Factors influencing the migration intention of health professionals in low and middle income countries: Critical review with a theoretical model

  • Sara Hajian Preventive Dentistry Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Shahram Yazdani School of Medical Education, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
  • MohammadPooyan Jadidfard School of Dentistry, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
  • Mohammad Hossein Khoshnevisan Preventive Dentistry Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.


Migration of healthcare workers could result in shortage of human resources and rising inequalities in service provision in resource poor countries. The aim of this review was to determine the factors influencing the migration decisions of medical and dental graduates migrating from low- and middle-income countries as well as introducing a practical model for health professional’s migration.
Google Scholar and PubMed were searched together with relevant journals for English studies from January 2005 to January 2020. The original studies which evaluated the motivational factors of dental and medical graduates migrating from low or middle income countries were included. The migration model was developed by investigating the factors and frameworks of selected studies.
Twenty-five articles were met the inclusion criteria. Push and pull theory was the most popular way to describe the driving factors of migration. These factors were classified into three macro-, meso- and micro-level with eight key domains.  Poor income, unfavorable socio-economic situation, political instability, lack of professional and educational opportunities together with family and personal concerns found as strong common reasons perpetuating migration.
Despite the fact that health workers migrate for different reasons, they follow a same route for decision to stay or leave their home countries. Un-fulfillment of expectations in mother land in addition to media reconstructed reality of life in foreign land can develop a positive attitude for better quality of life improvement after migration. Once individuals could overpass their national identity and barriers of migration, the final decision toward migration would be more feasible.
share this Article by


1. Aluttis C, Bishaw T, Frank MW. The workforce for health in a globalized context-global shortages and international migration. Global health action. 2014;7:23611.

2. Global Migration Trends Factsheet. Berlin. Global Migration Data Analysis Centre, IOM; 2017. Accessed Accessed 13 Sep 2017.

3. Lofters A, Slater M, Thulien N. The “brain drain”: factors influencing physician migration to Canada. Health. 2013;5(01):125.

4. The world health report 2006: working together for health. World Health Organization; 2006.

5. Limb M. World will lack 18 million health workers by 2030 without adequate investment, warns UN. BMJ (Clinical research ed.). Sep 22 2016;354:i5169.

6. Robinson M, Clark P. Forging solutions to health worker migration. The Lancet. 2008;371(9613):691-693.

7. P G Chen MN-S, D Berg, A Gozu, S Rulisa, L A Curry. International medical graduates in the USA: a qualitative study on perceptions of physician migration. BMJ Open. 2011:1-8.

8. Immigrant health workers in OECD countries in the broader context of highly skilled migration. In: OECD International Migration Outlook 2007. Paris: OECD Publishing, 161–228.

9. Balasubramanian M, Brennan DS, Spencer AJ, Short SD. The ‘global interconnectedness’ of dentist migration: a qualitative study of the life-stories of international dental graduates in Australia. Health policy and planning. 2014;30(4):442-450.

10. Lee ES. A theory of migration. Demography. 1966;3(1):47-57.

11. Willis-Shattuck M, Bidwell P, Thomas S, Wyness L, Blaauw D, Ditlopo P. Motivation and retention of health workers in developing countries: a systematic review. BMC health services research. Dec 4 2008;8:247.

12. Bidwell P, Laxmikanth P, Blacklock C, et al. Security and skills: the two key issues in health worker migration. Global health action. 2014;7:24194.

13. Witt J. Addressing the migration of health professionals: the role of working conditions and educational placements. BMC public health. Nov 18 2009;9 Suppl 1:S7.

14. Davda LS, Gallagher JE, Radford DR. Migration motives and integration of international human resources of health in the United Kingdom: systematic review and meta-synthesis of qualitative studies using framework analysis. Human resources for health. Jun 27 2018;16(1):27.

15. Asadi H, Ahmadi B, Nedjat S, Sari AA, Gorji HA, Zalani GS. Factors affecting intent to immigration among Iranian health workers in 2016. Electronic physician. Jun 2017;9(6):4669-4677.

16. Stilwell B, Diallo K, Zurn P, Vujicic M, Adams O, Dal Poz M. Migration of health-care workers from developing countries: strategic approaches to its management. Bulletin of the World health Organization. 2004;82:595-600.

17. Naicker S, Plange-Rhule J, Tutt RC, Eastwood JB. Shortage of healthcare workers in developing countries--Africa. Ethnicity & disease. Spring 2009;19(1 Suppl 1):S1-60-64.

18. Dayrit M, Taylor A, Yan J, et al. WHO code of practice on the international recruitment of health personnel. Bull World Health Organ. Oct 2008;86(10):739.

19. Carnwell R, Daly W. Strategies for the construction of a critical review of the literature. Nurse education in practice. 2001;1(2):57-63.

20. Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic reviews. 2015;4(1):1.

21. Young R. Motivations and experience of health professionals who migrate to the United Kingdom. Evaluation of international recruitment of health professionals in England. Journal of health services research & policy. 2010;15(4):195-203.

22. Oberoi SS, Lin V. Brain drain of doctors from southern Africa: brain gain for Australia. Australian health review : a publication of the Australian Hospital Association. Feb 2006;30(1):25-33.

23. Astor A, Akhtar T, Matallana MA, et al. Physician migration: views from professionals in Colombia, Nigeria, India, Pakistan and the Philippines. Social science & medicine (1982). Dec 2005;61(12):2492-2500.

