The Medical and Dental Council of Nigeria, MDCN, says there are 74,543 registered doctors in Nigeria for the country’s population of about 200 million. This puts the doctor-patient ratio in the country at 1:3,500 as opposed to the recommended WHO standard ratio of one doctor to 600 patients. Studies reckon that over 70 per cent of Africa’s healthcare practitioners are lost to migration where they currently make up one-fifth of physicians in developed countries.
Due to the emigration of healthcare practitioners, Nigeria has experienced a massive brain drain as skilled healthcare workers are moving to other countries to obtain better wages, improved standard of living and the opportunity to improve their skill set. Amidst the COVID-19 pandemic in 2021, 33,000 of the 75,000 MDCN registered doctors had left the country, leaving 42,000 to man all health institutions in the country.
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Brain drain is the movement of highly skilled workers from a developing country to a developed country. As a phenomenon, brain drain has drained Africa of healthcare practitioners, who make up three per cent of the global workforce in a continent that is burdened with 25 per cent of global diseases. The emergence of brain drain in Nigeria has hindered the development of the medical infrastructure to the standards of other comparable developing countries and is depleting Nigeria of its healthcare talents that could help build the health sector.
The poor budgetary allocation to the health sector by the government is a significant contributing factor to the brain drain and calls for a re-appraisal of the nation’s healthcare financing. The budget to the health sector in 2020 was a mere four per cent, whereas the African Union Abuja Accord of 2001 mandated all signatories to set aside 15 per cent of federal budgets for health care.
Findings from interviews with doctors leaving a large hospital in Abuja appeared to be consistent with the findings from several published national studies on the reasons for brain drain in Nigeria. Qualitative data analyses revealed commonly occurring themes such as improved pay for work, staff welfare, career advancement/growth, burnout and improved conditions of work. The majority of doctors (40%) who left the system did so on account of seeking opportunities for career growth and development and increased wages/ better welfare.
According to the National Bureau of Statistics Labour Force Survey, Nigeria’s unemployment rate was 27 per cent in Q2 2020 – four per cent points higher than the 23 per cent reported in Q3 2018.
Many factors combined precipitate brain drain in Nigeria. .
The Boko Haram/ISWAP attacks in the North East and other parts of the country, kidnapping, ritual killings, banditry/terrorism in the North West, IPOB activities in the South East and killing by Fulani herdsmen in Central Nigeria also accelerate the brain drain in the country.
People have lost trust in the health sector and this is evident in the actions of those traveling out of the country for medical attention, the Nigerian leadership inclusive. This is one of the reasons why people emigrate to developed countries.
The Nigerian health system has suffered several setbacks. It is vastly under-resourced in terms of personnel and medical infrastructure. While this is a widespread problem, conditions in rural areas are often far worse compared to urban ones.
If one works in a good environment with requisite infrastructure, a clean and healthy environment, maintenance of working equipment, the health of the workers and conducive working hours life would be good. However, most companies in Nigeria have not adequately addressed issues with the health and comfort of their workers. Most people work in hazardous areas, which in turn affect their health and productivity. Health care workers want to be valued and desire to work in safe and healthy environments.
The level of crime and corruption in Nigeria is still very high and appears to be getting worse. From the judiciary to ministries, the military, the police, public and private health systems and governments at all levels, corruption remains an infectious plague and prevalent problem. The phenomenon of knowing someone that knows another to get something done is currently the accepted practice and this has systematically eroded the merit-based approach to work or getting things done.
What is the way out?
The Nigerian government should create a conducive environment that will ensure employment opportunities and reduce poverty. The government ought to provide the needed infrastructure such as good roads and transport systems, affordable and functional education, water supply, security, stable energy in addition to a good healthcare system. But these are not enough to prevent the brain drain among medical doctors and other professionals. Other strategies are providing financial and other incentives to stay including institutional capacity-building that promotes career development, along with mentorship opportunities.
We recommend a better system that preserves the individual freedom of Nigerian doctors, while accounting for the costs of subsidised medical education in the country. To retain Nigerian doctors and avoid subsidising healthcare, multiple measures could be taken. For example, medical students could be offered a choice of state-subsidised training or market-rate education. Doctors who opt for subsidies would be required to work in Nigeria for a pre-defined period of time, post-qualification or repay the subsidies. Therefore, to make the compulsory work scheme more attractive, it can be combined with another option, which is to guarantee doctors’ employment and inflation-adjusted living salaries for a few years post-graduation on the condition that they stay in Nigeria. Apart from providing better remuneration, their work environment and career prospects should also be improved.
Nigeria should negotiate fair compensation with destination countries that persistently rely on foreign-trained doctors. In the UK, a conversation has already started on how poor countries are subsidising Britain’s healthcare system and should be compensated. Nigeria has limited tools to retain more doctors and upgrade its health system. The federal government’s healthcare budget for 2021 was a fraction of what it has lost to the migration of doctors to other developed countries. Nevertheless, the health sector ought to strive towards a future where Nigerian doctors benefit from more funds for training, salary and technical exposure, as a result of strategic partnerships with countries that require our doctors.
Government and private health sectors are to directly address the causes of emigration by upward review of their salaries and allowances and ensuring prompt payment, providing adequate medical and diagnostic/therapeutic equipment and training for doctors, expanding the current internship and residency training programs to boost the nation’s healthcare workforce and improving the overall working conditions of doctors.
Dr. Ede is Head, Healthcare Quality Improvement, Nisa Premier Hospitals, Abuja
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