Recently, photos of crowds of medical consultants jostling for positions in Saudi Arabia raised concerns over the exodus of medical professionals from Nigeria to other countries. Despite Nigeria’s Minister of Labour and Employment, Dr Chris Ngige insisting that Nigeria has surplus medical doctors to export, experts are warning of an imminent collapse in the health delivery system. Daily Trust on Sunday writes about the frustrations forcing medical professional to seek greener pastures abroad.
At a popular hotel in Abuja, dozens of medical consultants took turns being interviewed by a recruitment agency. Successful candidates will have the chance to work in Saudi Arabia.
“The working conditions for doctors over there are better than what we have here,” Dr Amina Garba, a consultant gynecologist told Daily Trust at the venue of a recruitment exercise.
The process commenced from 7am and continued well past noon when our reporter left the venue. In this time, doctors from different parts of the country and Abuja turned up to participate in the exercise.
“Most of us here are consultants, and not just in one field. There are eye specialists, pediatricians (doctors specialized in treating children), gynecologists and many more,” Dr Garba added.
Most of those sought are medical consultants, those who have done the mandatory six-year-medical training, including one-year house job, one-year National Youth Service and six to eight year specialist training in a particular field such as surgery, gynecology, or pediatrics, among others.
On average, a consultant spends a minimum of 15 to 18 years to attain a level of proficiency.
After putting in these years in training, why would these consultants want to leave?
One of them who gave his name simply as Dr. Kayode who came from the South West said, “There you have the required hospital infrastructure and equipment. I will also earn better over there,” he said.
In some cases, leaving costs a lot.
Mathew Okere, 37, is a doctor at a public hospital in Abakaliki, Ebonyi State. His parents and siblings are contributing money to pay mobilization and examination fees to firms and consultants that recruit doctors to Saudi Arabia and other countries.
“My mother has also directed that the rent of a house built by my family should be given to me to enable me pay those who are assisting me to leave the shores of this country to Saudi Arabia or any other country in the Arab world,” he said.
Doctors in public hospitals, especially those in state government hospitals are not properly paid and are being owed salaries for months, he said. The little they are paid is incomparable to what they could earn working abroad.
“Those countries value and care for doctors more than we do here. The doctors who left this country for those places also grew rapidly in their career than their counterparts in Nigeria,” Dr Okere added.
Another doctor, who craved anonymity is currently preparing to leave the country for Canada. He said he graduated from medical school in 1998 and is presently working as a specialist consultant.
He wants to leave because of the poor renumerations and ill-equipped hospitals, he said.
“I feel I am not compensated adequately for taking care of human lives and helping them get back to good health. Our hospitals are also ill equipped to manage serious medical cases. Who takes the blame when a patient dies from poor care? The doctor, of course. We often forget that the system he or she works under does not support the doctor.
“Our challenges in the health sector are legion. The decay didn’t begin today, but it gets worse with each successive government. The easy way out is to move out and seek greener pastures in countries where things work. I plan on moving to Canada so that I can actualize my dream,” he said.
But the exodus is not West bound alone as doctors are leaving for other African countries.
Julius Terkuma’s sister is a doctor in Rwanda. He said she left two years ago to work for a medical organization there and since then had access to wider opportunities such as conferences and research.
“She sends more money now to our family than when she was practicing in a hospital here in Nigeria,” he said.
Recently, a recruitment exercise for doctors wishing to travel out of the country was organised by Saudi Officials in Lagos. Doctors turned out in such huge numbers, there wasn’t enough room to contain them at the venue.
The exodus appears to have been ongoing for years but the increase in recent years is placing a brunt on the health sector.
“When I saw the massive turn out for the recruitment in Lagos, I was really concerned and heart broken. It is evidence that our health system has a problem. It means that a lot more needs to be done to make the country attractive to practice as a doctor. We want to practice here but there is no conducive environment,” Dr. Garba said.
President of the Nigeria Medical Association (NMA) Dr. Francis Adedayo Faduyile said poor funding of the health sector, lack of employment opportunities for doctors, overworking of doctors, hostile working environment and insecurity such as kidnappings, are contributing to the exodus.
He said others include poor remuneration, and disharmony in the health sector.
“There is poor employment of doctors, both consultants, junior officers and very senior officers. Many states are not employing doctors. We have consultants that are not gainfully employed or under employed. There are young doctors that 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.
