It is well known that the health workforce is unevenly distributed worldwide, and the World Health Organization has presented this issue as the basis for one of the sustainable development goals (SDGs) to progress towards global health goals (22). Predicting the intention to migrate in the future among the health workforce, including pharmacists, worldwide will be the first step to improve the worldwide uneven distribution of the health workforce. This study describes some differences in intention to migrate among respondents from countries with different income levels as defined by the World Bank classification.
Regarding the length of stay in the host country, the present results might be related to the motivation to migrate. The findings on the motivation to migrate to another country chosen by more than 50% of respondents showed that respondents from upper-middle-, lower-middle- and low-income countries chose many of the motivation items, while respondents from high-income countries chose only one, i.e., “to gain new experiences” (Table 3). And “to gain new experiences” choose by high-income countries might be able to get them in short term such as travel less than other motivation, such as “better pay/salary”, “better job opportunities”, “better professional development and training opportunities”, “better carrier pathways” and “better lifestyle and quality of life”. Because “Better pay/salary” or “job opportunity” or “professional development” require a substantial amount of time, and a “better lifestyle and quality of life” require living in the host country, it’s mean the “long term or permanently”. Therefore, differences in motivation might be related to the length of stay in the host country (Table 3 and Table 4). In a previous study, these motivations were reported to be “push-pull factors”, and our findings on motivation were similar (11, 23). However, our study has shown that the length of stay in the host country is related to motivation.
Respondents’ satisfaction with their initial pharmacy education (assessed as the number of respondents who answered “Strongly agree” or “Agree”) was similar in countries of all income levels, while satisfaction with the work of pharmacists in the home country among respondents from upper-middle-, lower-middle- and low-income countries was low. Satisfaction with the home country was also low, except for among respondents from high-income countries, and was polarized. Therefore, the degree of satisfaction might relate to an intention to migrate. In fact, a migration survey in South Africa in 2015 showed that the health workforce was dissatisfied with government economic policy and government health sector policy, which were the top rated reasons for wanting to migrate (9). A survey of pharmacy students in Ghana in 2008 showed that the students were disillusioned by pharmacy and that they perceived barriers to the achievement of professional aspirations in Ghana (14). These results were similar to the results in our study. Therefore, to improve the uneven distribution of the health workforce, countries that lack a health workforce might need to review government health policies or career development systems related to the health workforce. Moreover, the health workforce generally requires professionalism, including self-development (24). If members of the health workforce cannot develop their competencies in their home countries, they will naturally seek to migrate to countries where they can acquire or develop competencies. Almost all pharmacy students learn of the need for lifelong learning in initial pharmacy education. And their satisfaction with initial pharmacy education was not low in this survey. Therefore, to improve the uneven distribution of pharmacists, an education system that connects initial pharmacy education and lifelong education might need to be created or altered to address the role of pharmacists in each country. To that end, we need to share knowledge and practices related the development and implementation of lifelong learning systems and the role of pharmacists in various countries worldwide through studies and the work of international organizations (21).
Regarding satisfaction with the home country, there are many issues, such as salary, security and safety. All people have the agency or personal resources to establish their own goals, but no one can choose where they are born. If an individual aspires for a better salary, a better lifestyle and better safety, we cannot stop their ambitions. Therefore, we might need to provide political or economic support across the world as described by the UN development goals.
According to the World Bank classification, essentially, there are 80 high-income countries, 60 upper-middle-income countries, 47 lower-middle-income countries, and only 31 low-income countries (20). In our study, there were only 57 students and pharmacists from low-income countries. A limitation of our study was the number of respondents from low-income countries was small, and thus, the results might not accurately reflect the status of low-income countries. Further studies are needed in low-income countries, although a previous study showed similar results to ours.