For Nigeria’s ailing healthcare sector, the prognosis remains very bleak, as emphasised by Prof. Akin Osibogun, President of the National Post-graduate Medical College of Nigeria (NPMCN), Ijanikin Lagos.
In his stark warning, he shed light on the country’s rising scarcity of graduate doctors available for specialisation, a problem primarily attributed to persistent brain drain within the health sector.
During a recent media briefing, Osibogun issued a cautionary statement, emphasising that the ongoing medical brain drain is depriving Nigeria of the essential workforce required to guarantee the delivery of high-quality healthcare services to its citizens.
The Professor of Public Health pointed out that even the National Post-graduate Medical College of Nigeria (NPMCN) is not exempt from this challenge, as the pool of available doctors suitable for specialisation continues to diminish.
This decline is due to graduate doctors increasingly embracing the Japa syndrome.
Additionally, Osibogun highlighted that teaching hospitals across the country are also experiencing the repercussions of this trend, as they grapple with a shortage of resident doctors.
“Some of our sister countries in West Africa are already poaching our medical manpower by offering higher pay. This is aside from the 11,000 Nigerian doctors in the United Kingdom, the 12,000 in the United States and Canada, Australia, Saudi Arabia and other parts of the world. We have roughly between 30,000 and 40, 000 Nigerian doctors in different parts of the world,” he said.
Osibogun stressed that to effectively address Nigeria’s complicated medical brain drain challenges, the country needs to prioritise both the training and retention of a larger number of doctors.
“We need to ramp up our training processes, and we also need to put in place, largely on the side of the government, mechanisms to ensure that skilled manpower remains in the country,” he said while stressing that the continued emigration of medical professionals to foreign countries carries grave implications for Nigeria’s healthcare delivery system.
“We need to keep training more and retaining more in the country through the provision of financial and non-financial incentives by the governments. Every medical doctor needs to enjoy the work they are doing to boost productivity at the various hospitals. There is a need for improvement of the work environment, providing more facilities at hospitals, especially the teaching and general hospitals. We need to put in place mechanisms to ensure that our skilled manpower can remain in the country,” Osibogun said.
Just last week, NPMCN, the only body responsible for producing post-graduate medical doctors for the country, celebrated the graduation of 413 new fellows and 92 doctors of medicine. This institution, which has the responsibility of providing post-graduate medical education in the country, has successfully produced 8,500 specialists over time. Regrettably, similar to their predecessors, a significant proportion of these recent graduates may soon become targets for recruitment by more prosperous economies, perpetuating the trend of attracting well-trained medical professionals to serve their ageing populations.
Osibogun called on the Federal Government to implement financial incentives aimed at retaining the country’s valuable talents, especially within the healthcare sector.
The recent surge in migration among young Nigerians is a cause for concern. This emerging trend has given rise to the use of the colloquial term Japa among the population to describe the widespread emigration from Nigeria, particularly to Europe and other parts of the world.
Some view this term as emblematic of the entrepreneurial drive of young Nigerians who aspire to export their talents, skills, products, and even themselves.
According to Prof. Toyin Falola, Japa is a Yoruba word that signifies a hasty departure or flight, and once accomplished, it is often celebrated as a form of liberation. In essence, japa encapsulates the concept of Nigerians choosing to relocate to foreign shores in pursuit of better opportunities and improved prospects.
Many concerned professionals have described the crisis as a situation of dual adversity, especially in a country endowed with abundant human and material resources.
While patients continue to crowd into Nigeria’s severely underfunded and under-staffed public hospitals in search of healthcare services, the most skilled medical professionals are departing in large numbers to seek better opportunities abroad, leaving the country with an insufficient workforce to care for its population.
Admittedly, this isn’t a novel crisis, but the phenomenon of medical brain drain has evolved into a multifaceted challenge that is plaguing Nigeria’s healthcare system with problems of alarming magnitude.
The Nigerian Medical Association (NMA) and other related organisations have conducted assessments indicating that the country requires approximately 400,000 doctors to adequately serve its continually growing population.
According to the World Health Organisation (WHO), Sub-Saharan Africa (including Nigeria) has a mere three per cent of the world’s healthcare workforce, even though it bears the weight of 24 per cent of the global disease burden.
However, with fewer than 30,000 medical doctors, Nigeria faces an alarming doctor-patient ratio, with approximately 10,000 people for every doctor. This ratio, even worse than what is observed in many economically challenged African countries, falls far short of the WHO-recommended doctor-to-population ratio of 1:600. These are substantial challenges that directly impact claims of national development.
To illustrate this point, the UK’s General Medical Council confirmed that as of August 30, 2022, a staggering 10,096 doctors trained in Nigeria and subsidised by Nigerian taxpayers had emigrated to Britain. Similarly, in 2020, over 3,894 doctors funded by Nigeria were granted authorisation to practise medicine in the United States, and no fewer than 632 were actively practising in Canada during the same period.
