Data Analysis: How Nigeria lost her health personnel, and how to win them back

• 10 reasons why medical doctors migrate

By Daniel Adaji

The House of Representatives woke up last week from slumber to rush a Bill that would make it mandatory for Nigerian-trained medical doctors to serve the country for a minimum of five years before they could seek employment in overseas.

Realising that their days in the Green Chamber are numbered, the lawmakers speedily passed the  Bill in its second reading in a couple of days. Like an emergency treatment for a disease that has overwhelmed all the fabrics of Nigeria’s health sector, the Bill can accomplish too little, if not worsen the dwindling number of human resources in the health sector,  even if passed into Law.

The health workers ratio to the population is very grimy. There are 15.64 nurses and midwives to 10,000 people; 3.95 medical doctors to 10,000 peoples; 0.20 dentists to 10,000 people; and 0.81 pharmacists to 10,000 people.

Bill can accomplish too little, if not worsen the dwindling number of human resources in the health sector,  even if passed into Law

From a global perspective, there is one medical doctor to 45,000 patients in Nigeria, some of whom have to travel for more than 30 kilometres in rural areas to receive  medical attention.

In comparison with other African countries, the ratio in Nigeria is very poor. In Algeria, there are 17.32 doctors to 10,000 people; Egypt 7.09 doctors to 10,000 people; Gabon, 5.94 doctors to 10,000 people; Libya, 21.57 doctors to 10,000 persons; Morocco, 7.32 doctors to 10,000 persons; Namibia, 6.01 to 10,000 persons; South Africa, 8.09 doctors to 10,000 persons; and Tunisia, 12.51 doctors to 10,000 persons.  These countries’ population is far lower that Nigeria’s population.

From a global perspective, there is one medical doctor to 45,000 patients in Nigeria

A report produced by the development Research Project Centre (dRPC), Abuja, shows that Nigeria has engaged in efforts to deal with this deficit in health personnel, but the efforts have not been matched with necessary action. For instance, the National Development Plan of 2021-2025 targets an increase of doctor-to-patient ratio of 5 per 10,000 population, and nurse-to-patient ratio of 15 per 10,000 population by 2025. But the strategies for achieving this project are not in place.

Data source:dRPC

In view of this, a former President of the Nigeria Medical Association, Dr Francis Faduyile, has this to say: “It would take approximately 25 years to produce the adequate number of doctors required to cater to Nigeria’s growing population. Going with the current World Health Organization (WHO) recommendation, Nigeria will need to bridge the current shortfall of health professionals, which represents a production challenge, meaning there is an insufficient number of trained health professionals relative to the need.”

Nigerian trained medical doctors and other health personnel, as a result of poor remuneration, unemployment, under-employment, the lack of facilities and motivation, migrate to other countries to work.

It would take approximately 25 years to produce the adequate number of doctors required to cater to Nigeria’s growing population

The countries they migrate to include the United Kingdom, Canada, Saudi Arabia, Australia, Dubai, the Carribbean Islands, Ireland, South Africa, Qatar, and Botswana. These countries employ Nigerian doctors, and pay them living wages, in their deliberate attempt to meet their doctor-population ratio, at a time when the Nigerian government pays lip service to the welfare of medical personnel.

Data source:dRPC

The research done by the dRPC identifies the following shortcomings in the health sector, which discourage medical personnel from working in the country:

1. The available physicians and nursing staff are frequently overworked, experience burnout and stress due to work, and have a poor work-life balance due to the staffing deficit.
2. The critical shortages of health workers may be a result of 82% of facilities working with less than 20% of the recommended number.
3. Allowances are not paid on time and are paid infrequently.
4. The workers had to go on an industrial strike to claim benefits. In 2020, health workers had to embark on a national industrial strike due to poor hazard allowances and other entitlements.
5. The problem of paying for medical staff has remained a significant obstacle.
6. Incessant crises.
7. Corruption in the system.
8. Political negativity is also a factor in the rise of the brain drain problem. As a result of the political problems in the country, the anxiety of the citizens, including doctors, increases.
9. There is under-investment in healthcare, the education and training of health workers, and the mismatch between education strategies in relation to health systems and population needs, resulting in continuous shortages.
10. Insecurity has been a major challenge to healthcare workers, especially in Northern Nigeria, where health workers face significant challenges due to a lack of appropriate health facilities.

The problem of paying for medical staff has remained a significant obstacle

The research recommended some measures to reduce brain drain in the health sector. First, government must close the wage gap, ensuring that monetary and non-monetary incentive packages encourage qualified health personnel to work in rural and remote areas, where there is the  huge population of Nigerians.

Among the revelations in the report is the fact that female medical personnel are discriminated against, pushing them to go and practice in other parts of the world. Therefore, women should be given more opportunities to practice in the country.

Data source:dRPC

The researchers recommended that medical graduates should be encouraged to practice in Nigeria for a compulsory period of time after their degrees, before they could emigrate to other countries, but that should not halt emigration because of its economic benefits.

Other ideas that emerge from the research include that of destination countries giving temporary work visas to medical personnel to enable them enhance their skills and knowledge and later return to Nigeria, and also compensation for loss, where destination countries could pay back the costs of education, or as much as is needed to replace a graduating doctor, who migrates to their countries.

It is apparent from the foregoing that passing a Bill that halts graduates of medical colleges from migrating to other countries is just a tiny and inconsequential solution to a huge problem. Government must urgently tackle many other besetting social and bureaucratic issues that chase medical personnel away from Nigeria.