Editorial
Responding To NARD’s Alert
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. Comparing the growth rate, recurrent expenditure increased by 2,822 per cent between 2001 and 2021, while capital expenditure increased by just over 400 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.
There are moments in the life of a legislature when plain speaking becomes a public service. Senator Adams Oshiomhole provided such a moment on the floor of the Senate when he accused the Minister of Works, Senator David Umahi, of manifestly neglecting critical federal arteries in Edo and Delta States, and implored his colleagues to prevail on the Minister to adopt a more equitable and genuinely national approach to road infrastructure delivery. It was blunt, it was uncomfortable, and it was necessary.
The specifics of his complaint deserve restating. Drawing attention to the recent approval of some 20 new road projects despite the parlous state of existing ones, the former Edo State governor lamented that Nigerians cannot travel from Benin to Warri, Benin to Asaba, Benin to Auchi, or Auchi to Okene without encountering severe distress. He alleged a deliberate omission of these corridors from the national budget in the last three years, save for palliative interventions directed by President Bola Tinubu through tax credit arrangements. His question — “What have we done wrong?” — resonates far beyond the chambers of the National Assembly.
We lend our full and unequivocal support to that call. The Auchi-Benin Road, for instance, has been in a deplorable and near-impassable condition for several years, turning what should be a two-hour journey into an all-day ordeal of broken axles, extortionate fares, and despondent commuters. The media have, on multiple occasions, chronicled the suffering of motorists, traders, and students who ply that route. To describe it as a federal road today is to stretch the meaning of the term beyond recognition.
This pattern of sidelining is not confined to Edo or Delta. Even here in Rivers State, the disposition of the Federal Ministry of Works has left much to be desired, particularly along the Eleme axis of the East-West Road. That road, which ought to be a flagship of federal presence in the Niger Delta, has remained in a wretched state for long. Those who use it daily — workers at the Eleme Petrochemical Complex, the two refineries, Onne Port, and the countless ancillary industries — can attest to its deterioration. Work has proceeded in fits and starts without the sustained urgency such a strategic road demands.
The Eleme stretch is not a mere intra-state byway. It is the gateway to the nation’s economic jugular. According to the Federal Ministry of Works and Housing’s 2023 Highway Condition Survey, only about 35 per cent of the country’s 36,000 kilometres of federal roads are rated as being in good or fair condition, with the remainder classified as poor or very poor. The East-West Road, conceived in the 1970s to bind the entire Niger Delta, remains unfinished in critical sections more than four decades after. If it had been treated as a priority, the perennial gridlock, carnage, and economic loss on the Eleme-Refinery junction would have long been consigned to history.
The irony is as painful as it is glaring. The Niger Delta remains the goose that lays the golden eggs. Data from the Nigeria Extractive Industries Transparency Initiative [NEITI 2023 Oil and Gas Audit] show that the region still accounts for over 78 per cent of Nigeria’s federally collected export earnings and about 65 per cent of total government revenue. The National Bureau of Statistics [NBS Foreign Trade Report Q4 2024] similarly confirms that crude oil continues to dominate export receipts. By every metric of equity and economic logic, a region that sustains the national purse deserves first-rate consideration in the allocation of infrastructure, not afterthoughts and tokenism.
Road infrastructure is not largesse to be dispensed by favour; it is the skeleton upon which commerce, cohesion, and citizenship hang. When contracts are concentrated in one geopolitical zone while other zones are left to contend with craters, it erodes trust in the federation itself. The World Bank’s Nigeria Development Update [June 2023] estimated that poor transport connectivity inflates the cost of moving goods by up to 40 per cent and costs the Nigerian economy an estimated $1.5 billion annually in lost man-hours and vehicle maintenance. If we profess to be one country, then equity must be the compass that guides key institutions before any project is executed. Development must spread round, not pool in one place as though other regions do not matter.
There is also a grave security dimension that can no longer be ignored. The deplorable condition of federal roads has become a veritable enabler of criminality. The NBS Crime Experience and Security Perception Survey reported over 2.5 million incidents of kidnapping-related occurrences nationally, with transport workers identifying bad road spots as prime ambush points. When vehicles are forced to crawl at 10 kilometres per hour through failed sections at Auchi, Sapele Road, or Eleme, they become sitting ducks for armed gangs. Fixing bad roads, therefore, is not merely about convenience; it is about safeguarding lives.
By his intervention, Senator Oshiomhole has hit the nail on the head and reminded Minister Umahi of a fundamental constitutional truth: public office is held in trust. The Ministry of Works is not a personal estate where contracts are awarded according to whim or political convenience. It is a national institution funded by the collective resources of Nigerians, including the oil and gas rents from the very communities whose roads are now neglected. The Minister must demonstrate balance, transparency, and a pan-Nigerian outlook in the distribution of projects that impact the daily existence of citizens. Selective neglect breeds suspicion, and suspicion is corrosive at a time when the nation is preaching unity, oneness, equity, and justice.
Consequently, the National Assembly must go beyond rhetoric and assert its oversight powers with vigour. Sections 88 and 89 of the 1999 Constitution [as amended] empower the legislature to investigate and expose any maladministration in the execution of federal projects. If an office holder is not acting rightly, it is the duty of the Senate and the House of Representatives to call him to order. Oversight must not be reduced to budget approval ceremonies; it must translate to field verification, public hearings, and insistence that the Federal Character principle, as enshrined in Section 14(3) of the Constitution, reflects in road awards.
Let the Auchi-Okene, Benin-Warri, Benin-Asaba, and Eleme East-West gangways be restored to motorable dignity. Let priority be given to completing existing, economically vital roads before embarking on new ones. If those who, through their resources, sustain the federation are sidelined in the distribution of tangible dividends, it tells poorly of our nationhood. Bad roads must be fixed, and they must be fixed now, with fairness as the guiding standard.
