By Chioma Obinna

•’We have excess doctors if we add traditional healers’
•My story, by Ngige

For almost a decade, the exodus of Nigerian doctors to other countries has led to acute shortages in the nation’s various medical specialities. Some years ago, a former President of the Nigerian Medical Association (NMA), Dr Osahon Enabulele, had said that about two-thirds of Nigerian doctors who leave the country end up practising medicine in foreign countries while some of them switch professions.

According to him, of the 72, 000 doctors registered with the Medical and Dental Council of Nigeria (MDCN), only about 27,000 are practising in Nigeria while others are practising outside the country.

Enabulele also revealed that up to 7,000 Nigerian doctors combined work in British and American public health sectors, while some have left the medical profession on account of better working conditions in other professions. While WHO recommends one doctor to 600 patients, in Nigeria, due to the acute shortage, one doctor attends to around 6,000 patients.

And with the nation’s population put at 170 million some years back, experts said the country needs not less than 283,333 doctors to meet global standards. Now, Nigeria obviously needs more than 283,333 as the population has reportedly escalated to almost 200 million with over 2,000 doctors migrating to the United Kingdom, United States, Canada, Australia, United Arab Emirates (UAE), and South Africa, among others, every year.

Also, figures released in February 2018 by the British government indicated that no fewer than 5,405 Nigerian-trained doctors and nurses were working with the British National Health Service (NHS). It showed that Nigerian medics constituted 3.9 per cent of the 137,000 foreign staff of 202 nationalities working alongside British doctors and nurses in the United Kingdom (UK). Nigeria’s poor doctor-patient ratio (roughly 1:6000) is regrettable, according to analysts, when compared to the ratio of doctor-patient in India (1:2083) and in the United States (1:500) apparently due to the fact that fresh doctors no longer see a bright future within the shores of Nigeria. Despite this disturbing scenario that has worsened the nation’s health indices and promoted medical tourism, the Minister of Labour and Employment, Dr. Emeka Ngige, last week, was quoted as saying he was not worried about the situation. “No, I’m not concerned at all. I’m not worried. We have surplus.

If you have surplus, you export. It happened at one time with Indian teachers here. I was taught biology and chemistry by Indian teachers in my secondary school days. They’re surplus in their country.   We’re surplus in the medical field here. I can tell you, it’s my area. We have excess. We have more than enough”, Ngige  allegedly said on a television programme. He was reportedly responding to a question on alleged brain-drain in the medical sector against the backdrop of the recent visit of a delegation from Saudi Arabia to recruit doctors to work in the Middle-East country.

Sunday Vanguard spoke to some leaders of the various medical associations, among others, on the controversy the Labour Minister’s statement, who is also a medical doctor, is generating. To them, the statement was a reflection of the fact that those who make policies have no solution to the problems in the health sector. They argued that Nigeria needs about six times of what we have on ground for minimal acceptability.

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Ngige displayed ignorance – National Secretary, NMA, Dr Olumuyiwa Odusote 

I see the statement of the Minister of Labour as displaying ignorance of the problems on the ground which is government’s primary responsibility to solve.   It is not true and I am sure the rest of us know that many doctors are leaving in droves. We have less than 40,000 doctors and many are leaving on monthly basis which further drops the number and the population of those leaving keeps increasing. If you have one doctor to about 5,000 Nigerians, is what he said is surplus? Then we have a big problem in our hands. When the World Health Organisation, WHO, is saying that the minimum we should have is one doctor to 600 patients, I don’t understand the basis for the minister’s assertion and, definitely, it is not supported with facts. His statement is on the contrary. I think that the problem here is on the utilization of skilled manpower. It is the duty of government to assess the need and distribute available resources appropriately and, if the government cannot assess and determine what we need, then we have a major problem. If those who make policies are saying we don’t have problems, it means no one will find solution to the problems because they don’t perceive that there are problems. It also means that the health system has a very long way to go if this opinion is what is held in the Federal Executive Council. The NMA has been doing a lot in terms of brain-drain. Last year, the theme of our conference focused on brain-drain. And next week we are going to hold our annual delegates meeting in Abakaliki, Ebonyi State and brain-drain is also going to be the main theme. We are trying to bring it to the fore and find solution. We have invited all the tiers of government, from the President down to the chief medical directors of teaching hospitals and general hospitals, to attend the meeting so that we can brainstorm and everybody will appreciate the magnitude of the problem. And then work out a solution. We have been in the media advocating, making noise and trying to push for a solution. In 2017, the Vice President responded that government was going to do something to reverse brain-drain. It is pathetic that two years after, one of the serving ministers is encouraging doctors to go abroad because he knows one or two doctors who went abroad, 25 years ago, and came back to establish one or two centres which are catering for 10 or at most 30 patients a month in a country of 200 million. That is like a drop in an ocean. It is not going to impact any of the worst indices that we have in the world. We are talking about reversing the trend by ensuring that Nigerians are able to live longer, and in good health, and, for that to happen, we have to look at it in totality. Not just what happened in a few urban centres where only the rich can afford the service. We are talking about what is happening in the rural areas where the people cannot access basic care and survive long enough to change their economy and the economy of the nation.

