Among the factors introduced in Model 2, a negative but significant association was found between intention to migrate and those aged 25-29 (OR = 0.37, p = 0.001), as well as women (OR = 0.57, p = 0.010). In other words, students aged 20–24 are 2.7 times more likely to migrate than

those aged 25–29, whilst men are 1.8 times more likely than women to migrate. A similar procedure was followed in addressing the hypothesis that fee paying medical students are significantly more likely to feel they owe no allegiance to the government of Ghana. Again this was confirmed as shown in Models 3 and 4. With only fee status in Model 3, a very strong and significant association was found between fee status and non-allegiance to the government of Ghana based on fee status. SAR405838 in vivo Fee paying medical students were about nine times more likely (OR = 8.91, p = 0.000) to feel they owe no allegiance to the government of Ghana based on their fee status. The association became stronger (OR = 9.66, p = 0.000) when background factors were fitted in Model 4. None of the background factors considered in the model was statistically significant. Discussion This study suggests that the students’ fee-paying

status does affect their intentions to migrate after the completion of their training. This is a relatively new and emerging factor to be considered (in addition to the traditional selleck products post-graduation ‘pull’ and ‘push’ factors) in strategies aimed at curbing excessive health worker migration. In the currently widely favoured neo-liberal economic model, the trend is for more and more central governments to gradually shift from a fully public funded tertiary education through shared funding, and on to full fee paying training. In the study by WHO-AFRO, the reasons given by health personnel for their intention to emigrate from Ghana largely centered on socio-economic

and professional development issues.10 Whilst several studies have looked at the brain drain in Africa and the migration of doctors, we found none that specifically attempted to understand the role of educational funding mechanisms in influencing the desire to migrate. This study Carnitine palmitoyltransferase II argues that the seeds of flight are now being shown a lot earlier, with those who have funded their own education intending to leave well before even experiencing the traditional push factors. At the time of previous studies, fee payment was not an issue as it is today in local medical education and was not considered as a factor in their final analysis8,16 This study found a similar percentage of medical students having the intention to migrate compared with earlier work done among actual graduates of Ghanaian Medical schools (49% in this study versus 50% 4.5 years after graduation8). This appears higher than the average found in a study of medical students from six African countries (excluding Ghana) where about one fifth (21%) intended to relocate outside sub-Saharan Africa.