In a space of five years (2017-2022), about 57,000 nurses were said to have left Nigeria; while many medical laboratory technicians, pharmacists and paramedical staff have also quietly emigrated abroad.
The consequences of this shortage are readily apparent: chronic overcrowding in public hospitals. Across the country, patients are often compelled to wait for extended periods before receiving medical attention. Even in dire emergency situations, the story is not anything better, as individuals find themselves waiting for hours or resorting to private hospitals. Unfortunately, many private healthcare facilities, although better equipped, often impose prohibitively high charges in a nation where an out-of-pocket payment system is the practice.
As the emigration of Nigeria’s healthcare workforce to countries such as the United States and Europe continues to exacerbate the healthcare crisis, experts have pinpointed the factors responsible for this significant migration.
These factors, which include but are not limited to subpar working conditions, inadequate compensation and limited career advancement opportunities, serve as both push and pull factors that attract medical professionals to seek opportunities abroad.
Consequently, this ongoing exodus leaves Nigeria grappling with a severe shortage of healthcare workers. Additionally, the healthcare system faces the challenge of insufficient infrastructure and outdated equipment. Public healthcare facilities throughout the country often suffer from inadequate infrastructure, obsolete medical equipment and a scarcity of essential medical supplies.
Patients are frequently required to procure their medications and supplies, placing further strain on their financial resources. This equipment deficiency hinders healthcare providers’ ability to offer comprehensive care.
Furthermore, the problem of insufficient health insurance coverage exacerbates the situation. The majority of Nigerians lack access to affordable health insurance, exposing them to steep medical expenses that many citizens are unable to bear.
This absence of nationwide health insurance coverage not only imposes crippling financial burdens on patients and their families but also leads many individuals who cannot access care to resign themselves to their condition as a potential death sentence.
As rightly pointed out by those well-versed in the matter, a substantial increase in funding allocated to the healthcare sector can serve as a positive step toward addressing some of its multifaceted challenges.
Stakeholders, particularly governments at all levels, have the opportunity to make a meaningful impact on the lives of Nigerians by directing substantial investments into the sector. Such investment is urgently required and plays a crucial role in modernising outdated infrastructure, replacing obsolete equipment, and expanding the healthcare workforce through recruitment and retention efforts.
Experts have emphasised that brain drain not only depletes the healthcare workforce but also undermines the country’s ability to provide quality healthcare services to its citizens.
Firstly, it results in increased workloads for the remaining healthcare professionals, leading to burnout and decreased morale. Overworked doctors and nurses may not be able to provide the level of care and attention patients require, ultimately affecting the quality of healthcare services.
Secondly, the lack of specialised consultants in rural and underserved areas exacerbates healthcare disparities. Access to specialised care becomes a privilege enjoyed primarily by those in urban centres, leaving rural communities underserved and often reliant on unqualified medical practitioners.
Thirdly, the brain drain contributes to a loss of potential for medical research, innovation, and the development of indigenous medical solutions. Nigerian healthcare institutions suffer from a scarcity of experts who can lead ground-breaking research and medical advancements.
Addressing the brain drain challenge requires a multi-pronged approach that involves stakeholders at various levels. The Nigerian government and healthcare institutions must prioritise improving the working conditions of healthcare professionals. Competitive salaries, better facilities, and adequate medical equipment are essential to retaining talent. While it may seem counter-intuitive, investing in the training of more medical specialists, including consultants, is vital. This can be achieved through collaborations with foreign institutions, scholarships, and incentive programmes that encourage doctors to specialise in fields of need.
These collective challenges have prompted analysts to repeatedly urge politicians to utilise public hospitals for their healthcare needs. They argue that if political leaders were to become patrons of public healthcare facilities, it would provide them with first-hand exposure to the extent of the issues within the sector, including the daily struggles faced by citizens seeking medical services. To address the problem of medical brain drain, the government must take proactive measures to enhance the appeal of the healthcare profession. This can be achieved by improving working conditions, offering competitive remuneration packages, creating opportunities for career advancement and establishing working environments conducive to hitch-free tasks. Additionally, the government should expand access to a comprehensive and affordable health insurance system for all citizens. Such a move would alleviate the financial burden on patients and promote equitable access to healthcare services.
QUOTE
We need to ramp up our training processes, and we also need to put in place, largely on the side of the government, mechanisms to ensure that skilled manpower remains in the country. The continued emigration of medical professionals to foreign countries carries grave implications for Nigeria’s healthcare delivery system. We need to keep training more and retaining more in the country through the provision of financial and non-financial incentives by the government
