A case for better healthcare
It is incredible that while stakeholders decry brain drain in the health sector, the Minister of Labour and Employment, Dr. Chris Ngige noted that doctors who would like to relocate to other countries in search of greener pastures were free to do so, claiming that Nigeria had enough medical personnel to cater for the population. This is a paradox rolled into a tragedy.
According to the minister, Nigeria has 350,000 medical doctors, far more than the 260, 000 the World Health Organisation (WHO) prescribes for the country. As such, there was nothing wrong with doctors leaving the country as they would continue to send home money, which could in turn, grow the economy. This is surprising coming from a minister who trained as physician and retired from the public service health sector.
Does it mean that the minister is putting a price on human life or is it a way of showing that government officials are not interested in the wellbeing of the populace? Obviously, Nigeria’s own health sector challenge has become a bad ulcer that thrives on medications applied to it, one of which is the migration of doctors.
It is a pity that Dr. Ngige is not giving priority to the alternate cost of brain drain in the health sector, rather his priority is on the economic cost or benefit; which discounts the fact that the exodus of doctors is at the expense of the lives of Nigerians that may be lost. The more doctors leave this country, the higher the maternal and child deaths, very low lifespan and expectancy and poor disease treatment outcomes.
So, it appears that the minister is not abreast with the current realities in the health sector in terms of human capital; and the implication of this is that the country’s leadership is not about to address the reproach of brain drain in the health sector.
Although, Ngige argued that Nigeria has more than enough doctors; as such there is nothing wrong with them travelling out to earn foreign exchange; the Mo Ibrahim Foundation about a year ago, stated that Nigeria and other countries in Africa are losing about $2 billion annually via brain drain in the health sector. The Foundation stated in its 2018 report titled, “Public Service in Africa” that no sound governance in Africa would be achieved without strong public services and healthcare delivery is one that is abysmally, shamefully low, of all public services.
Also, contrary to the figures rolled out by the minister, the Nigeria Medical Association (NMA) president, Dr. Francis Adedayo Faduyile, in his reaction, revealed that Nigeria has 75,000 registered doctors, out of which only about 40,000 are practising in the country. Dr. Faduyile argued that Nigeria does not have enough medical doctors to serve the population. According to him, the country has a doctor/patient ratio of 1:6000), adding that in some areas it could be worse with 1:10,000; against the WHO recommendation of one doctor to 600 patients (1:600). Faduyile said: “So, it is obvious that for every 1000 people or patients, we are short by 10 doctors.” Therefore, we do not have surplus doctors in Nigeria. The doctors we have in this country are inadequate to serve the over 200 million population.’’
That means a doctor in Nigeria is seeing 10 times the number of patients (s)he is supposed to see. In the UK, it is 2.8 doctors to 1000 patients while in Nigeria it is 0.2 doctors to 1000 patients. It is really unfortunate.
Furthermore, figures released in February 2018 by the British government indicate that no fewer than 5,405 Nigerian-trained doctors and nurses are currently working with the British National Health Service (NHS) in the United Kingdom (UK). This means that medics of Nigerian extraction constitute 3.9 per cent of the 137,000 foreign staff of 202 nationalities working alongside British doctors and nurses.
Similarly, it is estimated that at least 2,000 medical doctors leave the country yearly for the United Kingdom, United States, Canada, Australia, United Arab Emirates (UAE), South Africa and Europe. This mass exodus of Nigerian trained doctors is blamed on the poor working conditions of not just doctors but all health professionals in the country and the harsh economic realities. Government at all levels in the country are not interested in the welfare and health of the citizens. Another hindrance to good healthcare delivery in the country is the perennial low budgetary allocation to health, which has never gone beyond six per cent of the national budget in the last 18 years against the African Union Declaration in 2001, at Abuja, and WHO recommendation of at least 15 per cent. Even, the proposed 2019 budget for health is about 3.4 per cent, which further underscores the fact that government is not interested in the health of the populace.
What is worse, apart from personnel, even basic diagnosis is unreliable in the country. Radiologists, for instance, reportedly face frustration and embarrassment owing to lack of imaging equipment to hone skills and provide quality service confidently. For most professional laboratory scientists, knowledge of modern equipment is at best theoretical and these inadequacies turn their professional lives into one of hard labour and frustration.
The nation’s leaders, including the president and governors are always flying abroad for medical care. This is unacceptable in a country that once boasted of having one of the best four hospitals in the Commonwealth.
Government must take healthcare seriously in view of its critical importance to the citizens. In fact, health care requires good governance and remarkable investment, not just increased funding. The amount of money budgeted for health should be increased and judiciously used. Greater investment in healthcare should translate to more remuneration for health workers, increased training opportunities for doctors, availability of equipment and other infrastructural facilities.
Trained health professionals are needed in every part of the world, and so when healthcare professionals lack opportunities for professional development compared to their peers in more advanced countries, they have no choice but to flee abroad. Enough to say that until Nigeria places the highest premium on healthcare, this exodus of doctors will not end.
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