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Technology and Process Redefinition: the Panacea to brain drain in the Nigerian health sector

By Guardian Nigeria
25 October 2022   |   12:34 am
Mr Muyiwa Eweregbemi, a nurse anesthetist and his wife, also a medical practitioner, migrated abroad, leaving their job in a federal government-owned hospital. Never for once did the thought of leaving his country to reside in a foreign land to practise a profession he holds dear, cross his mind. Until recently when he made the…

Mr Muyiwa Eweregbemi, a nurse anesthetist and his wife, also a medical practitioner, migrated abroad, leaving their job in a federal government-owned hospital. Never for once did the thought of leaving his country to reside in a foreign land to practise a profession he holds dear, cross his mind. Until recently when he made the tough decision to abandon all he had ever known for greener pastures overseas. Just like many other Nigerian medical practitioners, he’s had enough.

While many believe the brain drain currently ongoing en mass in Nigeria, which is not peculiar to the health sector, is due to massive disparity in welfare packages between Nigeria and other tier-one countries, Mr Muyiwa, however, argues otherwise. According to him, “Most doctors didn’t move abroad because of the pay, they moved for their sanity”
The Japa phenomenon is not new in Nigeria, nor is it restricted to healthcare professionals, however, the alarming rate at which Nigeria is losing its biggest minds, especially practitioners in medicine, calls for huge concern. While it will be convenient to see the mass exodus as unpatriotic, insensitive and selfish, it’s only fair that we know the reason these practitioners, who have dedicated their lives to serving humanity, are forced to make hard choices to leave a place they call home for another man’s country.

Nigeria Health Sector: A sector in Disarray
For a sector that caters to the health of 200+ million Nigerians, the healthcare sector is not living up to its expectation. The sector, on the World Health Organisation’s (WHO) ranking, sits in position 163 of 191 healthcare systems in the world, trailing South Africa and Rwanda.

The Nigerian healthcare system is suffering from profound dilemmas that hamper the system from delivering quality services to the millions of Nigerians with medical needs. From tertiary health institutions to primary health care centres, the reality remains the same.

These facilities suffer from intense neglect from the government, inadequate structures, lack of modern equipment, inadequate number of health care professionals, and of course, low funding. The Chairman of the Lagos Chapter of the Nigerian Medical Association (NMA),
alluded to this recently, when he said “Today, many of the country’s general hospitals, with the exception of those in Lagos, are not in good condition and are breeding grounds for infectious diseases.

“Many also do not have sufficient beds; so, corridors are turned into sleeping wards. The nation needs 303,333 medical doctors now and 10,605 new doctors annually to provide good quality patient care,” he added.

The unfortunate situation with the Nigeria health sector is so complex that privileged Nigerians now have to result to Medical tourism, a 1 billion dollars industry that remains one of the banes of the misfortune of the Nigerian health sector, Yet thousands of less privileged Nigerians die on a daily bases from illnesses that should not cause life in this present age, all because they could not access adequate health coverage.

Nigeria is Expelling her best brain
It’s a known fact that Nigerian medical practitioners are esteemed all over the world. According to the Chief Medical Director of the University of Nsukka Teaching Hospital, Prof. Obinna Onodugo, Nigeria doctors are one of the highest performing doctors in the world, “as healthcare providers in America, Europe, South America, Asia and other parts of Africa continue to recruit them in large numbers”.

The Nigerian health care system literally expels it’s best brains into the waiting hands of countries that value its citizens’ health. According to reports, Nigeria lost a total of 9000 doctors between 2016 and 2018 to the United States, the United Kingdom and Canada.

According to Professor Ayo Omotayo of the National Institute of Policy and Strategic Studies (NIPSS), Nigerian doctors account for the third highest number of foreign doctors in the United Kingdom after India and Pakistan. This figure is compounded by a poll put together by the Nigerian Polling Organisation (NOIPolls), which discovered that 80% of doctors in Nigeria are actively looking for work opportunities abroad.

This worrisome migration trend is not limited to the Doctors only, other health practitioners are packing their bags and leaving the country. According to data from NIPSS, the number of Nigerian registered nurses in the United Kingdom rose from 2790 in 2017 to 7256 in march 2022.