It is unfortunate that a minister is encouraging brain-drain – Lagos NMA Chairman, Dr Saliu Oseni

It’s an unfortunate situation that a minister of the federation is encouraging brain-drain.   Currently, we have about 35,000 doctors serving a population of over 200 million, which means you have one doctor to about 5,700 citizens. This ratio is frightening in some rural areas. Studies have shown that Nigeria has 0.2 doctors per 1,000 populations compared to the UK and Germany which have 2.8 and 4 respectively. WHO has recommended one doctor to 600 populations; so if a minister, who happens to be a doctor, can be saying we have surplus doctors, it’s clear why our health sector is in ruins.   We currently have one of the highest perinatal mortality, maternal and infant mortality and yet a minister is encouraging brain-drain. It means we have more problems than we think, as there is need to have appropriate insight into a problem to render solution. So, one can best imagine the advice of such doctor in the Federal Executive Council meeting on matters of manpower deficit in the health sector. Even a blind man knows we don’t have enough doctors except he is referring to traditional doctors. We will still advise government to improve the welfare package of health professionals to discourage their migration and also support the establishment of more medical schools to churn out more doctors. It’s clear why we had the rot in the health sector.   We can be sure that even the ministry of health doesn’t have the correct population of its staff. Well, government is trying to show some interest of recent but complete sincerity is only what God knows. That’s why we are saying that medical tourism should be denied public officers, so that they can feel the effect of bad governance on the people. Also, don’t forget that a doctor sees between 50 and 70 patients per clinic in eight hours.

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He appears not to be abreast with challenges of the health sector – National President, Association of Resident Doctors, Dr Olaopa

The minister appears not to be abreast of the challenges in the health sector. It is unfortunate he had to delve into a matter he did not appear to know much about. When the minister begins to think about the foreign exchange of a critical social issue and health of Nigerians, it is a misplaced statement on Nigeria’s health indices.   He should work on his subordinates to give him correct information or he should seek information by himself and sincerely approach such issue of national importance because, how do you address the challenge of inadequate manpower in the health sector when you think you have enough? The few doctors that are still around are unemployed or underemployed. And the employed ones are battling to provide services in a poor work environment and improper remuneration. What is obvious is that the minister doesn’t even appreciate the problems of job stress and dissatisfaction, a patient having to wait long hours to see the few available doctors amid the overall disenchantment with the Nigerian health sector. He can be excused of such reckless statement as a politician but the Federal Ministry of Labour and Employment should have done better.

