Diaspora of Brain Drain in Malaysia: Preliminary View of the Social Support Networks’ Role in the Intention to Migrate Among Healthcare Workers

The intention to migrate among healthcare workers has become a significant concern in many countries, as it challenges the stability and quality of healthcare systems. While earlier studies have primarily concentrated on individual-level factors influencing migration intentions, such as economic opportunities and job satisfaction, there is growing recognition of social support networks' role in influencing healthcare workers' migration decisions. This conceptual paper investigates the multifaceted connections between social support networks and the intention to migrate among healthcare workers, shedding light on the mechanisms underlying this phenomenon. By exploring the impact of social support networks, including professional networks, personal relationships, and community ties, this study seeks to provide insights into the complex interplay between individual and social determinants of migration intentions. This conceptual analysis will establish the groundwork for future empirical research, policy formulation, and interventions to mitigate the brain drain in the Malaysian healthcare sector, ultimately contributing to a more comprehensive understanding of the factors influencing healthcare workers' migration decisions and informing strategies to retain and attract skilled professionals.


Introduction
The development of skilled human capital is critical to achieving long-term economic growth on a global scale, and investments in the training and education of human resources are necessary for forward movement.Moreover, globalization has facilitated the movement of highly skilled individuals across borders, leading to the "brain drain" phenomenon, where highly trained people settle in other countries for better opportunities and benefits (Assfaw Vol 13, Issue 10, (2023) E-ISSN: 2222-6990 & Minaye, 2022;Balouch et al., 2022).This phenomenon harms countries that are the source of the brain drain, while it is advantageous to developed countries.The brain drain that affects developing countries causes a lack of trained professionals such as doctors, engineers, and educators, which makes it difficult for these countries to meet the Sustainable Development Goals (SDGs) (Brennan et al., 2023;Mohd Ezanee, 2023).As a result, these countries also have difficulty recruiting and training competent labour.The brain drain issue, particularly concerning healthcare workers migrating to developed nations, has become more urgent due to globalization and ageing societies.For instance, in 2017, approximately 258 million individuals migrated across international borders, with healthcare worker migration being a significant concern (Bernama, 2021).To achieve SDG 3c, the World Health Organization recognizes the importance of well-trained and motivated health workers for a robust healthcare system and has suggested maintaining a health workforce density of 4.45 per 1000 individuals (World Bank, 2019).However, there is a projected deficit of 18 million healthcare professionals by 2030, primarily in low-to middleincome nations (Ismail, 2023).This projection has prompted increased health financing and efforts to train, recruit, develop, and retain healthcare workers.The emigration rate of highly skilled individuals from Malaysia is a matter of concern, as it stands at 5.5% of the nation's population, significantly higher than the global average of 3.3% (World Bank, 2019).The emigration of highly skilled individuals can result in a deficit in a competent workforce, diminished levels of innovation and productivity, and a decline in Malaysia's overall competitiveness.The government is actively addressing the issue of skilled emigration in Malaysia by implementing initiatives and regulations to retain talented citizens.However, despite these efforts, the problem persists across multiple domains.The significant increase in the rate of healthcare professionals resigning, particularly in the Asia Pacific region, necessitates serious consideration to enhance the development of a resilient healthcare system.During the Covid-19 pandemic, Malaysia experienced a notable increase in the resignation of contract doctors in the public health sector.For merely five years 2017-2022, the attrition rate among contract doctors exhibited a remarkable surge of 1,131 per cent, escalating from 110 resignations in 2017 to a significantly higher count of 1,354 in the year 2022.Notably, the preceding year marked a significant juncture as the tally of resignations among contract medical officers crossed into four-digit figures for the first time.Due to the pressure placed on the public healthcare system during the crisis, there is ongoing concern over the potential for resignation trends to return to pre-pandemic levels (Boo Su-Lyn, 2023).One factor contributing significantly to the high rate of resignations is closely associated with job dissatisfaction.This dissatisfaction stems from various factors, including an unsatisfactory work environment characterized by inadequate facilities, inflexible working hours, limited career advancement opportunities, insufficient job security, lack of professional autonomy, and an ineffective management style.Additionally, service conditions such as low salaries, inadequate funding, and the duplication of activities further contribute to this issue.Therefore, this study aims to examine the social support networks that influence the intention of healthcare workers to migrate and offers insights into the complex decision-making process involved in considering migration.

