Health Policy Paper Series No. 18: Health workers from the Republic of Moldova: changing professions (2015)

For the period since 1995, there is no evidence about the phenomenon of internal migration in the Republic of Moldova – either migration in general or migration of health professionals from the health system, in particular. It is vital to address this in order to implement mechanisms for retaining health professionals in deprived regions, and to adjust education and employment systems to meet real needs. With the support of the WHO Regional Office for Europe and the WHO Office in the Republic of Moldova, a comprehensive study was conducted on the phenomenon of leaving the health system and abandoning the medical profession in favour of other areas of activity. 

The study reveals a number of push factors (insufficient remuneration, under-motivating working conditions, corruption and nepotism, lack of prospects for professional development, lack of adequate infrastructure, unfriendly attitudes in institutions), as well as pull factors from other areas of activity in the country (possibilities for own business, professional development, attractive remuneration, safety, less demanding working regime). The decision to change profession was frequently accompanied by a series of other factors: both material (insufficient salaries, lack of accommodation, lack of infrastructure) and psychoemotional (lack of satisfaction, burnout, lack of support from the administration of institutions). 

At the same time, selection of other employment did not influence the decision to leave the country as people are motivated by the wish to stay close to their families; the desire to preserve their dignity and avoid the humiliation of searching for a job abroad; the fear of cumbersome procedures for legalizing qualifications and obtaining work and residence permits; and linguistic barriers. 

The recommendations of the study are structured according to the level and competence of the relevant decisionmakers and include important aspects that should be tackled to keep health professionals in the Moldovan health system.