Table 3.

Reported results by main themes of a systematic review of health-care worker retention research in post-conflict settings, published between 2000–20

	Theme	Results
INTRAPERSONAL	Migration intention	70% Of nursing students express their intention to emigrate and identify financial renumeration as the most important factor for that intention (Hagopian et al., 2009).
	Rationale for leaving	Reasons to leave include lack of opportunity for higher income, desire to increase quality of life for family, dissatisfaction with general practice and reluctance to wait for consultant posts (Kiwanuka et al., 2017).
		Fear of civil instability and need to gain competitive advantage in oversaturated job market play role in decision to migrate (Witter et al., 2018).
		Reasons to leave include low salary, lack of continuing education, being overburdened and poor or absent equipment in health facilities (Chirwa et al., 2014).
		Significant relationship is found between condition of service, professional development and foreign development and migration intentions (Namakula and Witter, 2014b).
		Perceived better benefits, better job security and public incentives, more flexible leave entitlement and dual practice rules contributed to shift from private not-for-profit to public sector (Namakula and Witter, 2014a).
	Rationale for staying in service	Reasons to stay include lower importance of salary to the HCW, active involvement in facility, manageable workload, flexibility to balance demands of workplace and personal life and better opportunities for promotion. Older respondents are less likely to indicate desire to leave job and doctors most likely to report interest in leaving (Wood et al., 2013).
		Reasons to stay include community support, appreciation, effective working conditions, learning/developing skills, formal promotions, employment benefits, good leadership and communication, regular and adequate pay and flexible working (Martineau et al., 2017).
		Reasons to stay include personal calling, personal connections, prosocial motivations and local ties (Witter et al., 2017b).
		Workforce who lived through conflict and continued to work, usually mid- and lower-level cadres, are heavily female-dominated (Witter et al., 2017d).
	Return migration	Repatriation of physicians educated abroad contributes to international emigration of recent medical graduates due to an oversaturation of the labour market (Nguyen et al., 2008).
		Reuniting with family and completing the ‘mission’ of contributing to rebuilding the country are key pull factors for return migrants (Baba et al., 2020).
ORGANIZATIONAL	Work experiences	Workforce attributes of being locally employed, longevity of tenure, lack of qualification mobility and monolingual status may enhance retention (Okolo and Iruo, 2021).
		Poor working conditions, including shortages of qualified health workers, lack of equipment supplies and professional support and not receiving monthly salary negatively impact retention (Miyake et al., 2017).
		Conflict negatively impacts retention as HCWs afraid to go to work leave the country, or leave posts to seek refuge elsewhere (Witter et al., 2016).
		Providing relevant opportunities, accreditation and recognition could lead to retention (Microsoft Corp, 2019).
	Conditions of service	Health workers are specifically targeted, leaving lasting trauma while also carrying out roles above their station. Human resource management and information systems collapse including the fragmentation of renumeration and incentives packages linked to multiple actors (Finlay et al., 2011).
		Insufficient supportive supervision, delayed or insufficient provision of necessary equipment and supplies, poorly functioning referral systems, lack of continuing education opportunities and contested or undervalued professional status negatively impact retention (Roome et al., 2014).
		Attacks against health workers and political challenges contribute to the flight of health workers in post-conflict settings (Bdaiwi et al., 2020).
		Training opportunities, salary incentives and technical assistance, standardizing NGO salaries to match government pay to prevent outflow and reopening training institutions contributed to increasing the number of nurses and midwives (Akl et al., 2007).
POLICY & COMMUNITY	Deployment policies	Inflexible, strict, no change in deployment for a long time leads to attrition (Varpilah et al., 2011).
		Flexibility in deployment policies improves retention (Mangwi Ayiasi et al., 2019).
		Inability to sustain staff formerly employed by NGOs that depart, the inability to retain staff who did not originate from the region, brain drain to nearby nations for attractive salaries, fear that conflict will recur and lack of social amenities for health workers and their families in their current districts or places of work worsens retention. Recruitment and retention of HCWs (doctors and skilled cadres) is a greater challenge than lower cadres (nursing assistants) (Bronfenbrenner, 1979).
		Salary uplift contributed to better retention, especially for higher-level staff (Mashange et al., 2019).
		Remuneration is the single most important factor influencing health worker’s behaviour related to attrition (Witter et al., 2017c).