Medical brain drain: Primary health care centres now hit

Nigeria suffers from a huge brain drain issue across different sectors, particularly in the healthcare sector.  PAUL OMOROGBE, in this piece, reports that the current trend is alarming.

Nigerian doctors, nurses and other medical professionals have continued to leave the country for greener pastures. It is such that the medical professionals remaining in the country came together about a week ago under a group called Healthcare Transformation Coalition (HTC) to declare that the situation has assumed a national emergency status.

The HTC issued a statement issued in Abuja, in an agenda-setting move for the incoming administration to be sworn in on May 29, 2023, stating that the new government should take a comprehensive approach to addressing the challenges confronting the sector through a health sector reform bill that will take cognisance of all existing health institutions and agencies, with the aim of making them more efficient in line with current realities.


The brain drain is real

Medical doctors have identified poor working conditions and low remuneration as reasons for emigrating to nations with better working environment such as the UK, US and Canada, mostly, remuneration, opportunities for career progression and an overall improved quality of life. Paucity of healthcare resources and poor funding of the health sector, leading to frequent strikes has also been identified as a factor affecting brain drain in Nigeria. In 2019, of Nigeria’s annual budget of N8.8trn only 3.6% was allocated to healthcare.

In a 2017 survey carried out by Nigeria’s polling agency, NOI Polls, in conjunction with Nigerian Health Watch it was found that most doctors seek opportunities abroad as 88 percent of doctors were considering work opportunities abroad. On average, 12 doctors a week move to the UK.

Another survey identified push factors including the desire for better life which was said to be the most important factor for seeking greener pasture. Pull factors including better working conditions was also considered as a very important reason for migration. Similar findings were noted in the #CanadaRush Study carried out by the African Polling Institute (API) which identified Nigeria’s poor economic performance, lack of security of lives and property and the poor leadership as the ultimate and marginalization “push factors” and a driver of recent emigration pattern to Canada which has also introduced immigration policies with a background enabling environment. These serve as significant “pull factors” for the educated and highly skilled Nigerians.

In August 2021, when the COVID-19 pandemic was still in full swing, and Nigerian resident doctors (National Association of Resident Doctors) were on strike over poor remuneration from the government, Saudi Arabian authorities were in Abuja conducting interviews for doctors for possible employment and subsequent relocation to their country.

The interview was widely reported on national television.

A video showing doctors queuing for an interview by the Saudi authorities went viral on social media in Nigeria.

This interview was not a one time occurrence. It is not just the Saudis who are interested in welcoming Nigerian doctors. The UK is also a destination for Nigerian medical expertise.

Last year, the National President of the Nigerian Medical Association (NMA), Dr Uche Rowland Ojinmah, was reported to have said that 40 to 50 Nigerian doctors leave the country every week. He was speaking at the opening ceremony of 2022 Abia Physicians’ Week when he made the remark. He urged the government to take urgent measures to curb the trend.

Despite the hue and cry over the exodus of Nigerian doctors, the government of the day has maintained that there is no cause for alarm. At the 38th Annual General Meeting and Scientific Conference of NARD, during the opening ceremony on Friday, September 21, 2018, the then minister of health, Professor Isaac Adewole, was reported to have said that there is no serious shortage of doctors in Nigeria, as people think.

According to him, Nigeria has a ratio of one doctor to 4,088 patients. He said this is not bad when compared to other African countries. “The data obtained from the Medical and Dental Council of Nigeria as of May 30, revealed that 88,692 doctors are registered in their books. Of these doctors, only 45,000 are currently practising and that gives us a ratio of one doctor to 4,088 persons.

“Compared to many other African countries the ratio is not bad, for example, in South African it is one (doctor) to 4,000; in Egypt it is one to 1235; in Tanzania it is 1: 14,000; in Ethiopia, it is one to 1 to 118,000, in Kenya, it is one to 16,000 and in Cameroon it is one to 40,000,” he said.

About a year after the period Saudi authorities were recruiting in Abuja, the current Health Minister, Osagie Ehanire, in August last year, echoed his predecessor’s statement on the availability of doctors in the country. He said Nigeria has enough doctors in the system.

“We have heard complaints of doctors who are now leaving the system but there are actually enough doctors in the system because we are producing up to 2,000 or 3,000 doctors every year in the country, and the number leaving is less than 1,000,” the minister told the press.

Even the Labour minister, Dr Chris Ngige also a medical doctor by training, on national television in 2019, said that: “I am not worried about doctors leaving the country. We have surplus. If you have surplus, you export. It happened some years ago. I was taught chemistry and biology by Indian teachers in my secondary school days, they are surplus in their country. We have a surplus in the medical profession in our country. I can tell you this. It is my area, we have excess.”