Statement is display of comedy – President, HCPAN, Dr Adeyeye Arigbabuwo 

The unfortunate utterance of the Hon. Minister of Labour, Dr Ngige, has irked virtually all groups in the healthcare industry, especially those with a fair sense of responsibility and unbiased appraisal of the situation. For this reason, what we could obtain from the archives of the leadership of Healthcare Providers Association of Nigeria in the form of objective and reasonable statistics are as follows: Estimated population of Nigeria of 710 million people while the population of registered doctors from the records of the appropriate authorities is 40,000. Nigeria has urban and rural population. In the urban population, we have 30% of 170,000,000 = 50,000,000 people and rural population of 70% of 170,000,000=120,000,000. 30 per cent of 40,000 doctors give 12,000 doctors. These 12,000 doctors cover the healthcare services of 120,000,000 rural population while 70 per cent of 40,000, that is, 28,000 doctors, provide services for urban 50,000,000 people. In conclusion, more doctors (28,000) serve urban population of 50,000,000 people whereas lesser doctors (12,000) serve the thickly populated rural areas of 150,000,000 people. To the urban population, absence and shortage of specialists is the real brain-drain while to the rural settlement, the absence of the primary care doctor is the de facto brain-drain. What is the tail of an elephant to someone with a good sight may be perceived as a stick to a blind man. This is mal-distribution of statistical paradox and parallax.   Also, a faulty elitist summary is drawing a conclusion to assert that we have urban ‘pseudo’ overpopulated doctors without considering even where doctors are needed most in the rural population that is grossly undeserved. No matter the angle of observation, be it in rural or urban areas, we have a statistical distribution of the faulty doctor-patient ratio in Nigeria. Somehow, some other groups experience some form of shortage. The pattern may be different. But it is clear doctors are leaving en masse. What we expect, according to the NMA President, Prof Francis Faduyile, and WHO index for a poor nation like Nigeria is 1:600 doctor-patient ratio; but we are currently grinding with 1:3,600; it appears, therefore, we need about six times of what we have on ground for minimal acceptability. We have nations on 1:200; 1:150; 1:1000; 1:500 etc. But why is the Nigerian situation this bad?   Even the abysmally poor health indices are enough signals of the poor quality, quantity, harmonisation and coordination of human resource in health in Nigeria. Training facilities and structures are not even enabling. Private providers cry loud and relocate. Why do we shy away from accepting responsibility? Why don’t we own up when we are wrong? Some people in authority advised these doctors recently to go for fashion designing, fishery, and perhaps carpentry. They believe that, as doctors, they would fare better in those areas of specialty. It is public humiliation and embarrassment. Alas, some who have also crossed the river but removing the bridge are still suggesting that the sojourn in the diaspora is a form of profitable medical tourism for Nigeria. Is this not acceptance of self-exile to endorse corporate slavery knowing well that the Nigerian government has not created a seamless environment for health workers as exemplified by the doctors’ case now?   A man is not short changed until he submits himself deliberately for oppression. Let no one be deceived. If the cabinet members of our President hold this view concerning doctors, then their multitude of counsel to Mr President, who is not a member of the health sector, will simply be that the best testimony of all season is the one you obtain directly from the very major stakeholders. After all, no one can be more Catholic than the Pope. HCPAN, therefore, views the unfortunate statement of the minister as a mere display of comedy, oiled with executive utterance and painfully painted against national interest. We are gradually bringing the medical profession to the lowest ebb even by the supposed custodians.   We are, therefore, monitoring closely, and want to restate our unalloyed cooperation with the NMA and other professional groups, whose interest and perhaps relevance is being brought to disrepute before the population they serve whenever government is faced with seeming failure in their responsibilities. It is doctors today. Who knows whose turn it will be tomorrow!

We don’t have enough doctors – Provost of College of Medicine, University of Lagos, Prof. Lesi Afolabi   

We don’t have enough doctors because if you have a population of 190 million and, given the number of doctors practising in the country, which is about 32,00 to 35,000 doctors, that number is inadequate. It is about a ratio population of one doctor to 5000 patients in contravention of WHO recommendation of one to 600 patients. Even though we have about 72,000 registered doctors, that will not give us a true reflection of the number of doctors because many of them are practising in the diaspora. There are not enough doctors for our population. In our medical college, we produce about 200 medical doctors and dentists annually.   Not all medical colleges have the same quota of training. We and the University of Ibadan have the largest quota and a few first generation universities. Others have less; there are over 40 universities offering medicine and, if you do the maths, on the average, they will be producing not more than 2000 or 3000 doctors per year. The more competent person to talk about this is the Minister of Health and not the Minister of Labour. I cannot comment on the statement of the Minister of Labour because he is not the competent person to talk about the health workforce. The Minister of Health is the person to answer your questions.

Statement reflects govt. position on brain-drain threatening our health sector – Dr Moronkola, a former ARD President, LUTH 

The statement is quite unfortunate especially coming from a Minister of Labour who is expected to have statistics of the workforce in the country. It is even more worrisome knowing that the minister in question is a medical doctor. His statement shows he is either out of touch with the reality regarding the medical profession or he is simply being mischievous. As we speak, there are about 40,000 registered doctors in Nigeria. This does not translate to the workforce as some have left clinical practice for other more economically rewarding jobs. Some of this number practice abroad and only renew their practising fee in Nigeria so they remain in good standing with the Medical and Dental Council of Nigeria, MDCN. Statistics show that Nigeria has about one doctor to 5,000 patients as opposed to the 1/ 600 recommended by WHO. This means Nigeria needs roughly 10 times the number of doctors we have presently. Unfortunately, his statement probably reflects the mindset of the Federal Government on the issue of brain-drain that is threatening to crumble our health sector. There are lots of doctors and health professionals still jobless in Nigeria while service delivery in our hospitals continues to suffer. Instead of ensuring doctors are employed to fill the spaces in our hospitals, the minister is busy denying the obvious. The Federal Government needs to declare a state of emergency in the health sector in the interest of the nation.

VANGUARD