ABSTRACT

BACKGROUND: The health workforce is a crucial component of any functional health system, playing a pivotal role in delivering clinical and public health services. The availability, accessibility, acceptability, and quality of healthcare workers are paramount to achieving the highest standard of health. Crises within the health workforce pose significant challenges to global health system development, especially in Africa.

OBJECTIVES: In this study, we sought to assess the knowledge, attitude, prevalence, reason and determinants of health workforce attrition among healthcare workers in public health facilities in Benin City.

METHODOLOGY: A descriptive cross-sectional study design was used. The study was carried out among healthcare workersin public health facilities in Benin City, Edo state from December 2022 to December 2023. The sample size was calculated using Cochran’s formula for descriptive studies. A multi-stage sampling technique was utilized for the study. Data was collected using a structured self-administered questionnaire adapted from the Attitude Scale for Brain Drain and Brain Drain Questionnaire. Secondary data on employment and attrition in the last three years was collected from the tertiary facility to determine the facility’s health workforce attrition rate. Data was analyzed using the IBM SPSS version 25.0 and the level of significance was set at p < 0.05. Data was presented using prose, frequency tables, and graphs.  Ethical approval was obtained from the Ethics and Research Committee, University of Benin Teaching Hospital.

RESULT: A total of 711 respondents was used for this study with mean age ± SD (31.86 ± 7.01). The majority of respondents 535 (75.2%) were aware of health workforce attrition, primarily through the Internet. A significant portion of respondents 505 (71.0%) demonstrated good knowledge. Nearly all respondents 674 (94.8%) expressed a positive attitude towards health workforce attrition, with younger age (p < 0.001), working in tertiary facilities (p = 0.003), and good knowledge (p = 0.042) being associated with a positive attitude.

Nearly all respondents 694 (97.6%) are aware of HCWs leaving the country, with 477 (67.1%) expressing an intention to migrate, primarily to Europe and North America. Factors such as age (p = 0.004), gender (p = 0.019), good knowledge (p = 0.035) and positive attitude (p < 0.0001) towards HWF attrition significantly influenced the intention to migrate.

The prominent pull factors contributing to HWF attrition are the availability of better salary offers, up-to-date technological equipment, better standard of living and educational opportunities for children. Push factors indicated by respondents were as poor salary and working environment were key reasons for their intention to migrate.

Secondary data on employment and attrition in the tertiary health facility in the last three years revealed an overall HWF attrition rate of 615 (14.4%) from an average workforce size of 4,200, with more than half of the attrition being attributed to voluntary factors.

CONCLUSION: The study showed that the majority of the respondents were aware of health workforce attrition with more than half possessing good knowledge on the subject. The majority of respondents had a positive attitude towards health workforce attrition. The majority of respondents had the intention to migrate to other countries for work, with a timeframe for migration within the next two years. The preferred destination for those intending to migrate was predominantly Europe. Pull factors emerge as more influential than push factors in influencing health workforce attrition decisions.

Keywords: health workforce attrition, health system, pull factors, push factors