

less industrialized countries to richer, more developed ones. Another way to define brain drain is the phenomenon of highly

educated, skilled workers leaving a country for other countries to pursue specialized careers. As brilliant workers leave their

country and use their skills to boost the economies of other countries, brain drain is primarily seen negatively.

[4] identified three types of brain drain that commonly occur or are prevalent in various countries around the world. The first is

observed in wealthy countries around the world. Citizens of developed countries move to developed countries to establish,

investigate, or upgrade their skills in one or more areas. Brain drain also occurs when the citizens of developing countries travel

to other developed countries to seek a better job opportunities and improve their living conditions. Moreover, among developing

countries around the world, citizens interact or travel to other developing countries to help each other improve in areas where

developed countries excel or perform well. However, these travels or migrations are decreasing as information communication

technology (ICT) advances, allowing citizens from all over the world to work or be hired to provide services [4].

Sustainable Healthcare Development

[7]) define sustainable development as a form of human development in which the resources employed are aimed at satisfying

human needs while guaranteeing the sustainability of the environment and natural systems, so that these needs can be satisfied not

only for the present but also for future generations.

According to [7], in order to meet the growing demands of the future, the interconnections between social, economic, and

institutional processes must be continuously maintained via the development process. It follows that sustainability is viewed as a

model of a future in which social, economic, and environmental challenges interact harmoniously to advance and raise living

standards [8]. Raising standards in Nigeria's health sectors necessitates finding a durable solution to the brain drain issue that

characterizes the country's lethargic development.

Sustainable development is described as a development that meets the needs of the present without compromising the ability of

future generations to meet their own needs according to Brundtland Commission's 1984 report, which was quoted in [6]. This

definition of sustainable development is the most widely used and acknowledged. It is also thought to be the most common and

concise definition of sustainable development. It believes that intergenerational equity is a key component of sustainable

development.

Addressing the underlying reasons of brain drain and putting policies in place to draw in and keep healthcare professionals are

necessary to achieve sustainability in the delivery of healthcare. A balance between the availability of human resources, the

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caliber of services, and the flexibility to adapt to the changing healthcare demands of the populace defines sustainable healthcare.

This calls for all-encompassing policies that prioritize long-term retention and capacity-building activities over short-term fixes.

The conceptual framework needs to take into account how brain drain affects Nigerian healthcare delivery both directly and

indirectly. The exodus of qualified personnel worsens the current scarcity of workers in the healthcare industry, leading to lower-

quality services, longer wait times, and worse patient outcomes. The overall viability of the healthcare system may also be

impacted by burnout and low morale among the surviving healthcare workers.

III Theoretical Review

Change Theory

Lewin developed the Push-Pull hypothesis, also referred to as the Change hypothesis, in 1947. It is one of the theories explaining

brain drain. According to the hypothesis, the conflict between social environment satisfaction and irritation leads to behavioural

intention. According to this idea, there are two types of elements that might impact a situation: push factors, or forces, and pull

factors, or helping factors, which direct and propel movements toward a goal.

Theory of World Systems

Immanuel Wallerstein created the world systems theory in 1970. According to the theory, there are two sides to the economic

system: the giver (the exploited) and the taker (the benefiter). It goes on to say that the existing global system functions according

to a limited framework with a variety of rules that serve to unite the various subgroups that make up the system as a whole

(society). It is larger than a single juridical political unit and sees the entire system as a network of global capitalism.

IV Empirical Review

[9], this study investigates whether workplace safety, compensation, and equipment contribute to brain flight among Nigerian

health professionals. A survey research design was applied. The majority of the study strategy was quantitative, with fewer

qualitative elements included to allow participant recommendations. The statistical analysis of the data using linear regression

revealed that the factors that most strongly caused brain drain among health professionals were compensation, worker safety, and

working equipment. The report recommended important legislative changes, among other things, to address the inadequate

working conditions in both public and commercial institutions.

[11], the study looked at the factors that contribute to health workers in Ekiti state's public teaching hospitals leaving the field.

The study used a descriptive survey research design. The 3274 employees of Ekiti state's public hospitals made up the population.

356 employees were used as sample size, which was determined using the Taro Yamane formula. Multiple regression was used to

examined the study project's data. The research findings indicated that brain-drain among health personnel in public teaching

hospitals in Ekiti State was positively influenced by factors such as career growth, autonomy, low earnings and salaries, and

political instability. It was suggested that the government support the expense of education for Nigerian health workers and

guarantee that there are sufficient infrastructures and facilities to support career growth.

[12] used a diagnostic research design to survey public health staff in government hospitals in an effort to promote understanding

of the impact of the issue known as brain drain. Using a probability sampling method, the study employed a battery of modified

research scales of various measurements to validate the variables of interest. To obtain relevant data, 450 staff of four government

institutions in the public healthcare sector were questioned for the study. The study analyzed the data using artificial neural

networks (ANNs) and structural equation modeling (SEM). The study found that the brain-drain effect and subpar healthcare

delivery were the main causes of the low work-life quality that Nigerian medical professionals faced.