“Those who are fortunate to be employed face a very hostile working environment. We have often discussed how government has not been funding health appropriately. The few that are employed are over worked and they are frustrated. A job that you expect five, six, seven, eight or ten doctors to do is being done by only one.
“Sometimes you go to the consulting room and you don’t have the necessary equipment to use. Sometimes the place is very hot and the ambience is not conducive. 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? There are some states like Abia that are owing medical doctors; some owe doctors for eight months, eleven months,” he said.
He also points to the general insecurity in the country that is also affecting doctors as a major factor.
Dr Faduyile said all these cumulate in the frustration of 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?”
Dr Uchenna Ewelike , a public health physician and health economist said of the 45, 000 registered medical practitioners in Nigeria, many have left the country, a lot have retired, and a good number are no longer in practice, and many work in government, policies, programmes, or administration, thereby leaving the core clinical staff required to service the health delivery system very low.
This, he said, places on the Nigerian doctor a high burden of patient load, very little resources, environment, and equipment to work with.
“Another thing driving the movement is that those doctors who have already travelled out communicate with their classmate and colleagues in Nigeria about the conducive environment over there. So, they too begin to plan to write the qualifying exams and to take their families out of the country.
“The doctors in Nigeria also have class mates here who studied economics or business administration, go into banking and becomes very successful, while the doctor who has been practicing 15 to 20 years after graduation still struggles to make a living. So, remuneration is part of what is attracting them to other countries. A resident doctor who is earning N250, 000 in Nigeria, will go to an Arab country where he receives about N1.4 million monthly, has a convenient working environment , and has insurance for his work and his family.”
He added that as a result of poor remuneration, especially in state government hospitals, many doctors jostle to work with the federal government, teaching hospitals and federal medical centers, and when they are not absorbed after years of residency and consultancy , they go out of the country.
Dr Echendu Damian, immediate past President of the Nigerian Optometric Association (NOA), said the association has over 4,000 registered members in the country, and that in spite of the critical role they play in health care, government employs only very few of them in public health institutions and hospitals.
Optometrists are medical specialists involved in measuring eyesight, prescribing corrective lenses and detecting and treating eye diseases among others.
Dr Echendu said many optometry graduates find it difficult to get a place for their housemanship and employment and that this has led to over 80% of them practicing in the private sector.
“Many of our 3,200 members, engaged in private practice are leaving the shores of this country for hospitals in Asia and the Middle-East, especially Saudi Arabia, because the government has not been engaging them,” he said.
His proposal is that government should employ more optometrist, even if one per local government area, or at the very least, one per senatorial district.
Speaking during the during the recent International Conference on Hospital Management and Administration (ICOHMA) organised by the Institute of Medical Sciences Africa (IMSA) in Abuja, a medical Clinician and sonologist , Dr Joseph Williamson said Nigeria needs to invest in its health system.
“Nurses and doctors are leaving to other countries because we have not invested in ourselves. By investment, we mean investing in human capital; they should be made to feel they are important here in Nigeria.”
According to a survey conducted by NOIPolls in partnership with Nigeria Health Watch in 2017, about eight out of every 10 (88 percent) 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 sought work opportunities. Consequently, at the time of the survey, many Nigerian doctors were currently registered to write foreign medical exams such as PLAB for the UK (30 percent), USMLE for the United States (30 percent), MCCE for Canada (15 percent), AMC for Australia (15 percent) and DHA for Dubai (10 percent) amongst others,” the survey revealed.
The Survey found that 88 percent of medical doctors interviewed said they were currently considering work opportunities abroad.
Majority of survey respondents (87%) believe government is unconcerned with mitigating the challenges facing medical doctors in Nigeria.
The survey also revealed that other reasons for the continuous brain drain in the health sector were high taxes and deduction from salaries (98 percent), low work satisfaction (92 percent), poor salaries and emoluments (91 percent) and the huge knowledge gap that exists in the medical practice abroad (47 percent) amongst others.
Effects of doctors’ mass exodus on Nigeria’s health system
Dr Onwufor Uche, a Consultant Obstetrician, Gynecologist and Executive Director, Gynae Care Research and Cancer Foundation said about 2,000 Nigerian doctors leave Nigeria yearly to work outside the country.
For him, recent political and economic realities in the country have contributed to the situation.
