Exodus: They leave, we die

Recent data suggest that brain drain in the medical sector is far worse than was already feared and Daily Trust looks at the data and the causes of this exodus.

The current insecurity ravaging almost all parts of the country is pushing medical doctors and other health workers out of Nigeria in droves.

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While the country has consistently suffered from a brain drain for years as a result of poor welfare in the health sector, experts said the insecurity situation is now worsening the situation.

This is happening as the country battles the COVID-19 pandemic and continues to suffer from inadequate manpower.

According to the Medical and Dental Consultants’ Association of Nigeria (MDCAN), doctors are migrating to countries where they would feel safer and their welfare is giving consideration.

Like other Nigerians, doctors have been constant victims of kidnapping across the country, a situation that has led to some of them holding protests over the abduction of their colleagues.

Speaking during a news briefing on Wednesday in Jos, the National President of the association, Prof. Ken Ozoilo said, “The National Executive Committee noted with alarm, the very high rate of emigration of Nigeria’s highly trained medical and health manpower to greener pastures. The failure of the government to recognize the nexus between this massive brain drain and the COVID-19 recovery efforts in destination countries is most worrisome.”

Data

Data obtained from the Nigeria Health Work Force Country Profile 2018 showed that there is a progressive increase in the numbers of medical personnel who applied for letters of good standing to migrate from the country from 656 in 2014 to 1551 in 2018.

The country profile, launched by the Federal Ministry of Health in March 2020, in collaboration with the World Health Organization (WHO), also revealed that the number of doctors registered with the Medical and Dental Council of Nigeria (MDCN) totalled 74,543, meaning there are 36.3 medical doctors per 100,000 persons. This also translates to one doctor attending to over 2,753, persons in the country.

Most of the medical personnel migrate to the US, United Kingdom, Saudi Arabia and other Arab countries among others.

According to a survey conducted by NOIPolls in partnership with the Nigeria Health Watch in 2017, about eight out of every 10 (88 per cent) of medical doctors in Nigeria seek work opportunities abroad.

This includes junior, mid and senior-level doctors in both public and private medical institutions like house officers, medical and senior medical officers, corps members residents, registrars, consultants and medical directors.

“The United Kingdom and the United States are the top destinations where Nigerian medical doctors seek work opportunities.

“Consequently, at the time of the survey, many Nigerian doctors are currently registered to write foreign medical exams such as PLAB for the UK (30 per cent), USMLE for the United States (30 per cent), MCCE for Canada (15 per cent), AMC for Australia (15 per cent) and DHA for Dubai (10 per cent) amongst others,” the survey revealed.

The Survey found that 88 per cent of medical doctors interviewed said they were currently considering work opportunities abroad.

Senator Abba Moro (PDP Benue South), during a recent public hearing on five health bills, said there are only 35, 000 practising medical doctors out of the registered 72,000.

The senator, who sponsored a bill seeking for the establishment of the Federal University of Health Sciences in Otukpo, Benue State, said, “From available statistics, we have 72, 000 registered medical doctors in Nigeria and out of this, only 35, 000 are practising.

“The implication is that only that number is superintending over the health of over 200m Nigerians.”

Why they are leaving

Prof. Ken Ozoilo of the Medical and Dental Consultants’ Association of Nigeria (MDCAN) said that his association observed that “while these countries (where doctors are migrating to) have put in place measures to recover their health systems, including boosting personnel by luring our members with lucrative conditions of service, the Nigerian government has not put in place every serious measure to retain this highly skilled manpower. The link between the dilapidated state of the economy, poor remuneration, inadequate health infrastructure/equipment, and highly volatile security situation are also factors forcing doctors to emigrate.

“The current security challenges in Nigeria threatens the very fabric of our existence and should be a cause for concern for all well-meaning Nigerians. It ravages all sectors of Nigerian life, including the economy, food security, commerce, education, health, etc. The current brain drain that has increased exponentially in recent times is also partly fuelled by the need to flee this insecurity,” the group added.

Speaking during the launch of the Nigeria Health Work Force country profile in March 2020, Dr Emmanuel Meribole of the Federal Ministry of Health said, “Nigeria has over the years increased its production but has consistently lost health workers due to migration and brain drain because of inadequate motivation, remuneration and incentives; mal-distribution of the available health workers. Investment in the production of sufficient health workers. Health workers within the Nigerian Health system have remained the weakest link resulting in the loss of critical investments.”

The immediate past President of the Nigeria Medical Association (NMA), Dr Francis Adedayo Faduyile, in an interview with Daily Trust, said poor funding of the health sector, lack of employment opportunities for doctors, overworking doctors, hostile working environment and insecurity such as incidences of kidnappings, are contributing to the emigration of doctors.

He said, “There is poor employment of doctors, both consultants, junior officers and very senior officers. Many states are not employing doctors. We have consultants who are not gainfully employed or underemployed. Some young doctors finished either housemanship, National Youth Service Corps (NYSC), or who just finished their studies for housemanship and don’t have anywhere to work. So, they look for anywhere that they can get employment,” he said.

He said those who do find work are overworked.

“A job that you expect five, six, seven, eight or ten doctors to do is being done by only one,” he said.

He said this work is often done in an unconducive environment with poor facilities.

“Some facilities are poorly lit. They don’t have running pipe-borne water and many times you want to treat a patient, you know the diagnosis, you know how to do the necessary intervention but you don’t have the equipment to work with and you watch the patient die right in front of you.

“What about remuneration? Some states are owing medical doctors; some owe doctors for eight months, eleven months,” he said.

Dr Faduyile said all these cumulate in the frustration for doctors in their different work environments, adding, “They have made many doctors uncomfortable in the country. If they have opportunities outside, can you blame them for leaving?”

Way out

The MDCAN said the government must be more proactive in its approach to confronting security challenges, adding that the community policing initiative was laudable, but more should to be done to decentralize security and to further empower communities to take more responsibility for their protection.

MDCAN also called on the government to ensure clearance of arrears owed for the outsourced services in Federal Tertiary Health Institutions, especially on security.

“The operatives of some of these companies, who are paid very meagre salaries, have been owed for months or years. This state of affairs not only diminishes their fidelity at work but turns some of them into security risks as they may become prone to inducement into criminal activity, especially within the hospital,” Prof. Ozoilo said.