Cadre-Specific Factors Associated with Turnover and Migration Intentions in a Resource- Constrained Health System in Northern Nigeria

Abstract Background Persistent turnover and rising migration intentions among skilled health workers (SHWs) undermine service continuity and workforce stability in resource‑constrained health systems. Understanding the determinants of both turnover intention and migration intention is essential for addressing this crisis. Methods We conducted a cross-sectional survey among SHWs across northern Nigeria. Multivariate logistic regression models identified factors independently associated with turnover intention and migration intention, reported as adjusted odds ratios (aOR) and 95% confidence intervals (CI). Analyses were further stratified by specific professional cadres (doctors, nurses, and allied health professionals [AHPs]) to capture cadre-specific determinants. Results Overall, 865 SHWs were included, of whom 59.0% were male, 55.6% were Hausa-Fulani, 64.0% were married, and 45.2% had less than five years of experience. Turnover and migration intentions were reported by 86.1% and 84.6% of the workforce, respectively. In the final multivariate models, male sex (vs. female) was associated with higher odds of migration intentions (aOR = 2.71, 95% CI: 1.74–4.21, p < .001), especially among doctors (aOR = 3.65, 95% CI: 1.91–6.97, p < .001). SHWs in rural settings had a higher likelihood of turnover intention (aOR = 2.11, 95% CI: 1.09–4.08, p = .028). Furthermore, low organisational commitment was a strong independent determinant of migration intention among doctors (aOR = 5.32, 95% CI: 2.54–11.14, p < .001) and nurses (aOR = 4.37, 95% CI: 1.89–10.09, p = .001). Among AHPs, income below NGN 250,000, reflecting economic vulnerability, was associated with six times higher odds of intention to migrate (aOR = 6.07, 95% CI: 2.18–16.93, p = .001). Notably, belonging to the Hausa-Fulani ethnic majority group was associated with lower odds of intention to migrate for both nurses (aOR = 0.26, 95% CI: 0.11–0.62, p = .002) and AHPs (aOR = 0.39, 95% CI: 0.16–0.97, p = .043). Conclusion While economic vulnerability may drive migration intentions, particularly among AHPs, improving organisational commitment and workplace social support is paramount for retaining doctors and nurses. Effective SHW retention strategies will require cadre-specific and culturally grounded policies that strengthen organisational commitment and leverage local social capital to address the persistent shortage of SHWs in Northern Nigeria.