Abstract
Brain drain is one of the most serious challenges that health systems face in many developing countries. Malawi is not an exception. The determinants of brain drain phenomenon vary across regions and the brain drain of nurses is assuming an increasingly important role in the developing world. This issue has received great attention in recent years. Brain drain studies mostly in developing countries have fallen short of investigating determinants of brain drain from a source country perspective because the focus is mainly on the nurses who have already migrated. In this regard, this research fills the gap by adding to the understanding of major determinants of brain drain among registered nurses in the Malawi health sector. The problem with the knowledge gap is that it makes various stakeholders and experts fail to come up with strategies and measures in an informed, well-focused and systematic manner.
The study employed a qualitative approach and implemented in six public hospitals in rural and urban settings in Malawi to determine the factors of brain drain of registered nurses. The qualitative data were elicited from registered nurses and key informants using semi-structured interviews and focus group discussions. 18 nurses, 9 key informants and 3 focus group discussions of nurses were targeted to provide empirical evidence of determinants of brain drain in the Malawi health sector. The data were analysed using content analysis. Content analysis involved transcribing and reading thoroughly all interviews before identifying themes that were more recurring than others. This allowed compressing many words of text into fewer categories.
The findings of the study reveal the determinants of brain drain among nurses in the Malawi health sector. These factors are low salaries, delays in paying salaries, delays in adjustment salaries, high tax, regionalism, nepotism and tribalism, diseases, heavy workload, long working hours, non-provision of nurse uniform, non-provision of meals and non-provision of medical cover. Furthermore, the findings show that the lack of equipment, lack of medication, small and congested wards, the lack of training opportunities, the lack of scholarships, favouritism and non-reinforcement of bonding contracts are factors that contribute to brain drain of nurses in the Malawi health sector.
This research contributes to the enrichment of the theoretical knowledge pool of determinants of brain drain of registered nurses in the Malawi Health Sector and offers guidance to policy makers and hospital managers most appropriate strategies and measures to put in place to prevent the further loss of these much-needed professionals to keep the Malawi health sector system functional.