Two thousand Nigeria trained medical doctors leave Nigeria annually to seek employment abroad. The number is more than triple for nurses, especially the specialist nurses such as critical care nurses, nephrology nurses, oncology nurses, etc. Other medical professionals such as radiographers, medical laboratory scientists and physiotherapists are not left out. The trend of migration of our medical experts in the past few years is alarming and we are fast approaching the precipice as a country, though our leaders are oblivious of this pending crisis.
In 2017, NOI in collaboration with Nigerian Health Watch conducted a poll amongst Nigerian doctors. In that poll, 88% of Nigerian doctors randomly interviewed stated that they were seeking job opportunities outside Nigeria.
I had a brilliant and very hardworking young medical doctor who joined Alliance Hospital soon after his Youth Service in 2018. In his second year with us, he wrote his UK qualifying exam – PLAB and passed. He is now working in the United Kingdom. He visited me last year and shared his experience with me, much to my chagrin. In the hospital where he works in the UK, Five Nigerian doctors are working in the same department with him and a total of about one hundred Nigerian trained doctors work in the entire hospital in Nottingham’s, UK.
In the past five years, I have had to write reference letters for over thirty young Nigeria trained doctors seeking employment abroad and they have all left. I have had discussions with my colleagues who are medical directors of top hospitals in Nigeria. The situation is the same. It is also not different for university teaching hospitals across the country. These are the factory for churning out doctors both at graduate and post graduate levels.
In April 2021, the chief medical director of University of Calabar Teaching Hospital, Professor Ikpeme Ikpeme raised an alarm that about twenty senior medical doctors in that institution had processed their papers and were waiting to leave. They must have left by now. His deputy also left for greener pastures as they would say. The chairman of Nigerian Medical Association Lagos State in 2017 stated that over 800 doctors resigned from the services of Lagos hospitals within 2 years and about 100 doctors resigned from the University College Hospitals(UCH), Ibadan from January to November, 2017. These are elite places to work in Nigeria. Any doctor resigning from these places is most likely going across our borders to find a job.
On the average, about 2,000 Nigerian trained doctors leave our shores yearly to work abroad over the past 5 years. This number accounts for more than 50% of the number of fresh graduates from Nigerian universities per annum. Our current doctor to patient ratio as a country is about 1to 5000 persons as against 1to 600 persons recommended by WHO. An organization called Partnership for Transforming Health Systems in Nigeria (PATHS) conducted a study on human resource for health in 2012 and found that Jigawa state, North West Nigeria with a population of over 4million people as at the 2006 population census has only 67 doctors and almost half of that number were in administration. The picture is similar for many of the northern states. Things must have deteriorated with the heralding of Boko Haram and Banditary.
The situation with nurses is definitely worse. According to records from the nursing and midwifery council of Nigeria, 7,000 nurses left Nigeria to work abroad in 2021 alone. This translates to 600 nurses leaving per month. All the school of nursing in Nigeria combined do not produce up to 15,000 nurses per year.
Our specialist nurses are now simply just passing through our hospital enroute their final destinations abroad. Apart from those who have strong social ties in Nigeria, we have three other types of nurses: Those that have left, those waiting to leave and those who are not smart enough to read and pass any foreign qualifying examination. This last group may soon become the majority of healthcare workers left in Nigeria if the trend is not stemmed.
The exodus of Nigerian health workers to the west is a form of neocolonialism. The difference between the initial colonization and now is that raw materials were taken previously but human resources are taken now. It costs Nigeria a humongous amount of money to train these experts, perhaps less than 5% of the fees they pay through school in most instances. Britain, Saudi Arabia and other countries can save their expenditure on medical education and spend on other priorities since they can get them relatively cheap from Nigeria.
Why are they leaving?
