By Kola King
The recent news reports in which the President of the Nigeria Medical Association (NMA), Dr. Uche Rowland Ojinmah indicated that over 10,000 doctors have migrated to the United Kingdom in search of greener pastures is enough reason to declare a state of emergency in the health sector. Others have found their way to Canada, Australia and the United States of America. This revelation is a wake-up call demanding that government rise up to the challenge and take urgent steps to fix the rot in the healthcare sector. There’s urgent need to reconfigure the healthcare architecture in the country in a bid to stem the tide of outward flow of healthcare professionals to the developed countries.
Apart from doctors who are at the apex of the healthcare system, other critical healthcare workers such as nurses and midwives, pharmacists, physiotherapists, and medical technologists are also leaving in droves in search of professional fulfillment and greener pastures abroad. Also, the Pharmaceutical Society of Nigeria has lamented that over 5000 pharmacists have left for greener pastures in the last five years. The President of PSN, Professor Cyril Usifoh disclosed this at the 95th annual conference of the Society. Clearly, all this have brought to the fore the dire straits in which healthcare services have sunk in almost eight years of the All Progressives Party (APC) administration. Though it’s important to state that past administrations have paid scant attention to the health sector as well.
Moreover, Dr. Rowland Ojinmah said statistics have revealed that between 1 January and 30 September, about 1,307 Nigerian-trained doctors were licensed in the United Kingdom (UK) as the country continues to battle one of the worst brain drains in its history. He said Nigeria has the highest number of foreign doctors in the UK after India and Pakistan. What is more, the NMA President lamented the brain drain bedeviling the country, saying Nigeria is currently left with about 24,000 actively licensed medical doctors caring for over 200 million population, meaning it is one doctor to 10,000 patients.
Also, he expressed regret that the Nigerian government has not done a comprehensive review of health workers’ salaries since 2009 despite inflation. This, he said, has combined with annual poor budgetary allocation to the health sector, and impacted the country negatively.
According to Scientific American, in the U.S., there is one doctor per every 385 individuals. In South Asia, there is one physician for every 1,250 individuals. But in Sub-Saharan Africa, on average there is one doctor per 5,000 people with some countries faring far worse. For example, Tanzania has 1 doctor per 71,000 individuals. Roughly half of the Sub-Saharan African countries suffer a loss of more than 30 percent of the doctors they train. This equates to tens of thousands of doctors. Roughly equal numbers of nurses from such countries also immigrate to developed countries.
Speaking earlier on the doctor-patient ratio at an event organized by the National Institute for Policy and Strategic Studies in collaboration with the Partnership for Advancing Child and Family Health, Dr. Ojinmah said that: “Available data places it around 24,000 giving a horrible true ratio of approximately 1:10,000. This ratio of 1:10,000 is a national average but in most states, the situation is palpably worse.”
According to Dr Ojinmah, the situation is worse in the northern part of the country where one doctor is available to treat 45,000, disclosing that in rural areas, people travel more than 30 kilometers before accessing a healthcare facility.
“Based on WHO established minimum threshold, a country needs a mix of 23 doctors, nurses and midwives per 10,000 population to deliver essential maternal and child health services. This explains why Nigeria ranks as one of the countries with the worst maternal and child mortality rates,” Dr Ojinmah added.
The mass exodus of healthcare professionals, especially doctors, pharmacists, and nurses has been a burning issue in the country. A 2017 survey by the Nigerian Polling organization (NOIPolls) in partnership with Nigeria Health Watch, revealed that about 88 percent of medical doctors in Nigeria were seeking work opportunities abroad at the time. Earlier this year, the Medical and Dental Consultants Association of Nigeria (MDCAN) said more than 100 of its members left the country within 24 months. Similarly, in 2018, the National Association of Resident Doctors (NARD) said at least 12 of their colleagues leave Nigeria every week to practice overseas. A 2022 UK immigration report also showed that 13,609 Nigerian healthcare workers (including doctors) were granted working visas in the past year, making the country second only to the 42,966 from India.
At the heart of the problem, Dr. Rowland Ojinmah observed, is the fact that Nigerian doctors are poorly paid, overworked, lack necessary work tools, “and have become a target for kidnapping.” He said the medical profession has been taken from the lofty heights of nobility to nothingness by the neglect and possible disdain for the health sector by successive governments.
“The penchant of state governments for seizing or slashing our salaries and paying it piecemeal at their convenience without interest has become a subject of folklore and hence, cannot be allowed to continue,” he said. Dr Ojinmah further called for the review of the Consolidated Medical Salary Scheme (CONMESS), adding the need for increased hazard allowance for health workers.
The grim picture of the health sector presented by Dr Ojinmah is a mix of factors which include general neglect of the health sector by successive governments, economic downturn, and worsening insecurity in the land. Despite the Abuja Declaration of 2001 which advocated a 15% budgetary allocation to the health sector, successive administrations have not been able to meet that threshold and the health allocation has hovered at 7% of the national budget over the years. Besides, the government has been remiss on the demands of the National Association of Resident Doctors (NARD) on adequate funding of residency training, restoration of the Overseas Exchange Programme, the need to amend the Medical Registration Act, and an upward review of the salary structure for resident doctors, among others. It took the intervention of the Speaker of the House of Assembly Hon. Femi Gbajabiamila to avert major strike action by NARD.