24. Hagopian A, Ofosu A, Fatusi A, et al. The flight of physicians from West Africa: views of African physicians and implications for policy. Social science & medicine (1982). Oct 2005;61(8):1750-1760.

25. Akl EA, Maroun N, Major S, et al. Why are you draining your brain? Factors underlying decisions of graduating Lebanese medical students to migrate. Social science & medicine (1982). Mar 2007;64(6):1278-1284.

26. Syed NA, Khimani F, Andrades M, Ali SK, Paul R. Reasons for migration among medical students from Karachi. Medical Education. Jan 2008;42(1):61-68.

27. Sheikh A, Naqvi SH, Sheikh K, Naqvi SH, Bandukda MY. Physician migration at its roots: a study on the factors contributing towards a career choice abroad among students at a medical school in Pakistan. Globalization and health. Dec 15 2012;8:43.

28. Fouad YA, Fahmy YM, Abdel Hady SM, Elsabagh AE. Egyptian future physicians are packing to leave but may be willing to return. International health. May 2015;7(3):190-194.

29. Kizito S, Mukunya D, Nakitende J, et al. Career intentions of final year medical students in Uganda after graduating: the burden of brain drain. BMC medical education. 2015;15(1):122.

30. Hossain N, Shah N, Shah T, Lateef SB. Physicians' Migration: Perceptions of Pakistani Medical Students. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. Aug 2016;26(8):696-701.

31. Tomblin Murphy G, MacKenzie A, Waysome B, et al. A mixed-methods study of health worker migration from Jamaica. Human resources for health. Jun 30 2016;14(Suppl 1):36.

32. Castro-Palaganas E, Spitzer DL, Kabamalan MM, et al. An examination of the causes, consequences, and policy responses to the migration of highly trained health personnel from the Philippines: the high cost of living/leaving-a mixed method study. Human resources for health. Mar 31 2017;15(1):25.

33. Walton-Roberts M, Runnels V, Rajan SI, et al. Causes, consequences, and policy responses to the migration of health workers: key findings from India. Human resources for health. Apr 5 2017;15(1):28.

34. Asadi H, Ahmadi B, Nejat S, et al. Factors influencing the migration of Iranian healthcare professionals: A qualitative study. PloS one. 2018;13(6):e0199613.

35. Firdous SN, Naqvi SMZH, Akhter M. Factors affecting migration abroad of dental practitioners from Karachi: A cross-sectional survey. JPMA. The Journal of the Pakistan Medical Association. 2019;69(10).

36. Labonte R, Sanders D, Mathole T, et al. Health worker migration from South Africa: causes, consequences and policy responses. Human resources for health. Dec 3 2015;13:92.

37. MM B. reasons for doctor migration from South Africa. SA Fam Pract. 2009;51(3):211-215.

38. Al-Khalisi N. The Iraqi medical brain drain: a cross-sectional study. International Journal of Health Services. 2013;43(2):363-378.

39. Bleeker H. Factors Influencing Guyanese Health Worker Migration to Canada. University of Toronto Medical Journal. 2016;93(3):27.

40. Schumann M, Maaz A, Peters H. Doctors on the move: a qualitative study on the driving factors in a group of Egyptian physicians migrating to Germany. Globalization and health. Jan 7 2019;15(1):2.

41. Akl EA, Maroun N, Li CK, Grant BJ, Schünemann HJ. Factors Influencing Lebanese Medical Students’ Decisions to Train Abroad: Evaluation of a Conceptual Framework. Open Public Health Journal. 2012;5:19-27.

42. Poppe A, Jirovsky E, Blacklock C, et al. Why sub-Saharan African health workers migrate to European countries that do not actively recruit: a qualitative study post-migration. Global health action. 2014;7:24071.

43. de Silva NL, Samarasekara K, Rodrigo C, Samarakoon L, Fernando SD, Rajapakse S. Why do doctors emigrate from Sri Lanka? A survey of medical undergraduates and new graduates. BMC research notes. Dec 16 2014;7:918.

44. Balasubramanian M, Spencer AJ, Short SD, Watkins K, Chrisopoulos S, Brennan DS. Characteristics and practice profiles of migrant dentist groups in Australia: implications for dental workforce policy and planning. International dental journal. Jun 2015;65(3):146-155.

45. Imran N, Azeem Z, Haider, II, Amjad N, Bhatti MR. Brain Drain: Post Graduation Migration Intentions and the influencing factors among Medical Graduates from Lahore, Pakistan. BMC research notes. Oct 17 2011;4:417.

46. Dohlman L, DiMeglio M, Hajj J, Laudanski K. Global Brain Drain: How Can the Maslow Theory of Motivation Improve Our Understanding of Physician Migration? International journal of environmental research and public health. 2019;16(7):1182.

47. Blacklock C, Ward AM, Heneghan C, Thompson M. Exploring the migration decisions of health workers and trainees from Africa: a meta-ethnographic synthesis. Social science & medicine (1982). Jan 2014;100:99-106.
How to Cite
HAJIAN, Sara et al. Factors influencing the migration intention of health professionals in low and middle income countries: Critical review with a theoretical model. Journal of Contemporary Medical Sciences, [S.l.], v. 6, n. 6, dec. 2020. ISSN 2413-0516. Available at: <http://www.jocms.org/index.php/jcms/article/view/897>. Date accessed: 25 feb. 2021. doi: https://doi.org/10.22317/jcms.v6i6.897.

Most read articles by the same author(s)