‘How to curb crisis, brain drain in health sector’
Prof. Arinola Sanya, a professor of physiotherapy at the University of Ibadan (UI), is a former Commissioner of Health in Oyo State and also served as the Deputy Vice-Chancellor at UI between 2012 and 2014. A Specialist in Exercise Therapy for Health Promotion and Exercise Physiology, Sanya, who delivered the Second Nwuga Physiotherapy Foundation Lecture at UI recently, speaks about the development and challenges of physiotherapy in Nigeria, with appeal to policymakers to provide level-play field for healthcare professionals to operate as a means of curbing crisis in the health sector.
How satisfied are you with the development of physiotherapy in Nigeria?
I will say within the prevailing environment, I am fairly satisfied, although we could have gone further.
Why the prevailing environment and how did physiotherapy start in Nigeria?
Physiotherapy started as an area of need after the Second World War.The British government sent about two physiotherapists from the UK to Nigeria to treat World War victims. And what they did was to gather few people who had school certificate and train them. Those trained where called physiotherapy technicians; they were trained at Igbobi Hospital. For a long time, these were the ones rendering services. But then, some Nigerians went to the UK to obtain the same qualification the Europeans had. The first ones that got there qualified in 1953 and came back to University College Hospital (UCH),Ibadan.We can say that was when we started properly.
More people went to the UK and many of those trained in Igbobi went to the UK to convert. What UK was offering then was diploma certificate.
In 1966, degree programme in physiotherapy started at UI. Why it is worth celebrating Prof. Vincent Nwuga is because he has contributed a lot to how far we have gone.
Prof.Nwuga we are celebrating came to UCH and went back to Canada to bag a bachelor degree in physiotherapy. With that degree, he was able to take master’s degree and PhD in physiotherapy. When physiotherapy started in UI, it started four years later at the University of Lagos (UNILAG) as diploma programme. The UNILAG option would have drawn back the profession. But the professor who initiated physiotherapy in UI moved and took the young Nwuga to start degree programme in physiotherapy at the University of Ife (now Obafemi Awolowo University), thereby creating two-degree programmes and one diploma in Nigerian higher institutions. When University of Nigeria Nsukka (UNN) wanted to start physiotherapy, Nwuga was a big influence so that UNN started a degree programme. UNILAG had no option than to upgrade to degree programme in physiotherapy, after five years of offering diploma certificate.
But when Nwuga, with that drive, got to Ife, he started postgraduate programme, after he settled down.You know once postgraduate programme start, there is no stopping. Of the three first generation universities, Ife was the last to start physiotherapy. Ife started first degree in 1978, but with the zeal of this young lecturer, she started postgraduate programme in 1986, way ahead of UI that started first degree in 1966 and postgraduate in 1999.And UNILAG postgraduate degree started in 2007. Once UI and UNILAG catch the fire, two other universities (Bayero University Kano and UNN) started postgraduate programmes.
Today, we have PhDs, over 270 master’s degree holders in physiotherapy. We should give the praise to the man who had the vision:Nwuga. If we were going at the pace Nwuga was going, it could have been anything else.But the beautiful thing is that those who graduated in Nigeria, after Nwuga came on the scene, went abroad and were doing great.
As we speak, we do not have less than 50 professors of physiotherapy in the UK and US.One of them is a programme director. In South Africa, we have two Nigerian professors of physiotherapy. There cannot be less than 500 Nigeria-trained master’s degree holders in physiotherapy working in universities, hospitals and research institutes in abroad.
We have come this far, but I feel we should have come faster than this. Of course, we have a lot of professors in the programme. OAU and UI have two professors of physiotherapy each. And UNILAG has one. We have done well, but I think we could have done better.
It appears that the number of Nigerian-trained physiotherapists practicing abroad is more than the ones practicing in Nigeria.
The number in Diaspora are almost equal to the number we have in Nigeria.
Does that not call for concern?
Remember that there was an era of brain drain in 1988 to 2000. And physiotherapy was one of most affected professions. It was as if we were training for export. There was a particular set of my students in 1990. Only one out of over 20 of them is left in Nigeria practicing. And they are doing great abroad. Ask final year students ‘what are your plans’, they will tell you ‘ we plan to travel abroad’.
When I was the head of department, I did not discourage anybody from travelling abroad. This is because for you to discourage them you must find something good on ground. They go out and they are doing well.
Here at home, we train them but we cannot use them effectively. There was a time recruiters were coming from the US and the Middle East to recruit physiotherapists from Nigeria.
Why is it that we train but we cannot utilise physiotherapists?
As the Americans acknowledged, it is cheaper to recruit than to train physiotherapists, because the cost of training is very high.Our training is dependent on very expensive equipment..
Nigeria is working to reduce brain drain. How do you think that should be done for physiotherapists?
In order to reduce brain drain, you have to make the environment at home lucrative.
This can be done through enticing salary and improved job prospect.
What do you mean by improved job prospects?
That means entering point and advancement on the job should be attractive.
Kindly explain what the prospect should be like.
I think it is a fundament issue, which seems to me that the parliament is trying to resolve. We must have baseline or a platform for every professional to enter service. If it is arbitrary, you are likely to disenfranchise some and promote some. Right now, what is prevailing in Nigeria is whoever can make noise and goes on strike, will get what they want. That is not what it should be. There is should be a level-play ground.If you graduate with this degree, this is where you will enter service. It should not be a-once-and-for-all thing.There should be a constant review, because in the health sector for example, where there are many professions, if you keep upgrading some professionals and you let others shout before they get what they want, those who are not interested in shouting will look elsewhere.
There is a lot of work.And there should be a general review for everybody. It should not be that you left some people behind, while others are climbing, only for those who are unhappy feel that they should go on strike.
In the health sector, there is hardly anytime in the last five years where one group or the other did not embark on industrial action. Once you stabilise the platform, everybody knows where he or she belong, where he or she comes in and they know after two years, they will move up the ladder. But when you leave it for people to agitate before you do something for them, you are not providing enabling environment.
And rather for physiotherapists to join such crisis (people are looking for them elsewhere), they move out of the country.
Is Nigeria’s healthcare system missing anything from brain drain in physiotherapy?
I got information concerning a big teaching hospital in Nigeria operating with only 10 physiotherapists.
Is that supposed to be the standard?
That is no way the standard.
What is supposed to be the standard?
UCH has more than 50 physiotherapists. But that particular hospital has 10 physiotherapists. So there is no way there can be effectiveness, because the few physiotherapists have to cover outpatient department and inpatients. We are talking of a hospital that has more than 500 beds capacity. So, we are missing.
We when you have a physiotherapist with prospecting of working with National Health Service (NHS) in the UK, after his NYSC he is off. Is there any prospect that he will come back? What for?
What is making people go away? They are not satisfied with their take home pay; they are not satisfied with the lifestyle they have to live. There are physiotherapists in state services and some of them have not been paid for seven months.And they have to pay more for fuel and electricity; they have children in school and they have lifestyle they want to live.