Printed in Nigeria HEALTH CARE PROVIDERS MIGRATION AND BRAIN DRAIN PHENOMENON: PERCEPTION OF HEALTH CARE WORKERS IN LAGOS STATE IN SOUTHWESTERN NIGERIA

Introduction: As the movement of trained health care personnel out of developing countries in search of greener pastures continues, an end is not yet in view to the weak health systems created by imbalances and costs associated with brain drain in affected countries. The objective of this study is to determine knowledge and attitude of health care workers in Lagos State towards brain drain Methods: Descriptive cross sectional study of causes, implications and solutions to the phenomenon of brain drain among 600 health care workers in Lagos State, using multi stage sampling method. Research instruments were semi structured self administered questionnaires, and data was analyzed using the SPSS softwares. Association between categorical variables was determined at a P value<0.05. Results: Common causes of brain drain include a search for more money 504(84.0%), improved or higher technology 220(36.7%), and improved living conditions 519(86.5%). Felt implications of brain drain includes a shortage of health manpower 443(73.8%), dearth of highly skilled health care workers 348(58.0%), and reduction in quality of care in 404(67.3%) of respondents. Recommended solutions include the motivation of health workforce financially and professionally 556(92.7%), strengthening of the health systems 412(68.7%) and provision of a better living conditions for health care workers in 337(56.2%) of respondents. Conclusions: Causes of brain drain could be addressed if all relevant stakeholders strengthen the social and health system including better living conditions for both the society and health care providers KEYWORDS; brain drain, health care workers, health systems. INTRODUCTION Human resources are very important among the resources needed for delivery of services in any sector, both in the developing and more developed world. The World Health Organization in 2002 equally reaffirmed that Human Resources for Health (HRH) are central to managing and delivering health services. It has also been recognized that insufficient human resources for health in developing countries have been identified as one of the main constraints limiting initiatives towards the achievement of the Millennium Development Goals (WHO and CDC 2004). The movement of trained health personnel out of developing countries is one of the numerous health crises facing the African continent. This phenomenon of “brain drain" has been described as rich countries "looting" doctors and nurses from developing countries (James 2005). However a closer look at the evidence for and against the medical "brain-drain" stress the potential gains in managing medical migration to produce outcomes that are beneficial to individuals, households and the country. Globally, imbalances in the health workforce, partly influenced by the decision by these health professionals to migrate to parts of the world where incentives are better, tend to be influenced by a broad range of political, social, economic and professional factors, several of which are beyond the control of policy makers within the health sector (Vujicic 2004). As a result, the health worker population ratio is better in the urban and the developed countries as compared to the rural and the developing countries where health services are needed more in view of their poorer health indices. The cost associated with the “brain-drain” phenomenon includes reduced quality of care in public hospitals in the country (Daily Times 2005, Malawi CWQ 2002), loss of public educational investment and intellectual