2.0
Literature Review 2.1 Phenomenon of Brain Drain Among Healthcare Workers In the 1940s, as more highly qualified health professionals from Europe moved to the United Kingdom and the United States, this international movement became a huge public health concern (Akinwale & George, 2023).By the mid-1960s, the matter had generated sufficient concern.A study by the World Health Organization (WHO) in 2019 revealed that approximately 90% of migrating physicians were primarily relocating to five specific countries: Australia, Canada, Germany, the United Kingdom, and the United States.Although brain drain can yield advantages, such as establishing international networks or acquiring enhanced skills upon return, it can also result in substantial drawbacks for employers and workers (Botezat & Ramos, 2020;Fong & Hassan, 2017).It is imperative for governments operating within the public sector to effectively address these challenges to sustain a sufficient healthcare workforce within their respective nations.The consequences of brain drain exhibit variations contingent upon a country's level of development, wherein developed nations possess a more substantial reservoir of professionals compared to developing countries with limited resources (Liu et al., 2017).The issue of brain drain in the health industry is particularly detrimental to healthcare professionals who leave the field in search of better living arrangements and financial opportunities.The phenomenon mentioned above substantially impacts health service providers, necessitating increased allocation of resources towards training and retention endeavours.Healthcare worker migration is widespread in low-and low/middle-income countries, where healthcare professionals relocate to nations with abundant resources and from rural to urban regions (Mohammad Najib et al., 2019;Muhammad Nur Amir & Sharifa Ezat, 2020).The primary components of brain drain encompass comprehending the underlying causes of healthcare professionals' emigration, their migratory trends, and the factors that exert both attracting and repelling forces on their decision-making processes.Push factors are commonly observed in countries of origin, whereas pull factors pertain to countries of destination.The causes of brain drain encompass a variety of factors, including financial incentives, opportunities for professional growth, political circumstances, and familial considerations, among other contributing elements (Fun et al., 2021;Iqbal et al., 2021).In Malaysia, the Ministry of Health (MOH) is responsible for creating and enforcing health policies to improve the performance of the healthcare system and ensure high-quality treatment.It is essential to align the development of the health workforce with other critical components, such as service provision, information management, pharmaceuticals, immunizations, technology, financial resources, leadership, and governance.Therefore, implementing health workforce initiatives alongside the physical expansion of healthcare facilities is crucial for the sustainability of the public healthcare infrastructure in Malaysia.A well-defined plan and strategies are necessary to achieve this goal (Ismail, 2023).The depletion of medical practitioners in developing countries has substantial implications for the accessibility of healthcare, financial burdens, and the population's overall well-being.Malaysia faces difficulties in retaining and recruiting medical professionals (Ismail, 2023) and needs appropriate datasets to effectively monitor the migration patterns of its citizens who have chosen to relocate abroad.This absence of a dedicated dataset poses a significant obstacle to conducting a comprehensive analysis of the brain drain phenomenon in Malaysia.Previous studies have examined a range of factors that impact the migration decisions of healthcare professionals (Emmanuel et al., 2019;Iqbal et al., 2021).These factors include financial incentives, career prospects, educational opportunities, hospital infrastructure, political factors, and personal and familial responsibilities.Nevertheless, a dearth of scholarly investigations concerning brain drain in Southeast Asia, specifically in Malaysia, when approached from a social support network standpoint to understand this diaspora among physicians.In order to bridge this knowledge gap, the present study seeks to develop a comprehensive conceptual framework that can provide a more profound understanding of the migration intentions of healthcare professionals.

2.2
Social Support Networks Social support networks are complex systems of interpersonal relationships and interactions that individuals develop with others, providing them with a diverse range of emotional, informational, and practical assistance at times of need (Stephens et al., 2011).These networks play a crucial role in shaping individuals' psychological well-being, ability to adapt, and cognitive structures that form the basis of essential decision-making moments, especially in areas such as migration and career paths (Cohen & Wills, 1985;French et al., 2018).The following discussion explores three essential elements of social support networks: professional networks, personal relationships, and community ties.Each of these components represents unique aspects of support and influence, especially in the intention to migrate abroad.

