New Telegraph

Tackling brain drain to avert health sector collapse

The brain drain of doctors from Nigeria to practice medicine in advanced countries remain a festering sore that makes it difficult for Nigeria to meet the World Health Organisation (WHO)’s recommendation of one doctor to 600 patients. Stakeholders, however, believe declaring a state of emergency on brain drain could be the first step to tackle the menace, writes APPOLONIA ADEYEMI

Spending the whole day in hospitals in Nigeria is no longer news. For patients whose pain and suffering from ailments pressure them to seek care mostly in public health facilities, they are aware that they need not be in a hurry to leave the hospitals. Although, majority of them may have arrived at the clinics between 7 and 8a.m, they may not see doctors before 2pm.

It is actually normal that some patients end up seeing doctors on duty between 3 and 4pm and by the time they similarly queue up to purchase prescribed drugs from hospital pharmacies, it couldn’t be before 4 and 5pm. These don’t surprise most patients and their relations anymore; it has actually become the trend that when you seek care in public health facilities, you will be back home in the evening.

Sadly, it is a trend that has succeeded to discourage many sick persons from accessing health care from health facilities all over the country. Hence, talk about such delay in accessing healthcare from the Lagos University Teaching Hospital (LUTH) to the University of Calabar Teaching Hospital (UCTH) to the Jos University Teaching Hospital (JUTH), the University of Nigeria Teaching Hospital (UNTH), among others, the stories are the same.

This is the reason Mrs Teniola Ahmed, a 52-year old widow who has suffered severe pain in her legs for over eight months, had written off hospital care as an option for a solution for that medical condition. Relating her two previous experiences when she sought care at the Gbagada General Hospital in Lagos, Mrs Ahmad lamented that she didn’t leave the clinic before 5pm, though she had arrived as early as 7.30am. The worsening condition of her leg however prompted her elder brother to intervene and counseled her to resume hospital visit again in search of cure for the ailment which was finally diagnosed as the spread of breast cancer to her left leg.

Investigating what’s often the cause of the dreaded delays in most public hospitals, some patients who volunteered to speak were unanimous about the large number of patients which often overwhelm the few doctors on duty, particularly in public hospitals. The President of the Nigeria Medical Association (NMA), Dr. Uche Rowland Ojinmah confirmed this recently while speaking in Abuja, at a symposium to discuss ‘The Brain Drain in Nigeria’s Health Sector and Its Implications on Health Service Delivery’. Ojinmah lamented that only one doctor is available to treat 30,000 patients in some southern states, while in the north, it is one doctor to 45,000 patients. “In some rural areas, patients have to travel more than 30 kilometres from their abodes to get medical attention where available, thus making access to healthcare a rarity,” he said.

Doctor-patient ratio

Given the fact that there are only 24,000 licensed medical doctors available in the country, the current doctor-patient ratio is 1:9,083, a stark contrast with the World Health Organisation (WHO)’s recommendation of one doctor to 600 patients. With 218 million people to cater for, Nigeria requires at least 363,000 additional doctors to meet this target. Speaking on the trend of the migration, the President, Medical and Dental Consultants Association of Nigeria (MDCAN), Dr. Victor Makanjuola said many of their colleagues; doctors in particular are migrating to the United Kingdom (UK). There are also medical doctors going to Canada and the United States (U.S). There are specialists that are going to the Middle East countries. “The younger doctors are going to the UK primarily and a smaller number to the U.S and Canada. That’s the pattern we’ve observed,” he added.

Brain drain

The brain drain of medical doctors from Nigeria remains a festering sore. According to Makanjuola, MDCAN conducted a survey in 82 of its chapters in March, and out of the 37 that responded, 253 consultants from different specialties have left the country for greener pastures in the last two years.

The remaining chapters, he said, have not sent in their response for some reasons. “We are estimating that if 90 to 100 per cent of all the chapters respond, over 500 consultants from various medical fields might have left the country in two years.

“That’s our rough estimate and that is a major disaster for the country,” he lamented. For Makanjuola, this is just a tip of the iceberg considering that it is not only medical consultants that the brain drain has affected. Similarly, the National Association of Resident Doctors (NARD) has lost about 2,000 doctors to brain drain in the past years. According to the latest survey that was conducted by NARD, it was revealed that due to brain drain, six out of 10 doctors ‘plan to leave’ or ‘have the intention to leave’ Nigeria as soon as possible.

