Draining the Lifeblood from Nigeria’s Healthcare System an Investigation of Critical Drivers of Brain Drain in Lagos’ Public and Private Hospitals

Abstract

High rates of healthcare workforce emigration (“brain drain”) pose a critical challenge in Nigeria, depleting the health system of skilled professionals. This study investigates critical workplace factors driving healthcare professionals’ intentions to emigrate from Lagos State, Nigeria. A cross-sectional survey of 860 physicians, nurses, and other health workers from public and private hospitals was analysed using structural equation modelling to test the effects of five quality-of-work-life factors: workload, workplace safety, professional autonomy, perceived organisational support, and non-wage benefits on migration intentions. The structural model revealed that workplace safety was the most potent driver of brain-drain intentions, followed by workload and professional autonomy. Unsafe working conditions and excessive workloads significantly heightened intentions to migrate, while limited decision-making autonomy also contributed to higher migration propensity. In contrast, greater perceived organisational support and more robust non-wage benefits were associated with reduced migration intentions, although their mitigating effects were comparatively modest. These findings underscore that beyond low salaries, poor working conditions and lack of support drive healthcare brain drain. Policy interventions focusing on improving workplace safety, balancing workloads, and enhancing professional autonomy, along with strengthening support and non-monetary incentives, are critical to retaining healthcare talent. The study further contributes to the literature by demonstrating the decisive role of quality-of-work-life factors in driving health workers’ migration decisions.