In 2019, there were 24,600 doctors in Nigeria for a population of about 206 million people. This is according to The President of the Nigerian Medical Association, Uche Rowland, at a symposium on the brain drain in Nigeria’s health sector and its implications on the health sector, in October last year, stated that: “In 2015, 233 Nigerian doctors moved to the UK; in 2016 the number increased to 279; in 2017 the figure was 475, in 2018, the figure rose to 852, in 2019 it jumped to 1,347; in 2020, the figure was 833 and in 2021 was put at 932.”

The World Health Organisation (WHO) estimates that at least 2.5 medical staff (physicians, nurses and midwives) per 1,000 people are needed to provide adequate coverage with primary care interventions (WHO, World Health Report 2006).

However, WHO estimates that Nigeria’s physician-to-patient ratio is four doctors per 10,000 patients as of 2018.

Pharmacists, nurses other health workers also on the move

The demand for healthcare workers especially in the wake of the COVID-19 pandemic has increased in developed countries like the United States, Canada and the United Kingdom.

Over the course of the pandemic, Canada’s healthcare workers have been faced with unprecedented demands, states Canadian Institute for Health Information (CIHI), an independent, not-for-profit organisation that provides essential information on Canada’s health system.

About 23 per cent of Canada’s present physician workforce is foreign-trained, according to Robert Shearer, Director of  Health Human Resource Strategies Division, Health Policy and Communications Branch at Health Canada.

The Health Foundation’s REAL Centre in the United Kingdom published research that finds that by 2030/31, up to an extra 488,000 healthcare staff would be needed to meet demand pressures and recover from the pandemic.

Unsurprisingly, Nigerians have trooped abroad to meet these demands.

Speaking to Nigerian Tribune, Comrade Ronke Bello, the immediate past chairman of National Association of Nigeria Nurses and Midwives (NANNM), at Nigeria›s foremost teaching hospital, University College Hospital (UCH) branch said that nurses are moving to countries where their worth is recognised and they have job satisfaction.

According to her, the popular destinations remain the UK, US, Canada, while a few head to the UAE.

She said resignations take place on a weekly basis. On the toll the exodus has on the hospital, she said that there is a severe shortage of manpower among the nurses.

“In hospitals, issues can be mild, moderate, or severe. I think we are already on the path of severe shortage of nurses. This is not peculiar to UCH. It is national. It has affected primary, secondary and tertiary healthcare centres.”

Pharmacists have also been affected by the exodus outside the country that is popularly called “japa.” Kenneth Otene, the Delta State chairman of the Pharmaceutical Society of Nigeria (PSN), said that even in the remote part of the state where he practises about five pharmacists have left the country in the last three months.

“Pharmacists are leaving, everywhere! In my town, where I practise in a remote part of Delta State, between October and December last year, we had five members leave the country.”

He added that the reduced number of new pharmacists that had registered in the state could be due to the “japa” syndrome.


Any  way out?

There are no government policies to proactively address the decimation of higher education in Nigeria. Some solutions that have however been proffered to the protracted problem of brain drain including good leadership, mass employment, better salary and working conditions as well as a system for rewarding diligent staff.


Many Nigerians who have emigrated or plan to emigrate to North America and Europe have expressed the unlikelihood of their return or return of the children raised in their new country of settlement to Nigeria as there is a general distrust in the Nigerian political class and their ability to reverse the ongoing downward spiral in the educational sector.

However, Comrade Bello in her opinion said that the imminent healthcare crisis can be tackled not by forcefully stopping personnel from travelling, but by an immediate recruitment of healthcare personnel without the usual bottlenecks in the process.

“Right now, one nurse or midwife is already doing the work of 10 people. The government should look at a replacement plan very urgently both in the immediate term and in the long term. They need to employ core clinical staff. This is not the time for bottleneck bureaucracy in employment.”

She added that there must also be a replacement plan for retiring healthcare workers.

On his part, the Delta State PSN chairman said that the general economic and security situation in the country needs to improve for healthcare professionals to reconsider relocation.

“Pharmacists are sought after healthcare professionals in every part of the world. The situation in Nigeria is very bad. The security situation is bad. The remuneration is bad. This is what makes people seek for greener pastures. The solution is to improve the living conditions in the country.”

Giving his view, the chairman of Nigerian Medical Association (NMA) in Oyo State, Dr Wale Lasisi, called on government to give doctors incentives to halt their movement out of the country.

Noting that the issue had been ongoing for decades, he said, “In those days, the pattern was people training abroad and coming home to practise.

“As things degenerated over time, many people who have been exposed abroad ran back while those who have had the opportunity of training abroad also ran back when they saw the quality service there.

“UK is trying to replace its own workforce and make sure its people get the best of healthcare, thus coming down to Third World nations in Africa, including Nigeria, to recruit medical personnel.

“In the immediate future, the best that government can do is to add incentives to retain those who are on ground.”

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