The survey showed that only 12,297 resident doctors now work in both federal and state tertiary health institutions. The President of NARD, Dr. Dare Ishaya said, “As of the last time we issued the questionnaire,we found that out of 10 resident doctors, six of them are planning to leave or have the intention to leave. The statistics we had then was in December 2021. So, it’s either they are planning to leave or they have thought of leaving.” On his part, the President, Guild of Medical Directors, Dr. Abiodun Kuti, a consultant radiologist said the pattern of migration of medical doctors is scary.

At least 30 per cent of the health workers in Nigeria must have moved outside the country for better professional engagement. According to Kuti, although it will be tough to quantify the number involved in figures, except we have to get the nursing, medical and laboratory scientists’ regulatory bodies to give the specific figures, but “from most hospitals 30-40 per cent of members of staff have left this country.” It is not medical and dental practitioners only that are migrating; other health workers including nurses, pharmacists, medical laboratory scientists, among others are also among medical professionals leaving the country in droves to practice abroad.


On the impact of brain drain on care service provision in the country, Makanjuola said it has negatively affected the ability to provide adequate care for patients in the country. “Given the huge number of people that have traveled out for greener pastures, it means that in some clinics patients will stay longer to get to see the few doctors that are left; some units (medical specialisations) mainly exist because the people in the unit have all traveled. “We have an example in Benue State where the whole specialist in the Radiology Department has gone to Saudi Arabia and they had just employed new equipment that needed experts to handle them, but there were no experts available. “Some services will have to be shut and people will not have access to them. The quality of service will also begin to dwindle. If 10 medical doctors were attending to 50 patients before, we may have two or three doctors to attend to the same 50 patients. It is just natural that the quality will not be the same,” he added. Speaking further on the ordeal of patients arising from brain drain, the president of MDCAN said due to the limited number of doctors in service, consultation will have to be rushed and short and that will deprive patients the ability to interact with the doctors. “Those are some of the impacts brain drain has on patient care.” The President of the Guild of Medical Directors, also admitted that brain drain is definitely affecting the needed delivery of the adequate health services needed. According to him, the migration of medical doctors abroad is putting too much strain on the personnel left in most hospitals, both private and public hospitals in the country to manage patients, adding that the impact is worse in public hospitals. “I know a state government that makes their medical doctors cover three different general hospitals in the state so as to meet the patients’ coverage.” Kuti lamented that not only are the young medical doctors leaving to practice medicine in advanced countries, many older and more experienced doctors are also leaving. “We are losing the future hands for needed development of our health space; we are also losing the experienced doctors who could have impacted the young ones with their exposure, experience and knowledge.”

Effect of brain drain on doctors

Makanjuola said brain drain similarly has an impact on the doctors that are left behind in Nigeria. They will become overburdened and they will fall sick often. They will suffer burn out. They will get tired easily and their productivity will decline. “They begin to suffer some sort of mental health issues in the process of trying to make up for the doctors that have left. It’s a very bad situation that may eventually cause the collapse of the medical system if nothing is done.”

Why medical doctors are migrating

Kuti gave the main reasons for brain drain to include inadequate salary and emoluments, insecurity situations arising from armed banditry and terrorist activities, unhealthy working hours, inadequate equipment and working tools, poor mentorship programme for young doctors, poor financial support for medical services and hospitals, mental burn out, especially after the COVID-19 lockdown, among others.

Way out

On what is being done at the level of MDCAN to curb the migration, Makanjuola said the organisation has discussed salary and wages of its members with government and other employment agencies most of which have agreed on the terms. We are also in the interim set to replace those that have departed immediately. However, he lamented that the bureaucracy of applying for vacancies that take two to four years before they can recruit is a major challenge in replacing those that have left. “Once someone (a doctor) leaves, that is a vacancy and the head of the hospital should be able to appoint someone that is qualified.

“The problem we have now is that people are leaving and no recruitment is taking place to replace them. There is a guarantee you will find people to replace them. There are still a few people that are qualified, but they cannot get the job.” According to Makanjuola, some of the things that can be done in the short term to address some gaps created by brain drain is to employ professionals who are qualified to fill the vacant positions.

