Why the government should not allow Nigeria’s health sector die.
There could be no grimmer picture of the situation in the health sector than the recent disclosure by the Nigerian Medical Association (NMA) that over 10,000 Nigeria-trained doctors are currently practicing in the United Kingdom (UK), alone.
NMA National President, Dr Uche Ojinmah, who raised the concern during the 2022 Physicians’ Week, added that with the figure, Nigeria has the third highest number of foreign doctors working in the UK after India and Pakistan.
There is no doubt that the figure from the NMA president may be conservative. If you then factor in those working in Canada, United States (US), Saudi Arabia, Europe, South Africa and other parts of the world, you would appreciate the extent professionals in the country have abandoned the sector.
To be fair enough, emigration of Nigeria’s medical and other health workers, is not a sudden development. It has been on, over the years. The uncertainties in the country, have only exacerbated the trend.
As of 2021, it was estimated that about half of Nigeria’s 72,000 registered doctors were practicing abroad. In just six months between December 2021 and May 2022, a total of 727 medical doctors trained in Nigeria relocated to the United Kingdom alone.
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Last month, October, another group of 91 Nigerian doctors was licensed within two weeks by the British General Medical Council (BGMC). The accreditation occurred over 15 days between 10 and 25 October 2022, bringing to 10,387 the number of Nigerian-trained doctors in the UK. The figure does not include Nigerian doctors trained abroad who are working in the country.
Among the 10,387 are 5,210 associate specialists, 2,318 doctors in training, 1,837 general practitioners, and 1,273 specialists. The latest figure adds to the 1,307 Nigerian-trained doctors who were licensed in the UK in the first nine months of this year, from January to September.
As it is with the doctors, so it is with the nurses. Data from 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. With the figure released by the NMA president, the number must have gone up.
What perhaps may explain the despondency in the field better, is a certain development in August last year, when just in a particular occasion, over 500 Nigerian doctors turned up at a recruitment exercise organised by the Saudi health ministry in Abuja. Consultants are leading in the emigration exercise. These are the experts teaching the young doctors. Upcoming medics look up to them. By the time they lead the exodus, it tells the story of what is happening.
The way things are, if measures are not put in place to discourage the drift, Nigeria would be at the risk of having a collapsed health system. Apart from this obvious danger, the resources spent in training the personnel would have been lost. It is estimated that for every physician trained in Nigeria, government must have spent an average of N3.8 million. So, if after the training, the individual is forced to leave the country, the investments on him or her would have been lost. In a system that bothers about human capital development, this should give cause for concern.
There are other considerations. Experts are worried that given the frightening movement, it will take Nigeria about 100 years to have the number of doctors needed by its citizens, even if no doctor leaves the country after training.
The constant migration is already having drastic impacts on the doctor-to-patient ratio in the country now put at 1:10,000 as against the World Health Organisation (WHO) recommendation of 1:1,000. That was the complaint by the Taraba State branch of the NMA the other day. The chairman of the body, Dr Bako Ali in lamenting the situation, blamed it on non-payment of relevant allowances to members.
In Ekiti State, the NMA chairman, Dr Niyi Rosiji, raised similar issue, warning of the dangers ahead if the government fails to address the situation. In his words, “Every secondary health centre and specialist hospital in Ekiti should have at least nine doctors but the highest we have is two per hospital. We are supposed to have 276 doctors but we have just 85. We need about 195 doctors to run the Ekiti State University Teaching Hospital, but we only have 95. For the primary, we need 32 doctors, but there are only 12 and four of them will retire soon”. The story replicates in other states across the country. The immediate result is the rising mortality rate in the country.
This trend of skill migration from the health sector, happening when the country’s population is expanding exponentially, should be a source of worry for the leaders. But who really cares among them, when even the President seeks medical attention abroad?
Many conditions account for the migration of the professionals, not only to the UK but other parts of the world. They include poor working conditions, dearth of functional equipment, inadequate work opportunities, high cost of living, stifling tax regimes and multiple deductions from salary, low work satisfaction, poor salaries and emoluments. Insecurity, personal health and concerns about the future of their children, are equally reasons for the doctors and other experts to leave the country.
The government needs to take another look at the sector to halt the drift by professionals. The budget for health should be increased and the money appropriated, released promptly. Analysis of the recent budget proposal by President Muhammadu Buhari, shows that N1.17 trillion, representing 5.75 per cent, was allocated to the health sector out of the total of N20.5 trillion for the 2023 fiscal year. Poor as it is, the proposal is the highest so far and shows a significant increase from the N826.9 billion allocated to the sector in 2022 and the N547 billion in 2021.
But even as the 5.75 per cent allocated to health in the proposed budget is an increase from the 4.7 per cent allocated in 2022, it falls short of meeting the commitment made by African leaders under the 2001 Abuja Declaration to allocate at least 15 per cent of their annual spending to health. While countries like Rwanda and South Africa have met the commitment by allocating at least 15 per cent of their total budgets to health, Nigeria is yet to do so, 21 years after the Abuja accord.
The earlier the government takes the sector seriously, the better for the country. Health is wealth, is the saying. Security as a prime function of the government entails ensuring good health for the citizens. It is in the interest of the nation for the health sector to be given the good attention it deserves.
Let the presidential and governorship candidates of the various political parties tell Nigerians their agenda for the health sector at federal and state levels, respectively and how they intend to actualise them. Unless the challenges in the field are adequately addressed, the professionals will continue to move.
The best strategy to discourage the exodus is to create an enabling environment for the medical personnel to thrive. This will enable them provide the best services to those who need them most. Brain drain is a problem that must be addressed. The hospitals must be adequately equipped and the workers well-paid. Nigeria’s health sector should not be allowed to die.