“It has become worse as a doctor who earns N200, 000 when converted is about $560 monthly, necessitating moving to countries where they can be better paid for their services. For a country with over 180 million individuals, we have one doctor per 5,000 persons compared to the World Health Organization (WHO) recommended one doctor to 600 persons for effective medical care.
“This ultimately means that eight out of 10 Nigerians are presently receiving substandard or no medical care at all. It will get worse because as more senior doctors leave the country, there will be fewer experienced hands to train medical students which will lead to very poorly trained doctors being graduated as time goes on.”
Dr Uche said consultants take decisions over patients and engage in training of younger doctors
“Also, specialist care of patients will worsen due to dearth of consultants,” he added.
He said the issue of health care being a national emergency would never be appreciated as long as lawmakers and leaders have access to public funds for their healthcare needs in foreign countries.
He said instead of training doctors with public funds and shipping them out in droves to other countries, government needs to come up with a long-term plan to keep them by creating incentives. Health care tourism is a major source of revenue for many nations.
“What stops our government from harnessing the strengths of doctors to build and man state of the art health facilities around the country as well as encouraging the return of doctors in diaspora and encouraging health tourism in Nigeria? Look at what India did. The government needs to find alternate sources of funding apart from oil to increase the Gross Domestic Product (GDP) of the country.
“Also, funding for health care needs to improve to ensure our hospitals are equipped to manage patients and give tertiary levels of care beyond treating malaria and typhoid fever,” Dr Uche said.
Dr Uchenna Ewelike, a public health expert and health economist said it was unfortunate that doctors are leaving even as the country is at the receiving end of the paucity of human resources for health. He said Nigeria’s doctor-patient-ratio of one doctor per 6,000 people is a big burden to the health system as it is very difficult for doctors in Nigeria to satisfy the needs of the population.
He said though Nigeria is one of the greatest exporters of doctors in Africa, it still does not have enough doctors required to strengthen its own health system.
The public health expert said the country should begin to think of strategic, reforms that would brighten the demand side financing and the supply financing saying the country could not achieve Universal Health Coverage (UHC) without its doctors in the country.
He added that remuneration for doctors should be made the same and in such a way that it doesn’t matter whether a doctor is working in a federal or state establishment.
Dr Ewelike said other countries are requesting for Nigerian doctors because they are well trained. “They pass through difficult and rigorous processes so when they go outside the country, they excel; if you go to Saudi Arabia, Turkey, Dubai, Egypt and most Arab nations today, there are communities and villages made up of Nigerian doctors.”
Also, President of the Nigerian Medical Association (NMA) Dr Francis Adedayo Faduyile said inadequate medical personnel in the country was causing a lot of hardships on the health management of Nigeria.
“That is why we have very poor health statistics. The maternal mortality rate of Nigeria is one of the worst in the world. Same for the infant mortality rate and the perinatal mortality rate. Our live expectancy is very low even with our contemporary nations of this same group. So, the health indices in Nigeria is terribly bad and if we must improve it, the government must do more. We must have more personnel in place. Government should show more interest in the health sector,” he said.
He added that government should improve funding for the health sector in line with the 2001 Abuja Declaration which stipulates the allocation of 15% of the budget to the health sector.
Interestingly, Nigeria’s Minister of Labour, Dr. Chris Ngige in a recent interview insisted that the migration is not a crisis as Nigeria has “surplus” doctors to export without putting a strain on the health delivery system. The minister argues that the remittances from the medical doctors’ earnings abroad is an added boost to the economy.
Every other expert spoken to believes there are serious causes for concern.
Recently the Guild of Medical Directors , Federal Capital Chapter in her statement signed by the chairman, Dr Chito Nwana to mark this year’s World Health day , called on the government to improve the education and welfare of healthcare professionals to reduce emigration amongst them.
Minister of Health, Professor Isaac Adewole could not be reached for comments as at press time. However, the spokesman of the ministry, Mrs Boade Akinnola said “We cannot stop doctors and other health professionals from going anywhere to work. We also have foreign doctors and other skilled professionals who have found Nigeria a very attractive and hospitable place to work. In the era of globalization, professionals find it rewarding to work outside their native countries to gather experience.”
Like medical doctors, other healthcare professionals are also emigrating out of the country. They include, nurses, pharmacists, and laboratory scientists, amongst others.
There is therefore need to reposition the health system of the country to avoid the looming danger of the consequences of brain from the country’s health sector.