[13], the study investigated the rising causes of brain drain of Nigerian medical doctors abroad with country’s implications.

Secondary sources of information were used. Utilizing a mixed method research approach that combined quantitative and

qualitative techniques, descriptive and explanatory study designs were employed. The findings showed that some of the driving

forces behind doctors leaving their home nations include their unappealing pay, an unpleasant work atmosphere, and a lack of

opportunity for career progression. In accordance with the 2001 Abuja Declaration to enhance health infrastructure and the

welfare status of healthcare professionals, the Nigerian government should increase its annual budget allocation for healthcare

financing to 15% as a policy response.

A research conducted in [14] examined the effects of brain drain on Nigeria's health and educational systems. According to this

survey, the majority of industrialized nations frequently favor competent and educated laborers from emerging nations,

particularly Nigeria. Secondary sources provided the data for the study, which was then analyzed using content analysis. The

investigation was conducted in relation to the push-pull theory. The research concurs that both push and pull variables account for

the rising rate of migration in Nigeria's health and education systems. The report made several recommendations, one of which

was that the Federal Government of Nigeria make investments in the crucial sector of the economy since it is still essential to the

nation's long-term economic growth and development.

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V Methodology

The study was conducted in Ogun State Hospitals. The whole medical staff in the hospitals (Abeokuta, Ota, Isara-Remo, Ijebu

ode, Ifo and Ilaro) make up the target population for this study. A random sampling strategy was adopted. A systematic

questionnaire was used to obtain the data for the investigation. The data were summarized using descriptive statistics, and

regression analysis was utilized to get inferential statistics. The population of the study was 912 and sample size of 278 was

determined by Taro Yamane sampling techniques. The instrument for data collection was questionnaire titled “Brain Drain and

Sustainable Healthcare Development Questionnaire (BDSHDQ)”. The questionnaire was gathered using a 26-item questionnaire

with a four-point Likert scale. Cronbach's alpha statistic was used to evaluate the reliability of the instrument, whereas component

factor analysis was used to evaluate its validity. To assess the data, simple linear regression was employed. To aid in analysis and

act as a guide, the model was defined as follows:

SHD = f(BD)

SHD = β

………et……. i

SHD = β

………et ……ii

SHD = β

………et ……. iii

Where:

SHD = Sustainable Healthcare Development

BD = Brain Drain

ECS= Economic Sustainability

EVS= Environmental Sustainability

SOS = Social Sustainability

= Constant

2,.

= Coefficient of correlation

VI Result and Discussion

Table I Reliability Statistics

Cronbach's Alpha

Cronbach's Alpha Based on Standardized Items

N of Items

.859

.858

Source: Field Survey, 2024.

A result of 0.859 in Table 1 indicates that there is a high degree of internal consistency across the scale's items. An alpha of

0.859, therefore, suggests that the items are consistently measuring the same underlying construct.

Table II Total Variance Explained

Initial Eigenvalues

Extraction Sums of Squared Loadings

Component

Total

% of Variance

Cumulative %

Total

% of Variance

Cumulative %

6.171

30.854

6.171

30.854

4.685

23.423

54.277

4.685

23.423

54.277

3.534

17.671

71.948

3.534

17.671

71.948

2.471

12.353

84.300

2.471

12.353

84.300

1.517

7.584

91.884

1.517

7.584

91.884

.614

3.070

94.954

Source: Field Survey, 2024

Significantly, five components (91.884%) explain the whole variation. This implies that these five elements can provide a good

dimensionality reduction by summarizing the data efficiently. This analysis offers a trustworthy and thorough comprehension of

the consistency of the measured constructs and the structure of the dataset.

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Table III Descriptive Statistics

EVS

ECS

SOS

Mean

17.3957

52.2086

17.3094

17.3705

17.5288

Std. Deviation

2.02018

5.50021

1.79187

1.87212

2.17739

278

Source: Field Survey, 2024

Table 3, with BD (17.3957), SD (52.2086), EVS (17.309), ECS (17.3705), and SOS (17.5288) as the average values for each

variable. The following values are used to calculate the degree of variation or dispersion: BD (2.02018); SD (5.50021); EVS

(1.79187); ECS (1.87212); SOS (2.17739).

Table IV Correlation Coefficient

Table 4: Correlation Coefficient

EVS

ECS

SOS

Pearson Correlation

1.000

.857

.774

.781

.858

.857

1.000

EVS

.774

1.000

ECS

.781

1.000

SOS

.858

1.000

Sig. (1-tailed)

.000

EVS

.000

ECS

.000

SOS

.000

278

Source: Field Survey, 2024

The linear connections between BD and the following variables are displayed in Table 4 along with their intensity and direction:

BD and SD (0.857); BD and EVS (0.774); BD and ECS (0.781); and BD and SOS (0.858). This demonstrates the high positive

correlation that exists between all the variables. The correlations' significance levels are 0.000, which means that they are

statistically significant.

