WHILE responding to a question on brain drain in the medical profession in Nigeria, Health minister, Osagie Ehanire, disclosed — or perhaps thought aloud — to committee members of the National Assembly that Nigeria was looking to import specialist doctors from abroad to fill gaps in healthcare delivery. He also added that Nigeria would send doctors abroad to acquire needed expertise in order to help elevate the standard of medical practice at home. He has so far not refuted the report. If Nigerian doctors stayed back home and were not migrating at an alarming rate, and healthcare in Nigeria was adequately funded and made conducive for foreign medical experts to offer their services to Nigeria, it would be understandable that they were just feeling gaps in personnel shortfalls and skills gap.
Dr Ehanire, a surgeon himself, is regarded as an outstanding medical practitioner who trained in Germany and honed his skills there. That presupposes he has a fair idea of how medical establishments are established and run. There is nothing to show that he is not familiar with the funding and skills gap in the Nigerian healthcare sector. Even though statistics are not entirely reliable, it is estimated that some 45,000 doctors practice in Nigeria, about 5,400 of whom had migrated to the United Kingdom to practice there. Thousands of doctors trained in Nigeria also practice in the United States, some African countries, Saudi Arabia and other places, thereby leaving a severe staffing gap in the country. Insignificant annual budgetary allocations to the health sector complete an ugly picture of the Nigerian healthcare sector.
In the 2020 budget, for instance, the health sector gets a budgetary allocation of N46bn. That is hardly enough for a few teaching hospitals; nor is it unusual given the allocations to the sector in the past years. Yet, Dr Ehanire ignores the broken down infrastructure in public hospitals, the low wages and allowances which are sometimes not even paid, and the instability in the economy to suggest that specialists could be imported from Europe and America. Does he hope the experts would give their services free? Or has he prepared specifically upgraded facilities for the imported specialists? And the Nigerian doctors he wishes to send abroad for further medical training, where does he hope to get the money? From the N46bn? The minister is obviously confronted by more questions than answers. But what is clear is that Dr Ehanire did not think his answers through before making those unrealistic suggestions during the budget defence. His schemes are hard to implement.
Indeed, shocked medical experts in Nigeria gave his suggestions short shrift. According to a report in The Guardian, the president of the Nigerian Medical Association (NMA), Dr. Francis Adedayo Faduyile, wondered how the minister hoped to fund his suggestions. Said the NMA president: “Is it the four per cent budgetary allocation for health? Is it the equipment that is not there and is not working? Where will they work, with empty seats and chairs at most hospitals? The health minister needs to tell himself some truth. No doctor in the Diaspora will want to come back under the present circumstances. The health system is not functioning optimally and we have to fix it and prevent brain drain before thinking of attracting doctors practising abroad.”
The same newspaper quoted a consultant public health physician, Prof. Akin Osibogun, as suggesting the following: “The few ones (doctors) we have are leaving because of poor conditions of service, working environment and after service package. It means the physician-patient ratio has worsened, maybe from 1:3,000 to 1:5,000. When you compare, those countries that have better physician-patient ratio have better treatment outcomes. We need to make working conditions attractive. If they know they will have a house after 20 years of training, the lure to leave would be reduced. What are the benefits attached to the job? What are the provisions for the doctor’s family? What are the long-term prospects for the staff?”
Dr Ehanire might have been under pressure to say something, even if he knew his suggestions were not practicable. That is probably the best way to rationalise his flawed ideas. His ministry is hamstrung by an unresponsive federal government that does not prioritise health. The minister, therefore, has an obligation to study the problem closely, assuming he has not already done so but was just looking for a face-saving answer to kick the nuisance that the health sector had become down the road in the next four years. He can be sure that foreign doctors will not come except on medical aid trips, and local doctors will not get the sponsorship needed to train abroad except they can personally scout for help elsewhere. What is even worse is that the government will make paltry allocations to the health sector yearly. They do not have the vision for anything grand or different. And as long as they and their families can hop abroad for medical attention when the need arises, there will be little incentive to think outside the box.
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