Brain drain: Nigeria’s doctor-patient ratio now 1 to 5,000

By Ojoma Akor

Persistent brain drain by doctors is depleting the country’s medical care expertise and taking the country farther away from the recommended number of doctors per population, medical associations and experts have said.

Their position faulted the claim by the Minister of Health, Dr.  Osagie Ehanire that Nigeria has a sufficient number of medical doctors despite the brain drain.

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The minister during a briefing on Tuesday stated that there were enough medical doctors in the country and that the number of doctors produced annually exceeds the number leaving the country.

But the umbrella body of medical doctors in the country, the Nigerian Medical Association (NMA), and other stakeholders said the claim by the minister was far from the truth.

The NMA insisted that just about 30,000 medical doctors were currently practising in Nigeria out of the about 80,000 registered with the Medical and Dental Council of Nigeria (MDCN) from 1960 to date.

The NMA also revealed that Nigeria currently has a doctor-to-patient ratio of one doctor to 4000-5000 patients instead of the one doctor to 600 patient ratio recommended by the World Health Organisation (WHO).

Daily Trust reports that the spate of brain drain in the health sector, which has led to a shortage of manpower with attendant burnout, payment of hazard allowance, and outstanding Medical Residency Training Fund, was part of the reasons the Nigerian Association of Resident Doctors (NARD) had issued a two-week ultimatum to the federal government to address or it would embark on industrial action.

Findings by our reporter also reveal that many doctors in the country continue to troop to recruitment interviews or centres by foreign governments to leave the country for greener pastures.

A large number of those seeking to leave the country are consultants with different specialties in the field of medicine, thereby causing manpower shortages in the health facilities.

The minister of health had said: “At the moment we have heard complaints of doctors who are now leaving the system but there are actually enough doctors in the system in the country because we are producing up to 2,000 or 3,000 doctors every year in the country, and the number leaving is less than 1,000. It is just that the employment process needs to be smoothened.”

He said the ministry was working with the Office of the Head of the Civil Service of the Federation to have a one-for-one policy of employment.

“So if one doctor resigns today and goes abroad, we will employ one doctor. If it is one nurse, we replace it with one nurse. So, if we adopt a one-for-one replacement we are not likely to have a shortage.

NMA faults minister’s claim

However, the President of NMA, Dr Uche Ojinmah said there are only 20, 000 to 30,000 medical doctors currently practising in Nigeria out of the about 80,000  registered with the Medical and Dental Council of Nigeria (MDCN) since 1960 to date.     

He said that Nigeria has a doctor-to-patient ratio of one doctor to 4000-5000 patients instead of the one doctor to 600 patient ratio recommended by the World Health Organisation (WHO).     

He said out of the about 80,000 on the MDCN register since inception some have died, retired, joined politics, emigrated, or are no longer practising, or had joined other careers.     

He said if there were enough doctors in the country, primary health care centres in the country would not have been empty of doctors.

The NMA president said when there is a bias in a sample, there is bound to be mistaken, adding that the minister was talking about replacement in Teaching Hospitals and Federal Medical Centres without considering General Hospitals, PHCs, and mission hospitals.

 He said even if the number of doctors emigrating out of the country equals the number produced annually, the quality of specialists leaving cannot be replaced by the fresh graduates produced that year.

According to him, most of those leaving have often finished youth service or practised for at least two years, and cannot be replaced by fresh graduates in the hospitals.

“I am a consultant hematologist of 15 years standing, if I leave today, will I be replaced with a fresh graduate?” he asked.

He said that even if all of the doctors registered with MDCN to date, were still practicing, they could not adequately take care of Nigeria’s 200 million people.

He added that the magnitude of the brain drain of doctors is the fact that the General Medical Council of Britain (GMC) licensed 226 Nigerian doctors in a space of one to two months, adding that the number in a year could best be imagined.

“Nigeria should be importing medical doctors just like Europe and America are doing but we misplace priorities. If we are paying medical doctors well in Nigeria and have good facilities, doctors will come from Ghana, and the Gambia to work here. There was a time that doctors were coming to practice in Nigeria.”

He called on the government to improve remuneration for health workers and fund and open more medical schools where doctors can do house jobs so that the country could produce more doctors to take care of its needs.

The NMA also in April this year said that Nigeria lost over 9,000 medical doctors to the United Kingdom, Canada and the United States of America between 2016 and 2018.

The association said the loss left Nigeria with only 4.7 per cent of its specialists to service the health care needs of the population, adding that this does not paint the country in good light.

Similarly, the President of the Nigerian Association of Resident Doctors (NARD), Dr. Godiya Ishaya, said there is no way Nigeria will have enough medical doctors even if the whole doctors that have registered with MDCN in the country since its inception were practising.

He said the manpower shortage from a brain drain for instance led to the shutting down of the Federal Medical Centre, Owo, Ondo State last Friday.

“In fact, FMC Owo is on strike over manpower shortage. The remaining doctors are now overworking to cater to the teeming patients and they are breaking down frequently as a result of that,” he said.

Dr. Ishaya said an average of between 200 to 300 of his colleagues leave the country every two months, adding that last year alone, close to 1,500 emigrated to the United Kingdom and Saudi Arabia, as they have not been counting those who leave for Canada, United States, and other countries.

He said even the doctors produced yearly by the country are not been employed by the government.

“How many of the doctors being produced or graduating from the school has the Federal Ministry of Health employed, and how many are exiting out of the country?

“That is the reason we are calling for the employment of doctors to replace those who have emigrated out of the country.”

While applauding the efforts of the head of the service for forwarding requests to replace exiting colleagues through the Federal Ministry of Health, he said the process is currently marred by delays and bureaucratic bottlenecks such that before a colleague is replaced many more have exited again.

He said: “We fought for the replacement policy, we went on strike over acute manpower shortage, and while at the National Assembly, a lot of bottlenecks were identified.

“There was a committee being moved to be inaugurated but since we suspended the strike we have not heard anything.

“The Federal Ministry of Health should have pushed through with the committee. Before you write the chief executive, go to offices for verification, (and each of these offices takes three months each), it will take a minimum of six months to achieve the replacement.

“So if we allow the bureaucratic process to go on and five doctors exit and need to be replaced, before the process is concluded, maybe another 10 doctors would have exited. By the time they get replaced the deficit will still remain, and that is why we have been fighting it,” he added.

Also, the immediate National President of the Medical and Dental Consultants Association of Nigeria (MDCAN), Prof. Ken Ozoilo in an interview with Daily Trust said that his association observed that while these countries (where doctors are migrating) 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.

He said 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 threaten the very fabric of our existence and should be a cause for concern for all well-meaning Nigerians. The current brain drain that has increased exponentially in recent times is also partly fuelled by the need to flee this insecurity,” he added.