Table V Model Summary

EVS

ECS

SOS

Model

.857

.774

.781

.858

R Square

.735

.599

.610

.735

Adjusted R Square

.734

.597

.609

.734

Std. Error of the Estimate

2.83555

1.13693

1.17119

1.12222

R Square Change

.735

.599

.610

.735

F Change

766.231

412.063

431.766

766.794

df 1

A. Predictors: (Constant), BD

Source: Field Survey, 2024

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The following correlation coefficients show the relationship between the expected and actual values: SD (0.857), EVS (0.774),

ECS (0.781), and SOS (0.858). Out of the dependent variable (BD), the following proportion of variation can be predicted: SD

(73.5%), EVS (59.9%), ECS (61.0%), and SOS (73.5%). The prediction error standard deviations are as follows: SD = 2.83555;

EVS = 1.13693; ECS = 1.17119; SOS = 1.12222).

Table VI ANOVA

Dependent

variable

Model

Sum of

Squares

Mean

Square

Sig.

Regression

6160.762

766.231

.000

Residual

2219.137

276

8.040

Total

8379.899

277

EVS

Regression

532.636

412.063

.000

Residual

356.760

276

1.293

Total

889.396

277

ECS

Regression

592.250

431.766

.000

Residual

378.588

276

1.372

Total

970.838

277

SOS

Regression

965.682

766.794

.000

Residual

347.588

276

1.259

Total

1313.270

277

Predictors: (Constant), BD

Source: Field Survey, 2024

High F values show that a substantial portion of the variance is explained by the model. The models are statistically significant, as

indicated by the p-value, which revealed that all p-values are 0.000.

Table VII Coefficients

Model

Unstandardized

Coefficients

Standardized

Coefficients

Sig.

Std. Error

Beta

(Constant)

11.599

1.477

7.854

.000

2.334

.084

.857

27.681

.000

EVS

(Constant)

5.369

.592

9.066

.000

.686

.034

.774

20.299

.000

ECS

(Constant)

4.779

.610

7.835

.000

.724

.035

.781

20.779

.000

SOS

(Constant)

1.451

.585

2.482

.014

.924

.033

.858

27.691

.000

Source: Field Survey, 2024

For every unit change in the independent variable (BD), the following are the actual projected changes in the dependent variable:

For SD, the BD coefficient is 2.334; for EVS, it is 0.686; for ECS, it is 0.724; and for SOS, it is 0.924. The coefficient's standard

errors are SOS (0.033), EVS (0.034), SD (0.084), and ECS (0.035). The following are the coefficients in their standardized form:

SD (0.857), EVS (0.774), ECS (0.781), and SOS (0.858). The relevance of each predictor was shown by the t-statistics and p-

values for the coefficient. P-value = 0.000 indicates that all predictors are very significant.

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VII Conclusion

The results show that brain-drain significantly influences environmental sustainability, making it an important factor to take into

account in environmental policy and planning efforts. There is a significant relationship between brain-drain and environmental

sustainability in State hospitals in Ogun state. The significant F Change (p-value = 0.000) highlights that the model, which

includes brain-drain as a predictor, greatly improves the prediction of environmental sustainability compared to a model without

predictors.

The economic sustainability of state hospitals in Ogun State is significantly correlated with brain-drain. The statistical

significance of the association is indicated by the significance level of 0.000, which is significantly lower than 0.05. According to

the research, brain-drain has a substantial impact on economic sustainability, which means that economic policy and planning

must take it into account.

In state hospitals, there is a strong correlation between brain-drain and societal sustainability. The concept that brain-drain has a

favorable impact on societal sustainability is strongly supported by statistical evidence. The statistical significance of the

association is indicated by the significance level of 0.000, which is significantly lower than 0.05. The results imply that brain-

drain is an important area of focus for policy and strategic planning since it is a crucial component in anticipating and improving

societal sustainability.

In summary, there is a significant positive relationship between the brain drain and development of sustainable healthcare. In this

study, brain-drain is a significant predictor for all forms of sustainability, with high R values signifying robust models. While the

coefficients indicated that rises in brain drain are connected with increases in sustainable healthcare development, the ANOVA

tables validate that the regression models are statistically significant.

Recommendation

The mass exploration of Nigerians must be taken seriously immediately. Nigerians with advanced degrees and other talents would

keep moving to developed countries as long as there is poverty in the country.

Initiatives that support youth in realizing their full potential must be developed by the government, particularly in regions with

strong concentrations of information technology innovation. It should also provide access to specialized education for its residents

and encourage the production of local content.

The report makes it clear that in order for migrants and their families to invest their remittances in capital-building projects that

help the Nigerian economy as a whole, the government needs to offer sufficient incentives.

The report suggests that there should be more high-paying occupations available in Nigeria and fewer educational visas that allow

young Nigerians to study abroad. Implementing a sound macroeconomic plan and outlaw nepotism and corruption at all levels of

government are necessary.

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