By Olalekan Bilesanmi
The morning, they say, shows the day. From the first two sentences he made, it was obvious that this wasn’t just a talk show or a jamboree, but the discussion of a serious issue asking for an answer.
Professor Ayo Omotayo, Director General of the National Institute of Policy and Strategic Studies, NIPSS, left the podium and spoke extempore, momentarily.
Omotayo said he wasn’t at the gathering to massage anyone’s ego but to hit the nail on the head of our problems and ensure solutions are proffered. There was a pin-drop silence while his 15 minutes’ admonition lasted.
The event was a one-day symposium on medical brain drain in Nigeria facilitated by the development Research and Project Centre (dRPC) in collaboration with NIPSS and held in Abuja.
The high-level symposium was themed, ‘Nigeria’s health sector brain drain and its implications for sustainable child and family health service delivery and financing in the context of new national priorities’.
The assemblage of participants showed the importance attached to the event. They include the Federal Government through the Office of the Vice President, the Office of the Minister of Health, the Budget Office of the Federation, President, Association of Public Health Physicians of Nigeria, Permanent Secretary, Lagos State Primary Health Care Board, Registrar, Pharmacy Council of Nigeria, Registrar, Medical And Dental Council of Nigeria, President, National Association of Community Health Practitioners, Director, Family Health, Federal Ministry of Health, President, Nigerian Doctors in the UK, and Canadian High Commissioner.
Omotayo said the theme of the event was timely as more persons are leaving the country to settle in developed climes even as he said all sectors in Nigeria have one problem or another, including health which is a critical sector.
Nigeria, according to a foreign publication, Guardian of London, is a top exporter of medical talent to other countries; its doctors are a permanent fixture in emergency rooms in the UK, the US, Canada & Saudi Arabia. In South Africa, it is estimated that there are 5,000 Nigerian doctors; in the UK, that figure is 7,500, according to figures from the UK General Medical Council.
Currently, Nigeria is the highest, outside India and Pakistan, parading foreign medical doctors working in the United Kingdom, making doctors to patient ratio in the country to be 1:10,000 as against the WHO recommendation of 1:1,000.
Nigeria, according to research, lost over 9,000 medical doctors to the UK, Canada and the US between 2016 and 2018.
A total of 727 medical doctors trained in Nigeria relocated to the UK alone in six months, between December 2021 and May 2022.
The data from the Register of the Nursing and Midwifery Council (NMC) of the UK shows that the number of Nigeria-trained nurses increased by 68.4 percent from 2,790 in March 2017 to 7,256 in March 2022.
Problems abound on why the droves may continue: Poor funding; stressful medical education; non-existent house job slots; difficulty in gaining employment as residents, insecurity and poor remuneration among others.
Incentives, like sane system/society with order; ambient work and living environment; well ordered and timed residency training program; training institutions with cutting-edge technology medical equipment; readily available employment with little or no need for any form of bribery; rapid and easy recruitment interviews without much stress from immigration services of destination nations; better salary (in some instances negotiable) which is purposely made tax-free in some countries just for doctors, have gradually disappeared.
Ejiro Eyaru, President of Nigerian Doctors in the UK, who joined the conversation via zoom, said the precarious health situation in Nigeria is such that at least 40 doctors leave the shores of the country every week.
According to him, the Nigerian government can make more efforts in the health sector to prevent doctors from leaving the country.
The representative of the Population Association of Nigeria (PAN), Godwin Aidenagbon, believed that brain drain across all sectors has a significant impact on population dynamics even as he highlighted the negative implications for the health of the population.
According to him, PAN is for the advancement of demographic knowledge and controls the population question in Nigeria’s developmental process.
To Uche Rowland Ojinmah, President of NMA, Nigeria, from 1963 to date, produced only 93, 000 doctors, a number, he said, is inadequate to cater for the population. He said it was sad that developing countries are confronted with the loss of their most valuable intellectuals and the investment in their education, to the benefit of developed nations
He was not surprised by the trend. Given the opportunity, he would join the bandwagon. According to him, he would have relocated to Saudi Arabia but for his children.
“In Saudi Arabia, they offered me N5m per month, outside other benefits including vacation abroad. I am still ruminating about the offer”, he said.
“Based on WHO established minimum threshold, a country needs a mix of 23 doctors, nurses and midwives per 10,000 population to deliver essential maternal and child health services. This explains why Nigeria ranks as one of the countries with the worst maternal and child mortality rates”.
His speech didn’t end without proffering solutions. His words: “A private sector driven healthcare system with government support and enabling environment will over time stop and may even initiate brain gain.
“What shall we do with existing federal tertiary health institutions?
“I suggest a graded disposal thus:
• 51% of the shares federal tertiary health institutions sold to a core investor to become majority share holder and responsible for the day-to-day running of the institution, fixing salary, hiring and firing, and it turns in profit after tax.
• 30% of the shares should be retained by government to maintain control of prices and policies of the institution .
• 19% shares be sold to the workers so as to strengthen their commitment to the institution.
Health Development Bank
“This bank will facilitate development of health care sector”.
The Minister of Health, Dr Ehanire, represented by Mr Sydey Ibeanusi, admitted that doctors are leaving the country even as he reminded that every country has its own problems, including the country they are migrating from.
He said the situation was not totally bleak as being painted as some doctors are willing to return to the country. To encourage such return, he said an enabling environment must be created.
The Minister agreed that increased welfare package will go a long way to address the issues of doctors’ migration.
“We must have a way to reintegrate them and bring them back into the country”, Ehanire said.
“We need to look at the countries taking our best brains. We can tax countries that our doctors are relocating to”.
While a symposium like this should be encouraged, it can only be impactful when outcomes are put into use and not allowed to remain on shelves like other important recommendations and solutions gathering dust.