Nigeria’s doctors: We cannot continue like this

Health is wealth. Daily Trust cannot restate that statement frequently and forcefully enough for Nigeria. The wealth of nation is the health of its citizens. And the health of a nation, in turn, depends on the number and quality of its healthcare facilities and workforce. Doctors, the highest category of personnel in the health sector, are therefore essential to the health and wealth of a nation. Nigeria has so far treated these truisms with levity and it must stop.

Nigeria has major problems with this issue. The first is that there is just not enough of them for our burgeoning population. Indeed, with one of the most rapidly growing populations in the world, Nigeria has never really had enough doctors to cater for the needs of its citizens. Citing the President of Nigerian Medical Association (NMA), Uche Rowland, an October 20 2022 report in the Premium Times, indicated that Nigeria produced a total of 86,722 medical doctors from 1963 to 2019, Nigeria’s population grew over four times during the same period, from 48 million in 1963 to 201 million in 2019, according figures by the National Population Commission (NPC).

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The Premium Times story further noted that Nigeria now has just about 24,000 doctors, against 363,000 needed for optimum healthcare delivery, going by an estimate of the World Health Organization (WHO) that a mix of 23 doctors, nurses, midwives and other medical professionals are needed per 10,000 members of the population in a given country or territory.  In contrast, the United Kingdom (UK), with a population of 67 million people, or just about one-third of Nigeria’s about 218 million, has a total of over 345,000 registered doctors, more than fourteen times the number in Nigeria.

But the comparison between the number of doctors in Nigeria and the United Kingdom, relative to the population of each, is still inadequate because Nigerian doctors make up a sizable part of the total registered to practice in the UK. Last month, several newspapers cited the same NMA as saying that as many as 10,000 doctors had fled Nigeria to the UK over the past seven years. The news reports also show that just three years ago, the total number of doctors in this country stood at over 39,000, indicating an exodus of about 15,000 doctors between 2019 to date.

Therefore, the shortage of doctors is compounded by their mass migration abroad. The UK, U.S, Saudi Arabia and other gulf countries are the most sought-after destinations for migrating Nigerian doctors. And since the cost of training and educating doctors is generally expensive in most of these countries, often running into hundreds of millions of naira per doctor, this simply means that Nigeria is in fact subsidizing the cost of medical education and training for these countries. This is why countries like Saudi Arabi conduct annual recruitment fares in our major cities to cream off Nigeria’s doctors, mostly trained on free tuition from our public universities, all in a strategic bid to meet the same acute shortage in their own countries.

In previous interviews and surveys, doctors have cited “poor working conditions”. These include poor salaries, long working hours, and a generally hostile environment for research and career advancement as some of the major reasons why Nigerian doctors would consider “living as second class in foreign nations”, as a recent report put it. The average consultant in the UK, US, and Saudi Arabia, for example, earns five to six times the salary of their Nigerian counterpart. Thus, surveys show that even among the doctors currently at home, over 70% are contemplating moving abroad too.

Meanwhile, many doctors here find it difficult to get proper employment here. As this newspaper reported two weeks ago, hundreds of doctors, mostly younger ones, are facing unemployment and underemployment in the country. Many state governments provide bursaries and scholarships for medical students in the universities in the name of supporting their training and increasing their numbers. Yet, these state governments generally do not provide employment for even those doctors they helped to train, leaving many of them with little choice but to migrate or take up poor-paid employments in private hospitals.

Surely, we cannot continue to train medical doctors at public expense only to have them move in large numbers to practice in other countries. We cannot be happy exporting a collective resource we also badly need. If Nigerian doctors migrate massively to practice in other countries, then Nigeria is losing at both ends. We are losing the doctors we need to keep our society healthy, and therefore wealthy. But we are also losing the billions the government pumps into public universities for training doctors, all because of low pay and other unfavorable incidentals.

This must stop. We recognize that solving a problem such as this would be difficult in the short term. But concerted effort must be made. The first place to start would be to ensure that all qualified doctors are employed in the public health system, even at prevailing rates of pay, and even if the federal will have to supplement states to meet the cost of personnel increase in this specific case. The government should also review, as a matter of urgency,  upwards by at least 100% the salaries of all categories of doctors in the public health system. And third, government can also consider granting loans to companies to set up private practices that are large enough to pay doctors the prevailing rates in the public system.

These measures will not completely eliminate the migration of doctors out of the country. But we believe far more doctors will choose to stay than migrate. Above all, it will still be cheaper than training doctors with public money only to have them migrate to other countries.