Action, not law, will stop doctors’ exodus

The idea being mooted by the House of Representatives that brain drain of medical doctors can be stopped by legislation is a misnomer; a mere wishful thinking that can only scratch the problem on the surface. Exodus of doctors and other medical personnel to foreign land is not new, though it is obviously intensifying but the reasons are not opaque, as they border on lack of an environment conducive for professional fulfillment. Lawmakers, as part of government, will arrest the exodus the moment they start to provide concrete measures to help doctors practise and enjoy their trade.

“Life is survival. This instinct is shared by all living creatures – human and non-human.” Predictably, anyone confronted with the choice of hardship and survival would gravitate towards the latter. More than anything else, the quest for survival and attainment of professional height are the driving force behind the brain drain in Nigeria’s health sector, which over the years has become a medical crisis. Unfortunately, there has been no obvious effort to manage or mitigate the negative impacts of this growing trend on the already weak health system.

This development has drastically reduced the number of workers and skilled professionals in the health workforce thereby leaving a lot of patients without adequate medical attention. The doctor-patient ratio in Nigeria is 1:6000 which falls far short of the World Health Organisation (WHO) recommended 1:600 ratio.

Reacting to this disturbing issue, the Chairman of the House Committee on Health Institutions, Dr. Pascal Chigozie Obi, admitted that the issue of brain drain has become a recurring decimal in the history of the nation’s health institutions; hence deserving legislative intervention. The lawmaker further stated: “When doctors qualify and become marketable, they rush out of the country and start taking care of non-Nigerians; and their brothers and sisters who contributed in their training would be left in the hands of the people that may not be qualified. It is very bad. So, we are coming with an Act of Parliament that will curb this. If we cannot control the pull from the outside, we should be able to control the push from here through formal legislation.”

Obi appears to be passing the buck to the doctors, and if so, his retort is tantamount to victim-blaming unless the “push control” framework being envisaged will be directed towards improving the welfare of health workers generally. However, if Obi is contemplating enacting a law meant to restrict or prohibit Nigerian-trained doctors from migrating overseas, its impact on the problem is unlikely to be far-reaching. Curiously, why are the parliamentarians not considering a total ban on foreign medical tourism by public office holders?

Ironically, the “push” factor responsible for this brain drain is purely government-made; political leaders cannot pretend to be oblivious of this fact. It is not in dispute that the state of the country’s public health institutions across the board is deplorable. Little wonder political office holders prefer foreign medical services. The major causes of the acute shortage of manpower in the health sector include poor working conditions, poor healthcare system, poor remuneration, underemployment, high rate of insecurity, poor social security mechanism, and a host of others. Simply put, Nigeria does not have a conducive work environment as opposed to other climes. The Chairman of Ondo State branch of Nigerian Medical Association (NMA), Dr. Stella Adegbehingbe highlighted these much while speaking at the association’s yearly general meeting recently.

A government that has failed to live up to its responsibility is devoid of the moral standing to cast the first stone. As enshrined in Section 14 (2)(b) of the 1999 Constitution (As Amended), the security and welfare of the people is the primary purpose of government. Section 17 (3) further directs the government to formulate policies towards ensuring that all citizens have adequate means of livelihood, adequate opportunity to secure suitable employment, and conditions of work that are just and humane with adequate facilities for leisure and social life; and to ensure that “there are adequate medical and health facilities for all persons.” Clearly, government has not been able to meet up with these basic requirements. The self-acclaimed “Giant of Africa” cannot even boast of one world class hospital!

So, instead of lambasting medical practitioners, the fundamental questions to ask should be: Is the State House Clinic (‘Aso Clinic’) functioning? If yes, why are our number one citizen and other political officers always embarking on foreign medical tourism? Why do they not use any of our public facilities for their medical needs? The answers to these posers all point towards the neglect of the health sector by successive governments.

The government’s nonchalance towards the plight of medical professionals is not lost on the direct stakeholders. Doctors have repeatedly bemoaned their poor welfare to no avail. Even at the peak of the COVID-19 pandemic, it took persistent complaints before the Minister of Health, Dr. Osagie Ehanire, grudgingly approved the paltry sum of N5, 000 as a monthly hazard allowance for doctors! The other time, the Ministry of Labour and Employment, Dr. Chris Ngige (a medical doctor), downplayed this issue when he claimed that Nigeria has more than enough doctors to fill the gaps left by their ‘fleeing’ counterparts. For a country with about 200 million people having about 80,000 registered doctors; 50 per cent of whom are not practising in Nigeria, it is erroneous to boast of sufficient qualified hands when the country is obviously ‘‘under-doctored.’’

Unarguably, the non-stop migration of doctors calls for serious concerns and immediate resolutions. Nigerian doctors rank among the best in the world. A few years ago, Dr. Oluyinka O. Olutoye successfully performed surgery on an unborn baby (foetus) in the uterus at a Texas children’s hospital, considered a major feat. Nigeria cannot afford to lose the few goods hands left. Government should consider the “pull” factors that are making doctors do charity abroad instead of home. The external magnetising elements are not farfetched at all. They include competitive remuneration, conducive workplace, good job opportunities, an efficient healthcare system, modern medical facility, adequate security, good social security benefits, a high standard of living, continuous professional development and training opportunities.

In the absence of an enabling environment, emigration is certain – man must survive! Therefore, government should formulate a policy that can effectively remedy the lapses in health sector. The focus should be on how to attract and retain the right talents for domestic needs. The framework should be appealing enough for Nigerian doctors to resist the mouth-watering offers elsewhere. In addition to providing a competitive compensation package and improving the healthcare system, insecurity has to be tackled head-on. This matter should be treated with utmost dispatch because if the health sector is in trouble, the entire country is sick. Government needs to act, and the time is now!