📖 ABSTRACT/OVERVIEW
Background: The chronic attrition of family medicine practitioners from Nigeria's health system, driven by emigration and intersectoral migration, represents a critical threat to primary care sustainability. A systems-level analytical approach is required to understand and address this complex workforce challenge. This study applies complex adaptive systems theory to model the determinants of family medicine workforce retention in Nigeria. Methodology: A multi-method systems analysis was conducted across four geopolitical zones. Agent-based modelling simulated interactions between workforce determinants including remuneration, professional development, working conditions, and policy incentives. System dynamics modelling integrated longitudinal workforce data from the Medical and Dental Council of Nigeria. Qualitative causal loop diagramming sessions with 40 key informants validated model assumptions. Results: Feedback loops involving remuneration dissatisfaction, supervisory neglect, and stagnated career progression were identified as the dominant retention-reducing cycles. Policy levers including rural incentive packages and fast-tracked specialist accreditation showed the highest retention impact in simulation scenarios. Conclusion: This study contributes an original complexity-informed model of family medicine workforce retention with direct implications for Nigerian health workforce policy. Targeted system interventions must address interconnected structural deterrents simultaneously rather than in isolation. Keywords: workforce retention, family medicine, complex adaptive systems, health workforce, Nigeria
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