Medical brain drain: Sickness that needs surgery

Available statistics of brain drain in the medical sector indicate that the sickness needs something as severe as surgery. A former Minister of Health, Dr. Isaac Adewole, said sometime ago that by May 2018, Nigeria had trained 90,000 medical doctors. That is a happy revelation. The unhappy one is that of this number 70% of them have migrated to the United States, United Kingdom, Canada and Saudi Arabia etc.

More specifically, the Nigeria Medical Association (NMA) claims that about 50 doctors migrate from the country every week. Within the last one year, the United Kingdom alone has received, with open arms, 1,307 medical doctors from Nigeria. Also, according to the President of the National Association of Nigerian Nurses and Midwives, Mr. Michael Nnachi, about 57,000 nurses have migrated from Nigeria in the last five years (2017-2022). Others such as medical laboratory technicians, pharmacists and paramedical staff have also quietly left the country for greener pastures abroad.
No noise making. Only their relations are aware that they have gone and may only be coming here from time to time to say hello to us with their pockets bulging with dollars. When they take these dollars to the black market they become instant naira millionaires and the Nigerians that they left behind will be envious of them. The situation is pathetic and the United Kingdom’s High Commissioner to Nigeria, Catriona Laing, took pity on us and decided to hold meetings with Nigeria’s government officials on how to prevent brain drain from Nigeria in the health sector. Thank you ma.

On the other hand, our own officials are showing little or no concern about the deep depletion in the number of qualified medical personnel available in Nigeria. They are simply playing politics with the situation. On several occasions, the Minister of Labour and Employment, Chris Ngige, a medical doctor, has said a few times that our doctors migrating abroad is not a problem because we have enough and to spare. That is his avant-garde solution to the labour crisis that he faces in the health sector where doctors drop their stethoscopes from time to time and he finds it difficult to get them back to work. Another medical doctor who is directly in charge of our health matters, Osagie Ehanire, also said recently that Nigeria has surplus medical doctors so the country is not bothered by those doctors leaving for greener pastures.

Both of them may be good medical doctors but they are not good mathematicians. Their statements are far from accurate. The United Nations recently estimated our current population to be 216 million. The World Health Organisation (WHO) recommends that every nation should have a minimum of one doctor to 600 people. We have 24,000 doctors for our huge population. By the latest population estimate it means that we have one doctor to 9,000 people, very far from the WHO prescription. As more doctors leave the country the ratio diminishes further and our misery increases.

In the 60s and 70s, Nigeria’s public service commission officials used to go abroad to recruit young Nigerians just graduating from foreign universities. Also, during this period under reference a number of qualified expatriates used to come and work in both the public and private sectors in Nigeria. The principal of my secondary school, Ibibio State College, Ikot Ekpene, was an Indian named Patel. Some of my teachers in Higher School at Holy Family College, Abak in Akwa Ibom State, were expatriates from Ireland. Of course, there were many of such expatriates teaching in our universities or working in our medical facilities. The times have changed. Things are different, drastically different, today.

The Akwa Ibom State government built a modern, state of the art hospital in Uyo, the state capital, called 21st Century Hospital. It was supposed to be an elite referral hospital where advanced technology would be used to heal people of various ailments. It was also intended to stem medical tourism because many of the experts were foreigner-experts in several medical fields. Their salaries to be paid in naira were attractive when converted into dollars. So these expatriates were willing to come and work here.

With the crash of the naira their salaries were not sustainable and most of these experts, if not all, have gone back. The Akwa Ibom State Government had to find a solution to the problem by looking for Nigerian experts in the various fields whose salaries can be accommodated within the prevailing economic milieu. The moral of this story is that we must do anything and everything to retain Nigerian medical and other personnel within Nigeria. For them, the added advantage is that they are working for their fatherland, Nigeria.

But when we leave them to leave in droves to other countries where they work to build societies that are already better than ours we are the losers.
There are several reasons why Nigerians leave. It is not a question of lack of patriotism. It is a matter of survival. The attention paid to our medical facilities in Nigeria is low, very, very low. The federal budget for health has always been less than 5%. Even the approved budget hardly ever receives the full funding in any given year. This has led to a serious deterioration in facilities and equipment in even some of our university teaching hospitals.

There have been stories emanating from some of our teaching hospitals about lack of functioning power supply, stories of patients being asked to contribute money for diesel to power the generators, of medical personnel bringing their own medical equipment to work in these hospitals, stories of doctors referring patients from these government hospitals to their better equipped private clinics. The stories of woe are many.

Some of the doctors migrate because of poor remuneration or low-level equipment. If they do not have modern equipment to use their skills will diminish if not vanish. So to stay up to date, they feel that they must migrate abroad and make use of the most advanced technology available in their field of specialisation.

Also, the high level of insecurity in the country is a cause for concern. Some of those who migrate abroad feel that their lives are not safe within Nigeria especially with kidnappers stalking at random, taking travellers in trains and buses into the forests for ransom. It is scary and no matter the level of assurance given to Nigerians by the authorities the daily reports of more incidents occurring in various parts of the country are enough to push some people to search for safer places to reside abroad.

Of course, there is no society that is crime-free but the failure to punish most criminals in Nigeria is a disincentive to a happy life in the country.
Our health facilities have continued to deteriorate because those who manage our affairs are not sufficiently bothered since they have the freedom to travel and be treated abroad at public expense. With the kind of humongous wealth that Nigeria has made in the past several decades it is a mystery that there is no excellent, publicly-funded hospital in Nigeria, not even in the Presidential Villa where the President and his family reside.

Senior Public servants who ought to put pressure on the past and present governments for a massive improvement in the health sector have failed to do so either because they are entitled to medical pilgrimage abroad or they can, on their own, using money from known and unknown sources, travel abroad for medical attention. So the rest of the population’s concerns on health are not shared by these privileged officials.

As the politicians mount the soapbox asking us to vote for them in 2023 we ought to ask them specifically, what they will do to drastically remedy the situation in the health sector. The situation must be reset if we are to enjoy the benefit of good health and also stem the tide of medical migration. The press, the non-governmental organisations and the people generally must begin now to build a new architecture for our health by asking politicians the right questions in preparation for their stepping into office in 2023.
We must lay the building blocks for that architecture now and keep a good record of their promises for which we will hold them accountable in 2023 and beyond.