A health crisis is hanging over Nigeria owing in part to the incessant emigration of medical doctors to advanced countries. The recent attempt by 58 Nigerian doctors to migrate to the United Kingdom, which was foiled by the Nigeria Immigration Service at the Murtala Muhammed International Airport, Lagos, was not surprising. It underscores the widespread assumption that the number of doctors seeking to migrate is on the increase even during the unprecedented COVID-19 pandemic.
The medical brain drain did not just begin. The Nigerian Medical Association said in 2019 that between 10,000 and 15,000 Nigerian doctors work outside the country and 90 per cent of them were trained in Nigeria. And according to the General Medical Council, the government body that maintains the UK’s official register of medical practitioners, there are 7,875 Nigerian-trained doctors in the UK alone. The Deputy Director, Human Resources, at the Federal Ministry of Health, Shakuri Kadiri, once revealed that the Nigerian health sector recorded an increase in the number of doctors seeking migration from 656 in 2014 to 1,551 in 2018.
Now, the exodus of doctors and nurses is not expected to let up because demand from developed countries is surging owing to the ravaging terror virus. The UK, a fortnight ago, announced a new ‘Health and Care Visa’ policy, which aims to make it cheaper, quicker and easier for healthcare professionals to migrate to the UK, beginning from August. Earlier, the United States Foreign Mission in a statement advised medical professionals with approved immigration petitions to contact its embassies or consulates for possible visa appointments, indicating preference for those working to combat the COVID-19 pandemic.
But the country’s health care system, which is already on the brink of collapse, may not be able to withstand an additional strain. The Medical and Dental Council of Nigeria puts the total number of registered doctors in Nigeria at a paltry 74,543 for the country’s population of about 200 million. This puts the doctor-patient ratio in the country at 1:3,500. This falls far below the World Health Organisation’s recommendation of 1:600. The story is worse if broken down on a state by state basis, with reports that Zamfara State, with a population of over four million, has a doctor population of 300, a ratio of one doctor to approximately 13,667 patients. Such statistics should unsettle any serious government. No doubt, better pay and working conditions are the main reason why nurses and doctors continue to leave. It is reported that only four per cent of Nigeria’s budget is allocated to health. While the annual health care threshold per person in the US is $10,000, it is a miserly $6 here.
The trouble is that Nigeria’s health sector is suffering from a push and pull crisis. A poll shows that 88 per cent of Nigerian doctors are considering work opportunities abroad. At the same time, there is high demand for doctors in developed countries. In the US, for example, the shortfall of physicians could grow to nearly 95,000 by 2025, equivalent to 43 per cent of all doctors working today.
Ironically, the NMA says up to 40 per cent of doctors in Nigeria are unemployed, adding that after their National Youth Service Corps programme, it takes an average of a year or two to get employment, which is usually offered by private hospitals, where they are grossly underpaid. New doctors have to start with housemanship, a compulsory one-year internship where they practise under supervision in hospitals. But there have been complaints about the difficulty in securing a housemanship as well. Many doctors spend months or sometimes years at home looking for a placement and are frustrated in the process.
The conditions of a few doctors that are lucky to get a job are just a shade better. Nigerian doctors in the public sector have at various times embarked on strikes even during the pandemic, lamenting the poor working conditions, the meagre and sometimes unpaid allowances as well as the lack of proper personal protective equipment for health workers. The decision of the Federal Government last month to release N4.5 billion hazard allowance to doctors only after they had embarked on a strike is a clear illustration of the recurring problem that has bugged the health sector for decades. A new report stated that 33 of the 36 states failed to pay COVID-19 hazard allowance to doctors.
A more rounded and comprehensive strategy is needed to slow down medical brain drain. If properly managed, it can be a huge source of migrant remittances to Nigeria. In 2018, PwC said such remittances equalled $25 billion, representing 6.1 per cent of GDP. “This also represents 14 per cent year-on-year growth from the $22 billion receipt in 2017. The 2018 figure translates to 83 per cent of the Federal Government budget in 2018 and 11 times the FDI flows in the same period.” Cuba benefits hugely from Diaspora remittances. There are also the opportunities for improved training and long term professional networks for health workers.
But countries recruiting health care workers from Nigeria should know the consequences are weighing so heavily on Nigeria’s healthcare delivery. The WHO calls for more ethical recruitment policies and for aid donor nations to focus on helping expand the health workforce in poor countries.
The availability of funds for health is a fundamental question for all countries. The WHO says improving the health workforce database, wages, health resources and working conditions, task shifting, payback from recipient countries and migrant health professionals, securing additional investment in the health workforce, and the development of locally relevant medical training and research are useful measures to combat this problem. Unfortunately, public officials, including the President, Major-General Muhammadu Buhari (retd.), prefer to get medical treatment overseas rather than focus on rebuilding the decaying public health sector. This medical tourism costs Nigeria $1 billion yearly by the Federal Government’s own admission. On no account should the taxpayer be made to bear the cost of medical treatment abroad. And it should start with the President.
But there is a deeper issue. The poor budgetary allocation to health by the three tiers of government calls for complete rethink of health-care financing. The health budget, which stands at a mere four per cent in the 2020 budget, is in clear violation of the African Union Abuja Accord of 2001 that mandates all signatories to set aside 15 per cent of federal budgets for health care. As the WHO has advised, governments at all levels should give higher priority to health in their budget allocations, collecting taxes more efficiently, including compulsory insurance contributions, and raising additional funds through various types of innovative funding mechanisms. For instance, taxes on harmful products such as tobacco and alcohol should be directed at improving the health sector.
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