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Again, to save Nigeria’s health sector!

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Health sector

A recent update by the President of the Nigeria Medical Association (NMA), Dr. Francis Faduyile that out of the 75,000 Nigerian doctors registered with NMA, over 33,000 have left the country, leaving behind only about 42,000 to man all health institutions in the country of over 200 million people, is scary.

Furthermore, reports have revealed that even if Nigeria decides to graduate 3000 doctors every year, without the doctors leaving this country, it will take 25 years to meet the WHO estimate of one doctor to 600 persons.Annually, it is estimated that at least 2,000 doctors leave the country for the United Kingdom (UK), United States (U.S.), Canada, Australia, United Arab Amirates (UAE), Saudi Arabia, Kuwait, South Africa, Europe, Namibia, Senegal and Ghana. Specifically, the United Kingdom employs, on the average, 12 Nigerian doctors every week.

Besides, figures released in February 2018 by the British government indicate that no fewer than 5,405 Nigerian-trained doctors and nurses are working with the British National Health Service (NHS) in the UK. This means that medics of Nigerian extraction constitute 3.9 percent of the 137,000 foreign staff members out of 202 nationalities working alongside British doctors and nurses.

This is unfortunate as this newspaper has consistently noted, Nigeria does not have enough medical doctors to serve the population; as available statistics show that the country has a doctor/patient ratio 1:6000 and in some areas, it could be worse with 1:10,000. Disaggregating the data to rural and urban, reports have also revealed that the ratio is one doctor to 22,000 people, while in towns and cities, it is one doctor to 10,000 Nigerians or one doctor to 12,000 Nigerians, whereas the World Health Organisation (WHO) recommends one doctor to 600 patients (1:600) for any country to have a balanced ratio. So, it is obvious that for every 1000 people or patients, there is a shortage of 10 doctors.

Therefore, there is a huge deficit of doctors in this country to serve the over 200 million population. This means a doctor in Nigeria is seeing 10 times the number of patients 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. This is really unfortunate.

Anyway, while the migration of doctors is not new, it has been on the increase since the later part of last decade. This is a paradox, because where most Nigerian doctors are migrating to, have many doctors for their population, whereas Nigeria is in huge deficit. This deficit is partly responsible for why Nigeria has one of the worst health indices in the world.

The implication is that Nigeria’s health sector challenge has become a bad ulcer thriving on the medications of doctors’ exodus. Apart from doctors, other healthcare workers, including nurses and pharmacists, are leaving the country in droves. It is thus regretted that even in Africa’s so-called largest economy, doctors no longer see a bright future within the shores of the country.

What is responsible for this development? It is occasioned by harsh working conditions, poor remuneration, high taxes and deductions from salaries and emoluments, low job satisfaction, deteriorating facilities, poor infrastructure, huge knowledge gap, insecurity and the harsh economic realities. When healthcare professionals lack opportunities for professional development, lack enabling environment to function, cannot fully use their skills and find that the quality of their lives is woeful, compared to their peers in more advanced countries, they have no choice but to flee abroad for greener pastures.

Another issue once noted here is the perennial low budgetary allocation to health, which has never gone beyond six per cent of the national budget in the last 19 years against the African Union Declaration in 2001, at Abuja, and WHO recommendation of at least 15 per cent.

Even, the 2020 4.5 per cent budget for the sector also seems to show that the government is not interested in the health of the populace. These validate some of the excuses for the exodus of doctors to other countries and allegations that government at all levels in the country are not interested in the welfare and health of the citizens.

The reasons are not even debatable because many great doctors in Nigeria and other parts of the world are Nigerians, showing that the country has the brain but cannot just retain them at home. A recent example is the team of 78 medics in the National Hospital that separated the 16 months conjoined twins – Goodness and Mercy Ede on January 8, 2020.

At the international level is Dr. Oluyinka Olutoye, who had his medical degree from Obafemi Awolowo University, Ile-Ife in 1988, and in collaboration with his colleague successfully removed tumour from a baby in her mother’s womb. The duo removed the baby from her mother’s womb, operated on it, and returned it to the womb. The baby got healed and continued to grow until she was finally delivered at 36 weeks. This is just one of many medical feats by Nigerians working abroad. Olutoye is a Nigerian, who trained in Nigeria. And there are many like him. Perhaps, what made the difference largely is the enabling environment! Essentially, the toxic operational environment is getting worse and if nothing is done to reverse this trend, Nigeria’s health facilities already reputed as mere consulting clinics may even degenerate into something worse with no one to consult.

So, despite the fact that Nigeria doctors are dedicated professionals doing the nation proud at home and abroad, duty bearers appear to have turned a ‘deaf ear’ to the conversations on unbridled doctors’ exodus because of pathetic and insufferable work conditions. The indifference of our nation’s duty bearers to Nigeria’s health sector challenge, which discounts the fact that the exodus of doctors is at the expense of the lives of Nigerians, is a paradox rolled into a tragedy. The more doctors leave this country, the higher the maternal and child deaths as well as very low lifespan and expectancy. Besides, poor disease treatment outcomes can be worrisome. This too accounts for Nigeria’s poor ranking in global health index.

Notwithstanding, there has been no recent indication that the country’s leadership is about to address the reproach as they rather resort to medical tourism as, most of the nation’s leaders, including the president, always fly abroad for treatment, an unacceptable situation in a country that once boasted of having one of the best four teaching hospitals in the Commonwealth.

It would be recalled that sometime, President Muhammadu Buhari lamented that the country had been losing N400 billion yearly to medical tourism. This attests to the government’s inability to address the various health challenges.

Until Nigeria places the highest premium on healthcare, the exodus of doctors will not end. Therefore, the government needs to take healthcare seriously and make it a major priority in view of its critical importance to the citizens’ lives. As this newspaper has always noted, the value of budget proposals for health must be remarkably enhanced.

In fact, healthcare requires remarkable investment, not just increased funding. Better investment will certainly translate to more remuneration for health workers, increased training opportunities for doctors, availability of equipment and other infrastructural facilities.

Hence, to nil the deficit in medical personnel and to even attract health experts in the diaspora back to Nigeria for a more effective and efficient health service delivery, the reasons for their exodus should be dealt with using a participatory approach to improve the working conditions and enabling environment for professionals. Thus, there should be conversations and engagements among all the stakeholders in the country’s health sector. Furthermore, there is the need for better planning of the healthcare system, overseas training and private sector investment in health. These hopefully will trigger the much needed reforms to redesign and reposition the health sector. As such, NMA, Federal Ministry of Health (FMoH), civil society organisations (CSOs), development partners and organised private sector should rise to the occasion for a more globally competitive health care system.

As a matter of urgency, government at all levels must instil confidence in and show a willingness to improve healthcare services by enunciating necessary laws that are capable of increasing funding for the sector and ensuring that the funds are properly managed to save the nation’s health infrastructure and personnel.

It is also curious that Nigeria’s president who in 2015 campaigned on stoppage of foreign medical tourism for public officials in the previous administration has not made good his promise by investing robustly on health facilities. Specifically, this nation expects Buhari who has spent so much time in the United Kingdom on health grounds, to execute the change he promised since 2015 and restore trust to the Nigerian health sector and finish ‘healthy’ in this new decade.


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