The Nigerian Association of Resident Doctors (NARD) recently gave notice of the plan by 4,000 of
its members to disengage their services in the country and relocate abroad for greener pastures. This came as the association expressed concerns over the government’s handling of members’ affairs. NARD disclosed that the country had already lost thousands of doctors to the outside world in the past two years and charged the government to terminate the drift by doing what is required to avoid what it dubbed disaster in the nation’s health sector.
Nigeria’s healthcare system has suffered several reversals. It is woefully under-resourced in terms of personnel and medical infrastructure. While this is a general problem, it tends to be much worse in rural areas compared to urban locations. The nation’s terrible health system has led to penurious outcomes, prompting stakeholders to call for instant government intervention. Yet, the government’s health expenditure continues to be appreciably lower than the World Health Organisation’s (WHO) recommendation of 15 percent of the yearly budget.
Over the decades, the migration of medical doctors from Nigeria has increased. NOI Polls in 2018 revealed that 88 percent of doctors in our country were searching for employment abroad. Furthermore, between 2015 and 2021, about 4,528 Nigerian-trained doctors migrated to the United Kingdom (U.K). Even with the pandemic and existing health burdens in Nigeria, doctors’ migration has increased. This upsetting tendency heightens an already disintegrating health system. And it is unlikely to cease as Nigerian doctors continue to seek better working conditions abroad.
We are considerably dismayed by the saddening situation that has the best brains in the medical field jetting out to greener pastures far beyond our shores. This enormous loss has left Nigeria with only 4.7 per cent of its specialists to service the healthcare necessities of over 200 million people. Nigeria has a doctor-to-population ratio of about 1:4000-5000, which falls far short of WHO’s recommended doctor-to-population ratio of 1:600.
Although brain drain was originally limited to certain professions, it has now become a free-for-all with the introduction of visa programmes to fill workforce gaps in developed nations. This was scintillated by an economic downturn following a period of an economic boom in the 1970s and 1980s, driven by the discovery of oil wells in Nigeria. That reminds us of the Structural Adjustment Programme days of the military junta led by the famed General Ibrahim Babangida.
More notably, we should be asking ourselves about the root causes of brain drain with the salutary aim of proffering and acting on workable solutions. The answer is not far-fetched as persisting poor leadership has been fingered by some researchers as a crucial factor leading to mass brain drain. For instance, the political leaders could not manage the economic prosperity of the 1970s and 1980s, which came about through the discovery of oil wells.
Things have worsened in the sector so much that even the President, Muhammadu Buhari, alongside the political elite, does not trust the country’s hospitals enough for his medical needs. Instead, he resorts to medical tourism in the United Kingdom at huge public expense. The British Broadcasting Corporation says Nigeria spends about $1 billion annually on medical tourism, particularly to India. Consequently, doctors are now jumping at every opportunity to move out in droves. This should be addressed.
This could potentially sound the death knell on the country’s health sector, currently challenged by a dearth of medical doctors. Statistics from Nigeria Health Watch indicate that there are 80,000 doctors registered with the Medical and Dental Council of Nigeria as of June 2021, out of which only about 35,000 are practising in the country. The rest are working overseas –with about 4,000 in the United States and 5,000 others in the UK– while a few moved to other professions.
With over 200 million people, it would take about 25 years to produce enough doctors to cater for the population, says the Nigerian Medical Association (NMA). This ominous situation can only lead to poor health effects. High child and maternal mortality rates are preventable if doctors are readily available. The link between the number of physicians and mortality rates has been documented, reflecting the negative outcomes of the lack of doctors in Nigeria.
Figures from the World Bank are likewise heartbreaking. Nigeria’s public spending on healthcare amounts to just 3.89 per cent of its $495 billion GDP, compared to 8.25 per cent in South Africa and 5.17 per cent in Kenya. In 20 years, recurrent expenses gulp 78 per cent of the total health expenditure, while capital takes only 22 per cent.
The rising trend in the number of migrating doctors could prove destructive and pose a substantial limitation in accomplishing Sustainable Development Goals (SDG) 3 — good health and well-being — in Nigeria. It has sapped the country’s human capital, the majority of which was paid for with government’s resources. One target of SDG 3 is to enhance the recruitment, professional development, and retention of health professionals in developing countries. However, given the high rate at which doctors are fleeing the country, Nigeria may not achieve the SDG 3 targets by 2030.
Economic and social welfare conditions are among the basic causes of brain drain. Hence, a meaningful financial commitment through the provision of critical infrastructure in the health sector and improved governance would promote the retention of doctors within the country. The government should prioritise the health sector, given its link with better life quality and economic development. Workers’ remuneration should be made competitive with international standards. That would increase the opportunity cost of emigration.