The “Japa-Japada” construct: A theoretical framework for exploring the recent medical brain drain scourge in Sub-saharan Africa and the potential medical reverse brain drain

The emigration of professionals particularly doctors, colloquially known as “Japa”, has created a critical shortage in the country’s healthcare workforce. This mass exodus has contributed to one of the world’s lowest doctor-to-patient ratios being Nigeria, the focus of this research. In contrast, “Japada”, refers to the potential return of these emigrated professionals, offering an opportunity to mitigate the healthcare crisis. This study introduces the “Japa-Japada” construct, framed within the push-pull theory, to explore the factors driving both medical brain drain and those encouraging medical reverse migration. Leveraging Confirmatory Factor Analysis (CFA) and Structural Equation Modelling (SEM), this research investigates the dimensional drivers for Nigerian doctors' migration decisions, focusing on existential, social, growth, economic, and political factors. The statistical validation demonstrated the model fitness and ranked the critical push factors responsible for medical brain drain as social, political, existential, growth, and economic, respectively and the pull factors as political, economic, social, existential and growth respectively. Conversely, for potential medical reverse brain drain, the key push factors were ranked as growth, social, economic, political, and existential, while pull factors such as social, existential, economic, growth, and political dimensions showed a strong propensity to influence doctors' return to Nigeria. The findings emphasize the complex interplay between push-pull factors and mediating elements such as immigration policies within the broader socio-political landscape whereas validating the insignificance of the moderating elements. Thus, contributing to the global understanding of medical migration and offer actionable strategies for retaining and attracting skilled healthcare professionals in low- and middle-income countries.