Why more doctors will leave Nigeria to practise abroad

•NMA President says poor remuneration, lack of job satisfaction, security threat fuel situation
The newly elected President of the Nigerian Medical Association (NMA), Dr. Uche Rowland Ojinmah, in this interview with ANN GODWIN, reels out his blue print in revamping the ailing health sector and ways to tackle issues of brain drain in Nigeria.

Are issues of brain drain and increase in migration of Nigeria-trained doctors and nurses to United Kingdom (UK), United States (US) and Europe a concern to you, as NMA President?
Well, some years past we had a major drain that left us completely flat, some of us graduated from medical schools without having lecturers for some courses because a lot of them left and it is happening again. In classical analysis of the brain drain, you talk about the ‘push and the pull factors’, something is pushing them out and something is pulling them in. Now, what concerns us are the push factors while what is outside is pull factors we cannot control. But the push factors in Nigeria are majorly three, for doctors and other health workers. They include: poor remuneration, lack of job satisfaction and the security threat. These are the three things that are making Nigerian doctors to leave. Go and compare the highest paid doctor to the lowest paid member of the National Assembly, you will understand that there is a problem.

Outside this country, doctors are some of the highest earners apart from chief executives of industries. When you see the salary of a neurosurgeon in United State, you will understand but in Nigeria, the reverse is the case. I will like to inform you that not just doctors, all health workers are badly paid. The salary we earn today was conceived in 2009, that was when the Consolidated Medical Salary Scale (CONMESS) and Consolidated Health workers Salary Scale (CONHESS) salaries came out with a proviso that they will be reviewed after five years, that is in 2014. But by 2014, what we were begging for was actually an error in calculating our call duties allowances and what they call parity in the health sector.

For instance, it is like I have agreement with you that if I work for you for 24 hours, you pay me N20 and when you are now producing the second round, you stylishly made it N18 and you said, I should write to get it corrected, something you signed and you now made an error in transferring it into a circular. It took five years for it to be corrected with the appeal that we shouldn’t ask for arrears and so, five years later, instead of giving us a new and better salary structure, we got a correction of a wilful error that occurred five years earlier. That is ‘Wayo’ and Nigerian doctors are not happy about that and till now, we have not had what should be right.

The security situation is also a big threat, you know that doctors are being picked like groundnut because people think we are rich and they pick our relations. I know a doctor that was kidnapped and about two months after he was released, he left Nigeria. Talking about job satisfaction is zero, there is no equipment to work with, the environment is dirty and people are not being hired to work, sometimes you see us crying, one doctor is doing the job of 20 doctors. The impact of the brain drain now, is like let us say we were 1,000 doctors before seeing one million patients, now we have 600 doctors seeing one million patients. It means that the job has become doubled and we are still earning the same thing and there are opportunities outside. So, I don’t blame people who leave.

2023 is by the corner and several aspirants are clamouring to become president or governor and other elective positions what is your Health agenda for Presidential candidates and political office seekers?
Let me start by saying that I am not surprised of people trying to get into political office because it is the fastest way to be rich and only a fool like me will be running for NMA President, but there is God. The fundamental thing is this; I believe that those trying to be political leaders in this country need to have proper examination of their state of mental ability. Honestly, we need a psychiatric evaluation. It is not insulting and I don’t think that it is insulting but if you make a mistake and someone that is not okay goes into office, it is will be a disaster, especially in our system that is not strong enough to say, we will impeach this man.

Secondly, we have got to the point where everybody needs a sound president. Look, I ran for NMA President and I travelled to 34 states of Nigeria and the Federal Capital Territory (FCT) Abuja to sell my manifesto, which is beside me here. I couldn’t go to some states for some internal reasons and in every state I went to, I presented my manifesto and the stakeholders asked me questions and I answered them and that was the reason why you saw what you saw yesterday. It has been a long time that NMA had an election that members stayed on their seat till the end and they jubilated that way. So, we need to make sure that people don’t blunder box their way into office. We have had campaigns in this country where the candidates spoke less than other people working with him or her. Let us put the candidates on the hot seat, let’s ask them pertinent questions and let us not be sentimental about it. We will insist that they must show us complete plan to revamping the healthcare system. We can copy the Indian Model, we do not need to reinvent the will, just do the right thing.

What is your blueprint on how to revamp the ailing health sector?
To me, the most important thing is to have a united association. I want an association that will have the confidence and trust of our members. I want an association where the members’ voices will be heard. One of the most important things that my team and I will do is to work hard to bring unity in the health sector. I do not like the fractions and the frictions that occur in the health sector. So, we will do our best to minimise the health sector crisis that commonly occur, especially among the work force. We will bring humility, openness and transparency. I believe that if the healthcare workers are united, we are almost 50 per cent forward in having a better health sector.