While it is admitted that there has been recruitment of doctors by both the federal and state governments, such exercises have been few and far between. Some of the reasons that have often been blamed for this have been the non-availability of adequate funding to drive the process. Another reason could also be the negative attitude of government officials. Although, major stakeholders in the health sector have been overwhelmed with various plans that would effectively curb brain drain so as to prevent further decline of quality care provision in the country, the Minister of Health, Dr. Osagie Ehanire announced at a media conference in Abuja in August, that there are enough medical doctors in the country, but said the Federal Government is working towards replacing any medical doctor who resigns and leaves the country.

He also said there was no embargo on the employment of doctors and other health personnel in the country. “There is no embargo on employing doctors; where there is a need, we do. But, because there is a Civil Service regulation, there are processes before doctors are employed. “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. “It is just that the employment process needs to be smoothened,” Ehanire said.

The minister explained that the ministry was working with the Office of the Head of the Civil Service to use the ‘One-for-One’ employment strategy so that if one doctor or nurse resigns to go abroad, another one is employed. While the comment of Ehanire was completely in contrast with what is believed in the public cycle on the brain drain, the attitude of government officials have not helped in addressing the challenges. The views of the health minister is actually in line with that of the Minister of Labour and Productivity, Dr. Chris Ngige who in April, 2019 said Nigeria has ‘more than enough’ physicians to meet the needs of its nearly 200 million citizens.

He said, “In fact, Nigeria has just 2.27 doctors working in the country for every 10,000 people.” The controversy generated by the comment of Dr. Ngige prompted the reaction of the WHO’s Technical Officer, Aurora Saares who said a WHO global benchmark exists in relation to the Sustainable Development Goals (SDGs). According to her, these are the series of targets promoted by the UN. Under these goals, countries should aim for a minimum of 4.45 doctors, nurses and midwives per 1,000 people. Furthermore, as part of its recommendation to curb brain drain, the president of NMA recently called for an extension of the retirement age of medical doctors as an immediate response to the problem of brain drain. Dr. Ojinmah similarly suggested other measures such as better working condition and improved security for health personnel, saying these could also help to solve the problems.

Ojinmah during the 2022 National Conference of the NMA which held in Gombe in September, said, “While we appreciate that the government has realised the challenge of the ongoing brain drain, upward extension of retirement age of Nigerian doctors is one of the easiest ways of retaining some useful service while we are trying to sort out the issue of brain drain.” Similarly, in a briefing to mark 2022 Physicians’ week with the theme: Nigeria’s Healthcare Delivery System and The 2023 Democratic Transition: A Time To Change The Narrative, Ojinmah said, “Statistics also showed that between January 1, 2022, and September 30, 2022, about 1,307 doctors trained in Nigeria were licensed in the United Kingdom (UK) as Nigeria continues to battle one of the worst situations of brain drain in its history.

“Overall, 10,296 doctors who obtained their degrees in Nigeria currently practice in the UK.” According to the NMA National President, “Dispersion of the emigration data for Nigeriatrained doctors to the UK is as follows: 233 in 2015, 279 in 2016, 475 in 2017, 852 in 2018, 1,347 in 2019, 833 in 2020 in spite of COVID Pandemic and in 2021 during recovery from COVID. While calling on the Federal Government to declare a state of emergency with regard to the situation of brain drain, Ojinmah lamented: “Currently, Nigeria has the third highest number of foreign doctors working in the UK after India and Pakistan.” “Furthermore, let me inform you all that the Nigerian doctors are poorly paid, overworked, lack necessary work tools, and have become targets for kidnapping. We, Nigerian doctors have been taken from the lofty heights of nobility to nothingness by the neglect and possible disdain for the health sector by the successive governments,” he added. He also said that “The penchant of state governments for seizing or slashing our salaries and paying piecemeal at their convenience without interest has become a subject of folklore and hence cannot be allowed to continue.” In similar vein, the former governor of Ondo Dr. Olusegun Mimiko who lamented that “Eightyeight per cent of Nigerian doctors are leaving for abroad, seeking employment because of the poor facilities in Nigeria,’’ also urged the Federal Government to declare an emergency on brain drain as a strategy to urgently tackle the challenges the phenomenon posed to healthcare provision. That way, the table could ultimately turn while changing the current narratives.

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