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Poor salaries, absence of advanced technologies responsible for brain drain

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International migration first emerged as a major public health concern in the 1940s when many European professionals emigrated to the U.K. and U.S.A. 

In the 1970s, the World Health Organisation (WHO) published a detailed 40-country study on the magnitude and flow of the health professionals. 

According to this report, close to 90 per cent of all migrating physicians were moving to just five countries: Australia, Canada, Germany, U.K. and U.S.A.

In 1972, about 6 per cent of the world’s physicians (140,000) were located outside their countries of origin.

Over three-quarters were found in only three countries: in order of magnitude – the U.S.A, U.K. and Canada. The main donor countries reflected colonial and linguistic ties, with a dominance of Asian countries: India, Pakistan and Sri Lanka.

By linking the number of physicians per 10,000 population to Gross Domestic Product (GDP) per capita, the countries that produced more physicians than they had the capacity to absorb were identified as Egypt, India, Pakistan, Philippines and South Korea.

However, the lack of reliable data, probably excluded Nigeria from mention in these studies, as I personally experienced a mass exodus in the 80s/90s of doctors, nurses, pharmacists, etcetera, to Saudi Arabia, the U.K., U.S. and Canada, even South Africa.

Trained health professionals are needed in every part of the world, and so when healthcare professionals lack opportunities for professional development, enabling environment to practice and optimise their skills, and find that their quality of life and ability to train their children in the best educational institutions is gated by their poor salaries (compared to their peers in more advanced countries), they permit their brains to be drained.

Relocating to these countries provide for them and their families better standards of living and quality of life, higher salaries, access to advanced technology and more stable political conditions.

This should be of growing concern to our government, because of its impact on the health systems of developing countries.

As a radiologist, my colleagues and I in this country have faced frustration and embarrassment due to lack of imaging equipment to hone our skills and provide quality service confidently to our patient population, as well as hold our heads high at international fora, where we are faced with colleagues who run their daily practice on the latest high-end modalities.

For most of us, knowledge of such equipment is at best theoretical and these experiences of inadequacy turn our professional lives into one of hard labour and frustration.

In the past one month alone, I have watched three younger radiology colleagues relocate to Canada, U.S.A. and Britain. It is unusual for doctors to relocate after their postgraduate training; they instead do so after youth service. Now, that has changed. Two of these radiologists that relocated had been consultants for close to five or six years.

It has been enunciated that the pursuit of better health should not await an improved economy; rather measures to improve health will themselves contribute to economic growth. The way a country finances its health care system is a key determiner of the health of its citizenry.

Selection of adequate and efficient methods of financing, in addition to organisational delivery structure for health services, is essential, if a country is set to achieve its national objective of providing health for all.

Some key indices will assist in reducing this current exodus like more investment in healthcare by the private sector, more engagement of public hospitals in Public Private Partnership, Universal Health Coverage and government not running hospitals, but rather engaging in oversight.

The best private hospitals and private clinics in Nigeria deliver excellent healthcare services, if one can afford their exorbitant charges. The doctors and nurses are highly skilled.

The operating theatres are well equipped with the best technologies available in the industry; and there is usually a good back up of diagnostic laboratories and consultants.

Judged by the standards of highbrow services that can be found in Abuja, Lagos, Kaduna and Port Harcourt, the Nigerian healthcare delivery services leave almost nothing to be desired.

This goes to show that to run an efficient healthcare system in Nigeria is not unattainable.

At the other end of the spectrum, however, the situation is different. Our general hospitals nationwide, including most of our ‘mushroom private hospitals’, are in ruins.

Hospital equipment suppliers and corporate entities have all sworn that if Nigeria can engage in universal health coverage and make health insurance mandatory for all citizens, they will have no constraints in investing heavily in healthcare development.

Also, healthcare provision will be more efficiently run by the providers if, rather than employment, ‘fee for service’ is provided for all categories of healthcare providers.

For they will then earn as much as they work (which is what obtains in advanced countries and in private set ups; remuneration based on service rather than sticking to mandatory employment terms), and abolish competition among providers of healthcare service and the need for strike actions.

Exorbitant charges by private hospitals will even up and become competitive with public hospitals when there are enough of them, as happened in India, where the Indian government, in order to boost health tourism, supported ‘private hospital’ growth by enabling their acquisition of high end modalities.

Government oversighting hospitals, both private and public, to ensure quality and safety of service, will guarantee that patriarchism is abolished and malingering by staff curbed.

The conduct of clinical trials is ‘high on the list’ of enterprises that can leapfrog Africa into the recommendation of ranking bodies like Bloomberg.

Government and the organised private sector should key into the Association for Good Clinical Practice in Nigeria’s (AGCPN) effort to push a ‘continent-wide’ effort to ensure clinical trials become the ‘next frontier for growth for Africa’, through utilising their new Initiative, The African Clinical Trial Consortium (CTC).

Developing the clinical trial industry has the capacity to add value to identified growth indicators and become the cornerstone of health and economic transformational agenda, which should help Africa climb up the value chain towards industrialisation and provide opportunities to bring the large informal sector progressively into the formal economy.

Clinical trials have the following advantages: Creation of employment; emergence of CROs and ancillary CT organisations with capacity to employ; employment for scientists, researchers, and medical professionals; and revitalisation of science-based businesses.

Others are: reversal of the brain drain phenomenon; access to medical care and subsidised medical treatment; access to novel drugs; bringing attention of researchers to national health priorities; improvements in medical infrastructure and CT facilities; bringing new therapies into the country; better capacity to address local neglected diseases; improved standards of medical practice; knowledge transfer and skills development; growth of indigenous pharmaceuticals; and opportunities for Indigenous pharmaceuticals to be part of global pharmaceutical continuum.

Nigeria’s poorly funded healthcare systems are suffering from years of underinvestment, which, for health professionals, has resulted in low wages, poor working conditions, a lack of employment opportunities/leadership and very few incentives, giving room to desire for exodus.

This is cataclysmic, given the fact that currently, contrary to the recommendations of the WHO of a ratio of one doctor to 600 patients, Nigeria has a ratio of one doctor to 6,000 patients. This is regrettable when compared to India (1:2083) and in the U.S.A. (1:500).

Nigeria was projected to become the 20th largest economy in the world by 2025 and the 12th largest economy in the world by 2050. President Barack Obama himself declared Nigeria as ‘The World’s Next Economic Success Story’!

The health and pharmaceutical sectors will be critical in propelling Nigeria to make this transition.

Developing Nigeria’s health sector through a revolutionary reform strategy will add value to these growth indicators and could become the cornerstone of health and economic transformational agenda.

This should help Nigeria climb up the value chain towards industrialisation and provide opportunities to bring the large informal sector progressively into the formal economy. This would make growth more inclusive and offer a high potential for job creation, increasing income and reducing poverty.

There are prospects in Nigeria for sustained growth driven by an improved performance of the key non-oil sectors: agriculture, information and communication technology, trade and services.

Nigeria’s health sector can play an important role in contributing to a strong, vibrant and economically prosperous Nigeria and would be one of the ways to expand opportunities for the country to effectively access markets and diversify its economy beyond a narrow reliance on natural resources.

Realising this promise, however, requires a concerted effort, commitment and collaboration by all stakeholders, including the industry, the academia, research professionals, medical doctors, the media and the government.


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