The research team, led by Ukamaka Gladys Okafor of Euclid University, conducted an exploratory, phenomenological qualitative study between October 2024 and February 2025. Rather than surveying frontline clinicians or students, as most previous studies have done, the researchers purposively recruited the chief executives or representatives of six health regulatory agencies and fourteen leaders or representatives from eleven professional associations spanning nursing, pharmacy, medicine and dentistry, medical laboratory science, optometry and radiography. These are the professions the Federal Government of Nigeria has documented as being most affected by international health worker migration. Twenty participants were interviewed, in line with Creswell’s guideline that eighteen to thirty participants is appropriate for a qualitative study of this kind.

Data were collected through in-person, in-depth interviews and virtual sessions on Zoom, each lasting an average of forty-five minutes and recorded with informed consent. A semi-structured interview guide, developed from validated questionnaires used in earlier migration studies, probed how emigration had affected each sector, what it meant for the quality and cost of care delivered to the public, what it did to the professionals who stayed behind, and whether destination countries or emigrants themselves could give something back. Recordings were transcribed verbatim, anonymized as far as possible, and analysed with a hybrid coding approach that combined deductive codes drawn from the study objectives and prior literature with inductive codes that emerged directly from the participants’ narratives. The team then discussed the emerging themes with peers to guard against bias and reached consensus on the final interpretation, reporting the work against the Standards for Reporting Qualitative Research checklist. Ethical approval came from the Lagos University Teaching Hospital Health Research Ethics Committee.

The scale of the problem the participants described is enormous. The World Health Organization projects a global shortfall of eighteen million health workers by 2030, concentrated in low- and lower-middle-income countries, and Nigeria sits squarely in the blast zone. By 2030, the country is predicted to face a 29.25 percent deficit of nurses and a 33.45 percent deficit of doctors. A survey by the Medical and Dental Consultants Association of Nigeria found that more than five hundred medical consultants have already left the country to practise in developed nations, and nine out of ten consultants with less than five years of experience had plans to emigrate. Across the wealthy countries of the OECD, between 25 and 32 percent of physicians in the United Kingdom, Australia, the United States and Canada are international medical graduates, many trained in South Asian and African nations, a dependency that has deepened over the past five decades and was accelerated by the added demands of the COVID-19 pandemic.

Thematic analysis of the interviews produced two overarching themes, negative and positive effects on the health system, subdivided into seven sub-themes. On the negative side, participants described an acute shortage of skilled personnel across every practice setting, from academia and supply chains to clinical, regulatory, private and public sectors. One participant with thirty-eight years of post-qualification experience spoke of an acute shortage across community, hospital and manufacturing sectors of pharmacy practice, while another, forty-two years qualified, said migration depletes the pharmaceutical workforce so severely that businesses and institutions struggle to find qualified pharmacists at all. The shortage is the most immediate and visible effect, but the participants stressed that it triggers a cascade of secondary failures that compound over time.

Among the most insidious of those failures is the disruption of organizational plans and leadership continuity. When senior and skilled staff leave abruptly, institutional strategies stall: service expansion projects, training programmes and new policy implementations are delayed or abandoned, and replacements may take so long to arrive that inefficiencies and poor outcomes follow. Leadership and decision-making gaps open up, mentorship structures collapse, and junior staff are left without guidance or institutional memory. One participant with twenty-eight years of post-qualification experience noted that many professionals leave without proper handovers, affecting projects, policy and advocacy work. In a health system that depends on experienced practitioners training the next generation, the loss of a single consultant or professor can ripple through an entire specialty for years.

The quality of care delivered to the public is the next domino to fall. Participants reported longer wait times, reduced access to specialist care, misdiagnosis, delayed treatment and rising morbidity and mortality. One participant said many hospitals have lost fifty to seventy percent of their staff, with some shutting down specialized units entirely for lack of experts. Others warned that untrained personnel are stepping into roles meant for professionals, and that private facilities unable to find qualified staff are relying on assistants and technicians, a task-shifting that further erodes standards. Those who remain shoulder crushing workloads. Participants described overwork, stress, frustration, burnout, dissatisfaction and medical errors as direct consequences of the shortage, a finding consistent with international evidence that burnout and long weekly working hours are independent risk factors for medical mistakes. Burnout also breeds feelings of incompetence and emotional exhaustion that deepen professional dissatisfaction, feeding a vicious cycle in which miserable working conditions push yet more clinicians toward the airport.

The economic toll is equally severe. Participants lamented the loss of public funds invested in training professionals who leave almost as soon as they qualify, with one participant remarking that the country wastes enormous sums training these professionals only to watch them go. Previous economic analyses have estimated that low- and middle-income countries spend between roughly 29,898 and 65,997 dollars annually to train each physician, and that the economic costs of increased mortality from health worker shortages run into billions of dollars per year. The shortage also inflates the cost of care for ordinary Nigerians, who are forced to consult the few remaining practitioners or expensive private facilities, undermining progress toward universal health coverage. Brain drain and chronic underfunding have together fuelled medical tourism, particularly among the political class, draining further resources from a system already on the edge.

Yet the study is not a one-sided lament. Participants identified genuine benefits that emigration can confer on the source country. Emigrants often gain advanced qualifications, cutting-edge skills and technologies unavailable in local training institutions, enhancing their professional competence. Some return temporarily or periodically with experts, health products and devices, organizing medical missions and health outreaches in Nigeria that include complex surgeries, transplants and access to rare medications. Through teaching, mentoring and hands-on training, these returning professionals transfer international best practices to their colleagues at home, and participants reported improvements in service quality attributable to knowledge and skills transfer. Beyond individual returns, diaspora networks channel donations, funding for health projects, virtual mentorship, supportive telemedicine and cross-border consultations, and migrant health workers send substantial remittances to families left behind. The participants and the authors are careful to note, however, that these benefits do not outweigh the negative impacts, and the literature on which they draw reaches the same conclusion.

The study’s authors argue that the findings demand urgent, multi-sectoral and systemic action rather than piecemeal fixes within individual professions. Because migration cannot be completely halted, they recommend that the Nigerian government strengthen the national health workforce by creating and funding more training institutions, ensuring equitable distribution of health workers across the country, and developing practical, implementable retention policies. At the same time, they urge the government to maximize the positive side of emigration by pursuing bilateral partnerships with destination countries and encouraging emigrated professionals to contribute through structured mentorship, telemedicine programmes and health investments. The stakeholders interviewed for the study warn that if the outward movement continues unchecked, an impending crisis awaits the Nigerian health sector. What this research makes clear is that the story of health worker migration is neither purely a tragedy nor purely an opportunity; it is a systemic challenge that will be shaped, for better or worse, by the policy choices Nigeria makes now.

Subject of Research: The impact of health workforce emigration on Nigeria's health care system from the perspectives of regulatory bodies and professional associations

Article Title: A qualitative exploration of multi-stakeholder perspectives on the impact of health workforce emigration on Nigeria’s health care system

Article References: Okafor, U. G., Eze, O. P., Oseni, Y. O., Onwuchuluba, E. E., & Obiakor, N. M. (2026). A qualitative exploration of multi-stakeholder perspectives on the impact of health workforce emigration on Nigeria’s health care system. Discover Social Science and Health, 6(1), Article 105. https://doi.org/10.1007/s44155-026-00441-3

Image Credits: AI Generated

DOI: 10.1007/s44155-026-00441-3

Keywords: Nigeria, health workforce, brain drain, emigration, health care system, qualitative research, health policy, burnout, medical tourism, knowledge transfer, universal health coverage, stakeholder perspectives