As a medical doctor with 23 years post-graduation and 13 years post specialist experience, three major things are important to me and I believe same for my colleagues:
1. To practice my profession in a sane and secured environment where there is no threat to my life or that of my family.
Recently, the rate of kidnapping and slaughtering of people in Nigeria in the name of banditry and terrorism is alarming and many doctors have paid the supreme prize. This is not peculiar to medical professionals alone but it is contributing to their migration abroad.
2. Opportunities to upgrade my knowledge and skills and to move up the ladder of the profession.
Majority of our young doctors abroad would not have left if they got a space to undertake their residency training program which is a pathway to specialization in Nigeria. Due to dwindling budgetary provisions to training centres, the hospitals are admitting far less resident doctors than their allotted capacity hence qualified doctors cannot get space for their post graduate training. This is a push factor for our young brilliant doctors to leave our shores.
3. The Pay. By far the most compelling reason Nigerian health Professionals are leaving for the west and other parts of the world is not just the pay but the worth of the pay. Over the past seven years, the value of the Nigerian Naira has depreciated so terribly that it has lost almost two third of its value from ₦198 per dollar in 2015 to ₦580 per dollar in 2022. This has far reaching implications to determine which professional we can retain in Nigeria and who will leave.
In 2010, shortly after I qualified as an orthopedic surgeon, I took up an appointment with a private hospital in Abuja. My salary was about ₦600,000 per month. At the then exchange rate of ₦150 per dollar, I was earning Ֆ4,000 per month. Today, most government hospitals still pay specialist consultants salaries in the neighborhood of ₦600,000 per month which is equivalent to approximately Ֆ1,000 per month today. This is scandalously low to say the least. No wonder our doctors are leaving in droves. With Ֆ4,000 a month, I could send my kids to good schools, take care of my family expenses and still squeeze in a family vacation once in a year, but definitely not with Ֆ1,000 a month salary. Our doctors and other health care workers are not asking for too much. They just want to survive and give their loved ones a good life. This simple ambition does not seem possible with the current remuneration of health workers in Nigeria at the moment.
The reason for the incessant strikes by doctors is to draw government attention to the problem of poor welfare of health workers. Unfortunately, the government over the years has mismanaged the warning signs and now we are in crisis.
Disruption of interviews organized by the officials of Saudi Arabia authorities to ship our doctors out from Nigeria to Saudi Arabia is not the solution to the problem. There is an urgent need to fix the economy, save the value of the naira and correct the injustice in our reward system. A situation where very senior doctors in Nigeria get to envy politicians with a school certificate degree because of the differentials in earning is a broken system.
There is a need for deliberate massive investment in our healthcare. The national health insurance scheme is a low hanging fruit. If the NHIS is overhauled and appropriate legislation is put in place, so much finances can be unlocked to invest massively in hospitals and allied institutions who will in turn pay healthcare workers competitive wages.
In 2001, African leaders appended their signatures to a document popularly now called the Abuja Declaration. The provision of that agreement is that member countries commit to budgeting a minimum of 15% of their annual national budget to healthcare. Since 2001, the highest percentage budgeted for health in Nigeria was 6.2% in 2012.
In 2021 at the peak of the global COVID-19 pandemic, healthcare received only 4.5% of the Nigerian national budget.
It is also important to note that the amount budgeted is far more than the amount released which is also far more than the amount spent.
At a growth rate of 3% per annum, Nigeria’s population is projected to reach 400,000,000 in 2050, making it the third most populous country in the world. Without good healthcare as epitomized by a sizable and well motivated health workforce, what we will have then would be a large but ineffective population with high fertility and mortality rate, high disease burden. In fact, it will be a rendezvous of broken humanity.
As 2023 general elections draw near and as politicians criss-cross the country canvassing for votes, let us all as citizens remember that amongst other critical issues, the healthcare of Nigerians would be on the ballot. If we do not choose wisely, we and our loved ones will live to bear the consequences of our actions and inactions since not everyone can leave.
DR. OTABOR CHRISTOPHER, FWACS, MBBS
ALLIANCE HOSPITAL ABUJA