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Before our fleeing doctors arrive UK

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Two recent developments, though seemingly unconnected, should cause the Federal Government and the Ministry of Health more worries.

In Lagos, 58 doctors were intercepted for attempting to travel to the UK without a visa. In London, the UK government relaxed its migration policies to woo the best health professionals globally. Given the benefit of hindsight, the Lagos-London route will soon get busier with cabins full of Nigerian health practitioners. But if Nigeria must for once, keep its healthcare providers at home, then proper reforms that engender better conditions of service should not remain an afterthought.
 
The Nigerian landscape is perpetually suffering from brain drain. It is one peculiar country that hates to keep its best or play its first-eleven. It is frightening that more than half of over 72,000 locally trained and registered health personnel have left the country for greener pasture. More applications are still pending at various visa processing centres for Europe, Americas, Asia and even African countries. Indeed, the recent interception of 58 doctors by the Nigeria Immigration Service (NIS) at the Murtala Muhammed International Airport (MMIA), Lagos, tells of the desperation to ship out – either temporarily or permanently. By the rules, travelling without a valid visa or its equivalent is illegal. And anyone in the status of a medical doctor cannot claim ignorance of the basic international protocol and its aversion to irregular migration.

 
Indeed, the medical profession is awash with stories of colleagues leaving the country almost in the middle of an epidemic or even pandemic and never to return again. The complaint is the same poor working condition. It manifests as a broken health system, lack of good opportunities and basic tools, high cost of living, excess taxes and deductions from salary, poor remuneration, general insecurity, personal well-being and future of children, and more. Just like the rule that attends money, essential professionals and skill-sets will naturally flow from where they are undervalued, stressed, and unappreciated, to where they are regaled and courted with princely rewards. 
 
Expectedly, one of these destinations for Nigerian doctors in the United Kingdom. Its National Health Service (NHS) is the opposite of the Nigerian health system and everything the ‘fleeing’ doctors loathe. Already, there are over 4000 Nigeria trained doctors in the UK alone. They could tell that the UK is a fortress for medical professionals, just like the system would affirm that Nigerian doctors are some of the best in the world. As a system that plans for the future, the UK has introduced the ‘Health and Care Visa’ policy to attract the best healthcare talents. Besides the devastating effects of the COVID-19 pandemic, the UK is prepared for life after BREXIT. A British Medical Association (BMA) survey of more than 15,000 General Practitioners (GPs) found that nine per cent of GPs hope to leave the UK to work overseas in the next five years. They would need replacement and Nigerian practitioners are dependable allies.
 
But the UK’s gain will be Nigeria’s loss. A committed and pro-people government should not play the ostrich. It is bad that the countries best are absconding in search of a better life that is lacking at home. Allowing the drift to fester in the midst of a long-haul medical emergency will be worse on poor Nigerians, especially the rural hard-to-reach settlements. Nigeria, with about 200 million people, currently has the doctor to patient ratio of 1:4000 patients, as against 1:600 approved by the World Health Organisation (WHO). Ab initio, the deficit is huge. Should Nigeria recoup all its 72,000 doctors back home, the doctor to patient ratio will still hover around 1:2778 and might take our medical schools 100 years of uninterrupted capacity building to fill the yawning gap. The challenge is daunting, but the patient needs to stop bleeding, for a start
 
It is imperative that Nigeria urgently considers a health reform that keeps its best at home. The exodus of Nigerian doctors and nurses to North America, Europe and the UK’s open arms reiterate the point that there is nothing wrong with our medical personnel, including those fleeing for their sanity, for family or both. But everything is wrong with the toxic system where they operate and want to elope. The overriding problem is the less than the charitable disposition of superintending ministers to palm off the problem as if it is not real. 
 
The Minister of Labour and Employment, Dr. Chris Ngige, once remarked that the doctors were at liberty to migrate as Nigeria has more than enough. It is true that they are free to migrate like other free Nigerians. But the exodus of your greenhorns; best consultants and very senior doctors, is not natural. Nigerian health professional, like most average Nigerian, is content by nature and would not freely swap his fatherland for second-class citizenship in Europe or America. So, such a lousy thought process of making migration look attractive has never helped the health sector. It is a blight upon its growth process. Facing the grim realities that have made migration the most compelling will be most helpful. 

Like the UK’s NHS is doing, this period of medical emergency requires some strategic and innovative moves to strengthen the healthcare system. Our peculiar case needs a complete overhaul, with good funding of infrastructure and fellow-feeling for the frontline workers. It is not the time to further agitate the beleaguered workforce. The current industrial action or its threats by resident doctors nationwide over salary, basic Personal Protective Equipment (PPE) and hazard allowances, is an anomaly, yet avoidable. 
 
A better strategy out of the woods is to rally stakeholders at various levels of governance to the realities of the moment. Handlers should be clear-headed and consensual over the roadmap of health system development, with deliverables broken into short, medium and long-term plans. The goal is to create an enabling environment both for users and the providers. It must be such that for once, places a premium on human life and reward hard work. Health insurance should be most valuable at this time, to ensure functional and sustainable healthcare financing across the country. Health insurance has made life more tolerable for all in the UK, Germany, France, Canada, United States, Ghana, Rwanda, and South Africa. Nigeria cannot be an exception if it must instil confidence in the health sector. 
 
Finally, those at the helm of affairs must remember that a nation that cannot keep its best will not develop. With the pandemic forcing all world leaders and the elite alike indoors, it must be clearer to our leaders that there is no place like home. And as you lay your bed, so shall you lie on it. Our leaders have a responsibility to the people and to themselves too to give proper health reform a chance, at least, for enlightened self-interest. Indeed, if the healthcare system among others gets better, made effective and efficient, a lot of doctors, with or without UK visas, will stay back and our world-famous practitioners will voluntarily return home. 


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