With 3,000 doctors trained annually, it will take Nigeria 25 years to meet demand
Health totally relegated in Nigerian Constitution
By Sola Ogundpe, Chioma Obinna & Gabriel Olawale
Nigeria’s medical brain drain has become an albatross. Every day, at least one doctor or health worker leaves the shores of the country for greener pasture, yet the migrants struggle to complete foreign exams to get work placements abroad.
Many doctors have blamed the mass exodus on poor working conditions and the non-prioritisation of health by the authorities. Findings reveal that while the annual healthcare threshold per person in the US is $10,000, in Nigeria it is $6.
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The country’s polling agency, NOI Polls, in partnership with Nigerian Health Watch in 2017, found that 88 percent of doctors are considering work opportunities abroad. Reasons for emigrating include better facilities and work environment, higher salaries, career progression and improved quality of life. Nine in every10 doctors are considering work opportunities outside Nigeria, according to the Polls.
With a population of over 200 million, one doctor in Nigeria attends to 10,000 patients compared to the World Health Organization (WHO) recommendation of one doctor per 600 patients. The Medical and Dental Council of Nigeria, MDCN, says there are 72,000 registered doctors with over 50 percent practicing outside the country.
Last week, the President of the Nigerian Medical Association, NMA, Dr. Francis Faduyile spoke to Health Writers Association of Nigeria on brain drain in the medical profession during their 10th Anniversary in Lagos.
He warned that there may not be end to the phenomenon in the short term, adding that even if Nigeria produces 3,000 doctors annually, it will still not end the problem.
Nigeria has one of the worst health indices globally and the reason for that is very simple. The World Health Organisation, WHO recommends one doctor to 600 patients but what we have in Nigeria is about one doctor to 10,000 patients and it’s even worse in the remote parts of the country where it’s like one doctor to 22,000 patients
It has been found out that if Nigeria is producing 3,000 medical doctors annually it will take us 25 years to be able to produce the total number of doctors that will adequately take care of the populace. So we are in serious deficit. The brain drain is not limited to doctors. Some of our nurses, pharmacists and other health workers are leaving. The most skilled individuals are leaving to contribute their expertise to the economy of another country.
In the normal definition of brain drain, it is usually from a less developed country to a more developed country, but what we are experiencing in Nigeria is not following that trend, we have some doctors migrating to developing countries or even underdeveloped countries because we have other issues that are pushing people outside this country.
One is lack of equipment. So many of our doctors are leaving because what they require to safe patients are not available and by the time they sit in their consulting room and watch patients die in their presence, such persons will be frustrated and would have to look at any other place he can intervene to help humanity.
Another major push is economic underdevelopment. When President Buhari assumed office, despite the high rate of inflation, the exchange rate was around N200 to $1 but through some form of economic calculation, today it is N360 to $1. So if you were earning N200,000 and you convert to dollars, that was $1,000 but if you are still earning that same amount now, that will be around $600. So in actual sense, the salary we are receiving has actually gone down because our purchasing power has reduced.
Inter-professional disharmony is another major issue, one thing we have done as NMA is to look back at why are we in the health sector, we are in this sector for the people and the people who will call our patient include every one of us.
NMA has refocused and our focus is to see the patient as centre point. Disharmony has created a lot of havoc because we have heard cases where you go to the hospital and other professionals try to frustrate your efforts.
The Nigeria government is not interested in the health sector and this is evidenced in the failed National Health Insurance Scheme, NHIS. Recently, during the public hearing on NHIS, I pointed it out that in the Nigeria constitution there is no single word that has a semblance of health, the best is that the government shall take care of the security and welfare of the people.
So health has been totally relegated and that is why the Nigeria Medical Association, NMA is crying every day to let the government knows that the 3 percent allocation to health cannot help the sector.
It is sad that despite the fact that in 2001, Nigeria hosted African Heads of State and they all agreed to commit a minimum of 15 percent of their annual budgetary allocation to health but regrettably, Nigeria has only go beyond 5 percent once.
The current budget is around 3.8 percent, the government is not walking the talk, and once there is not enough funding for health, it will be very difficult for us to have appropriate employment or equipment that we need to improve the health of Nigerians.
Today the primary healthcare sector level that should take care of over 70 percent of Nigerians is dead; most of the state is not even doing what they should do with public funds. We have some states like Abia that owing the workforce, health and education ministry over nine to 12 months’ salaries.
When as professionals they are not being paid, there is nothing you can say that will persuade such person to stay home in abject poverty, hunger and continue the service. The government is not interested in employment. Those in service are over-stressed in a situation whereby one person is doing the work of 10, so most of the time they are frustrated. Some have left as a result of insecurity.
Pros and cons of brain drain
Since there is no investment in research, our country is not contributing to the body of knowledge worldwide because we don’t have independent material to do our own research. All our investment as a country in education has became waste
Brain drain can be said to have an advantage, but the disadvantage outweighs the advantage. Although some of those who leave gain knowledge and come back home while some help in the area of remittance back into the country. In 2017, five or six countries were topmost in remittance back into their countries – China, India, France, Egypt and Nigeria.We have remittance but at what expense? The expense is the death of our brothers and sisters who need their service at home.
First, government needs to create enabling environment and encourage health workers. Second, we need to have an environment that is cordial among health workers. We have had meetings with the leaders of nurses, pharmacists and others, I can tell you the major cause for disagreement is because we have failed to talk to ourselves. And we have always assumed that the other person is against the interest of one group. Unfortunately, media reporting also escalates the disagreement.