Professional Networks
Professional networks comprise a fluid and interconnected web of relationships individuals develop within their occupational environment.These connections comprise all types of bonds, including relationships with coworkers, mentors, supervisors, and other professionals in the same field.These networks provide a valuable collection of resources closely related to one's professional development, encompassing opportunities for sharing knowledge, improving skills, exploring job chances, and receiving assistance on career progression (Nembhard & Edmondson, 2012).This information collection becomes particularly relevant among healthcare professionals, as it provides a means for exchanging knowledge regarding international job prospects, requirements for licensure, and the varying working circumstances found in other countries (Denis, 2022).In the present era, many digital platforms, conferences, workshops, and professional groups provide opportunities for healthcare professionals to establish and cultivate these connections (Kim & Fernandez, 2017).These networks play a crucial role in providing access to the most recent trends and advancements in the subject and broadening one's network of connections and potential collaborators.The influence of professional networks on migration intentions is significant in this context since they expose individuals to many paths and opportunities within their field, shaping their decision-making process (Manchin & Orazbayez, 2018).For example, the networks established through these relationships can expose healthcare professionals to prospects in nations facing shortages of specialized medical workers, thus offering a potential pathway for relocation.Furthermore, interactions within networks can yield valuable knowledge about the scope of career advancement, illustrating how migration can align with an individual's professional goals.Exploring career options and opportunities through professional networks may stimulate healthcare workers to consider migrating as they aspire for new challenges or improved career chances beyond their current environment (Assfaw & Minaye, 2022).In a more expansive framework, these networks may highlight the potential advantages of migrating and clarify the approaches to handle the practical complexities that arise during this substantial life move.For example, the guidance and practical recommendations obtained from healthcare professionals who have successfully undergone migration can contribute to making well-informed decisions and developing efficient migration strategies (French et al., 2018).Moreover, establishing interpersonal connections within professional networks can cultivate a spirit of companionship and unity, potentially mitigating apprehension associated with seclusion and adaptation in an unfamiliar setting.In summary, professional networks play a significant role in the decision-making processes of healthcare professionals regarding migration, as they strongly influence their thoughts and considerations.These networks shape the overall framework within which these professionals make their decisions.The networks have a tangible influence on the migratory intentions of healthcare professionals by providing access to alternative career paths, knowledge about global opportunities, and practical support for transitioning into new roles.

Personal Relationships
Personal relationships are crucial in human social dynamics, constituting a complex network of connections, including familial ties, friendships, and others.The emotional support and psychological nourishment obtained from these interactions play a crucial role in empowering individuals to undertake the transforming process of migration.Emotional support empowers individuals by instilling the confidence, resilience, and reassurance needed to explore uncharted territories (Lanati & Theile, 2021).Individuals within one's family and inner circle often enhance interpersonal connections, assuming roles as trusted confidants and compassionate listeners.These individuals provide diverse perspectives, guidance, and the will to take action (French et al., 2018).Furthermore, these entities fulfil significant functions as motivation providers, cultivating the notion that the endeavour of relocation might result in favourable consequences and prospects.Solid interpersonal connections are essential beyond simply emotional support within the migration framework.These relationships have the potential to serve as protective mechanisms, providing a buffer against the numerous obstacles and uncertainties that come with the process of moving to a foreign country.Providing support through personal relationships alleviates feelings of loneliness and homesickness, as individuals can exchange experiences, obtain guidance, and find comfort (Jin et al., 2022).According to Iqbal et al. (2021), establishing these relationships fosters a feeling of belonging, cultivating a sense of being firmly grounded in the unfamiliar environment, thus counteracting the destabilizing consequences of cultural displacement.Therefore, cultivating robust interpersonal connections can enhance persons' holistic and psychological well-being throughout the transformation process.On the other hand, damaged personal connections or the possibility of being separated from loved ones might be significant obstacles to the migration process (Stephens et al., 2011).The interconnectedness of cultural, familial, and social bonds amplifies their impact on an individual's migration decision.The complex network of relationships developed over time and the fear of being apart from loved ones might create concerns that discourage individuals from seeking migration.Concerns about the potential degradation of familial and cultural ties and feelings of guilt associated with leaving family members or dependents behind may increase these concerns (Manchin & Orazbayez, 2018).The significance of personal ties and the emotional connections they entail plays a significant role in the decision-making process, wherein the potential consequences of these relationships are given considerable importance and are thoroughly evaluated compared to the potential advantages of migrating.In conclusion, personal relationships exert a significant impact on the migratory intentions of individuals.These relationships serve as powerful motivators by providing emotional support, encouragement, and a sense of belonging, which foster the necessary confidence to embrace the act of migration.Concurrently, troubled relationships or the possibility of separation can elicit apprehensions and discourage individuals from beginning these transformative journeys.The amalgamation of cultural, familial, and social connections influences individuals' evaluations of the diverse ramifications of migration, encompassing both the possible benefits and trade-offs entailed.

