Betrayal to border crossings: the mediated-moderated trajectories in psychological contract breach to migration intentions among Ghanaian healthcare professionals

What is it about?

Many African countries, including Ghana, are experiencing high levels of health worker migration. While low pay and poor infrastructure are often cited as key reasons, this study shows that everyday workplace experiences also strongly influence health professionals’ decisions to consider working abroad. This study examined whether healthcare professionals are more likely to think about migrating when they feel that their employer has failed to keep important non-financial promises. These promises include having a safe and supportive work environment, access to training, opportunities for career growth, involvement in decision making, and adequate support from managers. When such expectations are not met, workers may feel disappointed, stressed, and undervalued. We also explored whether reduced well-being explains this relationship and whether emotional resilience helps some workers cope better than others. Data were collected from healthcare professionals working in three teaching hospitals in Ghana using a short two-wave survey design. The findings show that perceived broken promises increase migration intentions mainly because they reduce workers’ psychological well-being, social well-being, and satisfaction with their workplace. However, healthcare professionals who are more emotionally resilient are better able to cope with these challenges, which lowers the likelihood that unmet expectations will lead to plans to migrate. The study suggests that reducing health worker migration requires more than financial incentives. Strengthening supportive work environments, improving staff well-being, and building emotional resilience can play an important role in retaining healthcare professionals in resource-constrained health systems.

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