We are going to advocate to the government for a health bank. You see, everyday, we talk about the health workers going on strike, having issues, have you ever looked at the government to see if they are doing their part? There is a proverb in my place that says, ‘where you see someone that talks too much, there is someone that does too much’ and it is a bite that brings a slap. So, don’t just look at the health workers alone, go around our institutions, they are almost in the state of decay. There is nothing as dissatisfying as knowing what to but not having what to do it with. I am a dermatologist, recently we got equipment where I work and we are happier, that is what makes people stay. Then, conducive environment is important. Hospitals are not prisons and so, it supposed to be clean. Go overseas and see what a clinic, a ward look like. We are still consulting where you are supposed to be properly dressed in suit and there is no air condition, there is no fan.

A lot of state governments are jumping into teaching hospitals and they cannot carry it, neglecting the secondary health care system of the General Hospitals. I will call on the governors of the States to please focus on the General Hospitals. Except Lagos State and few other states, where do you have functioning General Hospitals. Everybody will go and establish a teaching hospital that they cannot fund and therefore, the teaching hospitals are on strike. Look at Abia State Teaching Hospital, go to Imo State University Teaching Hospital, they are all in terrible state. I walked away as a consultant in Imo State Teaching Hospital leaving behind one-year salary because I got tired of all the stories.

So, we will tell government to fix the institutions, get equipment, then we will mobilise our members to work and reach out to other health care workers. Where I work today, I made bold to say that I am the head of the department of dermatology and all the staff under me, work together, we don’t have a department, we have a family. So, we will also bring such system to see how we can make it nationwide so that, with collaboration, love empathy is vital. That you are a cleaner doesn’t mean you are not human being, that you are a nurse doesn’t mean you should be slapped. That you are a doctor doesn’t mean that people can take out their anger on you and expect you to take it. Everybody should know his or her job and do it with pride.

We are also going to take care of our medical students. I am interested in medical students because what they pass through is one of the reasons why they leave as soon as they graduate. We hear tales of 1970s, how people while in school, your duty as a student will serve students is just to go to school and learn. But now, you have10 people in one room trying to be doctors, how do you train such people in such condition and expect them to be useful, so we are architects of our misfortune. We will make our medical schools comfortable for the students so that when they graduate, they will want to stay. Our house officers are suffering, a young doctor graduates and wants to work but there is no place to work. We made it compulsory for them to do house officers job but there are no available places, it is frustrating. So, we need to fix all these systems. There is need for a linkage system that when you finish this, this is the next thing you should do.

What are your recommendations on budget for health and health financing towards universal health coverage?
Budget for health as of today is paltry. The funny thing is this, in 2001, African leaders gathered in Abuja in Nigeria, our own home and agreed that they need to increase the health sector budget to be 15 per cent of the annual budget. Nobody forced them to come and after that agreement and signing, it is only two countries, Rwanda and one other country that have implemented it, Nigeria has not exceeded six per cent since then. So, why sign what you cannot implement, there is what we call evidence-based action. There must be bases to say 15 per cent of your budget should go to health. See, if I am not well, I cannot grant you this interview and if you are not well, you cannot be here asking these questions. So, the building block to every productivity is good health and that is what every reasonable country goes for. So, we need to up our budgets. I know the systems are not yet okay, the economy is not wonderful but I don’t think that 10 per cent is too hard for us to achieve, we must be realistic to sustain the system that’s what I think.

Now, the universal health coverage, I am happy about the new Health Insurance Act, it looks better than what we had before and I also pray that it will be properly implemented. I believe that the time has come when children should not be rolled into schools if their parents don’t have health insurance and those who come for antenatal should produce evidence of health insurance. I think that will help us to achieve universal health coverage with a lot of jingles and education.

Do you recommend a ban on medical health trips by Mr. President and other political office holders as a way of forcing them to look inwards?
Let me say this, recommending ban is easy but does it make sense? And you are asking the man who made the law, who can amend the law to ban him or her from leaving the country to seek help outside the country? See, they will not even do that. Have they even changed their salaries? To me, I don’t like exercise in futility. What I believe is that we should apply pressure on them through legitimate means to fix our system. It is not difficult. Sincerely, if you hear the amount of money people take away from Nigeria, you will ask yourself what do they use to build those places they go to? You will see that it is not much; it is lack of political wills that is affecting us. No matter how small your money is; you can achieve something. Rwanda is a shining example and my prayer is for us to stop having accidental presidents, we need people who actually planned to be president. Like my humble self, I looked forward to be the President of NMA and I prepared myself, my manifesto was written over six years ago. I continuously observe things and I put things down and I hope that such a president will be witnessed in Nigeria not an accidental President.