On his part, the Speaker of the House of Representatives, Hon. Femi Gbajabiamila, has expressed sadness over the brain drain phenomenon that has hit the medical sector in the country. Gbajabiamila said a situation whereby over 2,000 resident doctors had left the shores of the country, with about 800 leaving in the last eight months, bringing the average to about a hundred medical doctors leaving the country monthly in search of better working conditions, was unacceptable.
The brain drain in the healthcare sector which started in trickles before 2015 has turned to waves of emigration by this critical segment of society and with no end in sight due to the general neglect of that sector and challenges of insecurity. In many towns and cities, doctors have become soft targets for kidnappers which have further compounded an already bad situation. For example, the Niger State branch of the NMA has issued a 7-day ultimatum to the government over the growing level of insecurity in the state, especially against the background of the kidnapping of a doctor and other health workers in the state. The Chairman of the NMA Dr. Yusuf Mohammad had warned that doctors would down tools if the security situation does not improve.
Back in 2015, the APC came with voluptuous promises on the health sector promising to fix the rot left behind by the Peoples Democratic Party (PDP) with candidate Muhammadu Buhari decrying the neglect of the sector. Then General Muhammad Buhari condemned the practice whereby public officers and politicians went abroad in search of medical care. He promised to put an end to that and to improve the health sector. Today the health sector is in shambles reduced to mere consulting clinics to paraphrase words of the December 1983 coup speech that swept General Buhari into power as military head of state. Almost forty years down the line nothing has changed and instead things have grown steadily worse.
Shortly after Buhari came to power, he not only kept his promise in the breach but went ahead to avail himself of medical treatment abroad for upwards of six months. For a president who raised much hope and gave assurances of fixing the health sector, his actions belie his criticism of previous administrations. Much as we cannot begrudge the president for seeking the best healthcare services anywhere in the world, still it is his bounden duty to provide adequate and comprehensive medical healthcare for the teeming masses who voted for him. By the general negligence of the health sector, the president had left the most vulnerable members of society in the lurch.
Asked on Channels TV if the well-funded Aso Rock clinic could not cater for the president’s medical needs, Buhari’s spokesperson, Femi Adesina’s response was that “President Buhari has used the same medical team for about 40 years.”
He added that: “Once you can afford it, it’s advisable you stay with the team that has your medical history.”
However, the growing brain drain reveals the fact that our much maligned and underfunded public universities have continued to produce competent doctors and other professionals, despite the paucity of funding and general neglect of tertiary education. Thus, it can still be argued that the level of education hasn’t dropped to an abysmal level as being imagined, which explains why our doctors and other healthcare professionals are in high demand abroad.
Despite the growing emigration of doctors and other healthcare professionals, recent reports by doctors who have relocated to the UK have shown that the grass is not always greener on the other side. Some Nigerian doctors in the UK have complained that they are being used as slave labour and overworked without corresponding remuneration to justify the long hours they put in the job.
To a large extent, the Coronavirus pandemic exposed the underbelly of Nigeria’s healthcare system. Poor budgetary funding, poor remuneration, and general neglect of the health sector have been the bane of that sector and have further eroded gains made in the past. While Nigeria is losing its health professionals in geometric progression, Lassa Fever, Malaria, COVID-19, Ebola, and others still pose a major challenge in the country.
Besides, steps should be taken to discourage the poaching of doctors from Africa and other developing countries to service the healthcare needs of developed countries. In 2010, the World Health Organization adopted a Global Code of Practice on the International Recruitment of Health Personnel to discourage the recruitment of practitioners from developing countries with shortages. Yet its voluntary principles have largely been ignored.
As the worst offender, the U.S. should take the lead in reversing this practice. Of the nearly 650,000 foreign-born doctors in developed countries that are members of the Organization for Economic Co-operation and Development (OECD), 42 percent reside in the U.S., compared to 13 percent in the United Kingdom, the second highest destination (this figure also captures some children who immigrated at an early age to OECD countries and individuals who migrated to an OECD country to study medicine), says Scientific American.
Meanwhile, the Medical and Dental Council of Nigeria, (MDCN), has denied allegations that it signed a bilateral agreement aimed at restricting the emigration of Nigerian-trained doctors to the United Kingdom (UK). MDCN is the agency with the mandate to register and regulate the medical profession in Nigeria. The agency said it had various discussions with the UK medical council including “the repatriation of some funds in line with global health initiatives from Nigerian doctors, who were trained with taxpayers’ funds.”
Despite the economic challenges, the government needs to place more emphasis on the healthcare sector and do everything possible to fix our hospitals, review the wages of health personnel, and provide enabling environment for professional fulfillment. Most importantly, the government has to reverse the trend in which our best brains who are trained at the public expense are lost to the global North after having invested so much to train them for the development of our own healthcare system. Doctors leaving the country in large numbers is a drain on the national resources and the loss of a major investment. No effort should be spared to reverse the brain drain in the health sector.