The fact that Nigeria is suffering this huge loss put the country in a dire situation when we acknowledge the fact that the sector still has a huge dearth of medical practitioners to make up for in the first place. While the World Health Organization’s (WHO) recommended Doctor to patient Ratio is 1;1000, Nigeria presently has 1 doctor catering to 10,000 patients. This work burden leaves doctors and other health workers overwhelmed, frustrated and dissatisfied with work. This leaves them no choice but to move to a saner clime, where the sector is prioritized.

Nigeria’s health Care Sector’s Many challenges
The challenges in the Nigerian healthcare sector are numerous. Like many other sectors of the economy, the health sector in the country has been largely mismanaged and undermined; This will continue to be the case as long as those in the realm of affairs can afford to travel abroad for medical tourism.

The Neglect of the Nigeria health sector is evidenced in the annual budgetary allocation the sector receives. For instance, while Security has a budgetary allocation of 12.5% of the proposed budget for the 2023 fiscal year, amounting to N2.56 trillion of the total N20.51 trillion, the health sector only secured 5.75% of the budget for 2023. This is an aberration.

This is contrary to the recommendation of WHO, which mandates its members to allocate at least 15% of their annual budget to the health sector. This recommendation was also echoed by the Africa Union in its resolution in 2001. A resolution from a meeting that ironically took place in Abuja, Nigeria’s capital. Despite these resolutions, which Nigeria is a signatory to, Nigeria’s budgetary allocation to health remains one of the lowest in Africa. While South Africa, for instance, allocates 12.5% of her budget to the health sector in 2023, Nigeria’s budgetary allocation for the last three years still cannot compete with that of the rainbow nation for 2023, a nation whose population is slightly above a quarter of Nigeria’s 200 million population.

There is no gainsaying that inadequate funding is one of the main problems of the Nigeria health sector. This issue affects the service delivery of the sector. This problem leaves hospitals and health centres in sorry states.

Without funding, medical practitioners cannot be properly remunerated and adequately trained “The health sector is underfunded when compared to many other countries. There is inadequate equipment to work with, the government is no longer bothered about training and retraining health workers. All this is because of the low allocation to the health sector. Many hospitals are in a state of disrepair” Mr Muyiwa said.

How Transparency, Process Redefinition and Technology can help
The challenge of corruption in Nigeria and in extension the health sector is such that even the meagre available funds for the sector are mismanaged, embezzled and stolen by public servants at various levels of administration in the sector.
The problem of funding does not only apply to inadequate funding but also the mismanagement and misappropriation of the available funds in circulation. While the government is obligated to fund the health sector, it must be categorically stated that the government cannot bear the burden alone. No country is capable of funding the health sector alone without some form of help. Our public health facilities can no longer rely solely on funding from the government. There is a need to look inward to solve this problem.

As a matter of fact, many of these facilities are sitting on the solution to the problem of funding; Internally Generated Revenue (IGR)
While the government should readily accept a huge chunk of the blame for the failing sector beyond funding, but also due to lack of strict enforcement of adaptation to readily available technology, we must also not overlook the lack of transparency and accountability in hospitals and health facilities in the country. Due to the ineffective manual mode of revenue collection, hospitals and health centres lose billions of their internally generated revenue to corrupt handlers, sharp practices, human errors and billing issues. The IGR of these facilities can go a long way to boost the quality of healthcare deliveries at various healthcare facilities.

An increase in the IGR of hospitals would mean increased remuneration for healthcare workers, well-equipped facilities and happy patients.
To ensure that healthcare facilities can be effective in their service delivery to members of the public, the role of technology cannot be over emphasized. Technology should be a driving force to solving some of the issues health facilities face in the country, most especially the challenge of funding. For instance, technology could play a huge role in patients’ data collection and handling, revenue cycle management challenges, enhancing patients experience and ensuring that the leakages in revenue generated by public health institutions are blocked totally.

With such technologies, hospitals can revamp and fully automate their entire revenue collection architecture, thereby eliminating possible manual interference to the bare minimum and ensuring accountability and transparency across board, including availability of applicable data and statistics to facilitate future projections in view of more funding opportunities. Such solutions will increase IGR and the expected ripple effect can only be positive outcomes, and if managed well, will ensure better service delivery to clients which will in turn mean more IGR and will further position such hospitals to employ more health workers’ and provide better welfare packages.  

“Tolu Oluyemi is the CEO / Co-Founder Avancee Pinnacle Limited, owners of Pay1One Smart revenue assurance platform, developed to plug leakages while automating the entire payment and service delivery processes in public hospitals. A health sector enthusiast who’s simply just keen about revamping the public health care system, leveraging technology.”