Community Ties
Community ties encompass a complex network of social connections that extend beyond the confines of familial relationships and intimate friendships.The complex network stands out through its associations with religious, cultural, or social institutions and active engagement in communal events and activities.The ties mentioned above effectively cultivate a deeprooted sense of self, a sense of inclusion, and a smooth assimilation into the social structure (French et al., 2018).Healthcare professionals establish connections with colleagues, peers, and support groups within the healthcare field, adding significance and relevance to their working experiences (Brennan et al., 2023).In the context of healthcare, community connections provide a diverse range of support to those considering migration.Lanati and Theile (2021) assert that practical support entails disseminating knowledge about migration processes, necessary prerequisites, and the diverse opportunities individuals can access.Sharing experiences among individuals within a community who have undergone comparable travels is a source of guidance, offering direct insights into the difficulties, successes, and adaptive techniques linked to the relocation process (Kim & Fernandez, 2017).Healthcare professionals often carry a profound sense of emotional support as they move, deriving from shared experiences of overcoming challenges and attaining accomplishments.This support instils in these professionals a revitalized sense of purpose and fortitude.Providing emotional support can be especially significant during challenging adjustment periods since it helps alleviate feelings of loneliness and enhance psychological welfare (Emmanuel et al., 2019;Assfaw & Minaye, 2022).Community networks provide a mechanism for individuals to navigate the complex array of changes associated with the migration process.When individuals find themselves in unfamiliar surroundings, they often encounter significant challenges due to differences in language and culture (French et al., 2018).However, community connections can help overcome these obstacles.According to Jin et al. (2022), the existing networks serve as conduits, facilitating an understanding of indigenous traditions, conventions, and behaviours.Furthermore, establishing common affiliations within the group promotes a faster acculturation process and facilitates a more seamless absorption into the host society.This affiliation facilitates the transfer of healthcare professionals into their new roles, enhancing their effectiveness and fostering a greater sense of belonging (Assfaw & Minaye, 2022).In conclusion, the strength of healthcare professionals' community connections significantly influences their migration intentions.These networks significantly influence individuals' migration decisions by providing comprehensive support mechanisms that include practical aid, shared experiences, emotional support, and guidance in adapting to a new culture.Community ties play a crucial role in the complex web of elements that individuals consider when contemplating a substantial life transition, as they serve as vehicles for identification, belonging, and social integration.

Conclusion
In the current period, healthcare systems in various countries face the challenges posed by the movement of healthcare workers.Consequently, there is an inescapable need to comprehend the fundamental mechanisms contributing to this phenomenon.Existing scholarly literature has focused on individual-level elements influencing migration intentions, such as economic opportunities and job contentment.However, there is a growing recognition of the significant influence exerted by social support networks in shaping these choices.This conceptual article signifies a significant advancement in exploring the complex relationship between social support networks and the migratory aspirations of healthcare workers.It sheds light on the numerous mechanisms that govern this diverse interaction.Through a comprehensive examination of social support networks, which encompass professional networks, personal relationships, and communal ties, this study aims to elucidate the complex dynamics between individual and collective factors that shape migratory intentions.The combination of these observations sets the stage for future empirical investigations, the development of practical strategies, and the implementation of specific initiatives aimed at addressing the issue of brain drain in the healthcare sector of Malaysia.In essence, this endeavour results in an enhanced understanding of the various elements that influence the decisions of healthcare workers to migrate, thus guiding the development of strategies aimed at both retaining and attracting competent healthcare professionals to strengthen the healthcare sector.This study has the potential to make a significant scholarly contribution by elucidating the indispensable function of social support networks in comprehending and forecasting job goals within the realm of health professionals.In the contemporary epoch of globalisation, the matter of employment relocation within the health sector has assumed heightened importance and urgency.This study illuminates the significance of social support networks in connection to employment decisions and intentions to remain in the healthcare sector.Specifically, it examines the influence of several social factors, including professional networks, personal relationships, and community ties.Furthermore, with its exclusive emphasis on Malaysia as the primary research topic, this study offers a pertinent contribution to the comprehension of the genuine challenges that the nation presently confronts in the retention and attraction of skilled professionals in the healthcare industry.This study additionally contributes to a broader comprehension within a larger scope by emphasising the significance of social elements in the process of making crucial decisions regarding occupational migration.The examination of the significance of professional networks, personal relationships, and community ties in relation to employment and migration holds relevance not only for Malaysia but also offers valuable insights for other nations grappling with comparable issues in the maintenance and management of their healthcare workforce.Furthermore, this study provides insight for the academic community and practitioners about the importance of considering social support networks in the context of occupational migration.It highlights the need to move beyond individual characteristics and recognise these networks' significant impact on shaping job decisions and migration intentions.Therefore, this study is a significant scholarly contribution to the current body of knowledge and holds extensive implications for addressing global health workforce challenges.