Factors contributing to the emigration and retention of health workers in Bhutan

BackgroundBhutan faces challenges maintaining an adequate health workforce, exacerbated by a post-COVID-19 exodus. Little is known about the reasons for emigration from Bhutan, known for its happiness and stable governance, and about mitigation strategies. This study aims to identify drivers of emigration and explore potential strategies for improving health worker retention. MethodA narrative literature review was conducted in the context of Bhutan and similar settings, complemented by seven semi-structured interviews with researchers, policymakers, and health managers. FindingsBhutan has witnessed a surge in health worker departure post-COVID-19, particularly young professionals. Data from various sources underscore its gravity. Better financial opportunities, career prospects and a shift towards a materialistic mindset in Bhutanese community drive emigration. Societal pressure and family are both push and pull factors for health workers. Existing retention policies encompass financial incentives and bonds, but their impact remains to be evaluated. Drawing inspiration from global practices, strategies like circular/return migration, bilateral agreements, task shifting, and community engagement present promising avenues to mitigate emigration and fortify retention initiatives in Bhutan. ConclusionThe study highlights the inevitability of emigration in a globalised world. While financial incentives and career opportunities are crucial, addressing societal factors and social values in retaining health workers is equally essential. By upholding the "right to move" while safeguarding the "right to health," Bhutan can foster a sustainable and resilient health workforce.