Home Cover Story Brain drain: Doctors, nurses’ exodus cripples Nigeria’s health sector

Brain drain: Doctors, nurses’ exodus cripples Nigeria’s health sector



The mass emigration of health care professionals, especially doctors, pharmacists and nurses, is on the verge of crippling the nation’s health sector, Business Hallmark findings have revealed.

Though, the mass exodus of these skilled health workers abroad for greener pasture has been on unabated over the years, it has now reached an alarming proportion, with more than  1, 500 doctors abandoning the country in the last two years with fewer practising physicians and specialists to over 180 million Nigerians, according to sources.

While the statistics is alarming enough, the situation could get worse, as a recent survey by the Nigerian Polling organisation, NOIPolls, in partnership with Nigeria Health Watch, revealed that about eight out of every 10, representing 88 percent of medical doctors in Nigeria are currently seeking work opportunities abroad.

Chief Executive Officer of NOIPolls, Mr. Bell Ihua, said that the finding cuts across junior, mid and senior levels in both public and private medical institutions such as house officers, corps members, medical and senior medical officer, residents, registrars, consultants and medical directors.

“Nigeria has about 75,000 medical doctors registered with the Medical and Dental Council of Nigeria but only approximately 35,000 are currently practising in the country. The United Kingdom and the United States are the top destinations where Nigerian medical doctors seek work opportunities.”

According to the World Health Organisation (WHO), for any country to be deemed to have enough doctors for its population, it should have one doctor for every 600 persons.

However, there are about 35,000 working in the country currently, according to the Nigerian Medical Association (NMA). That means Nigeria needs more than 237,000 medical doctors to meet WHO standard doctor-patient ratio.

The implication is that only one doctor is available to treat 30, 000 patients, while states in the North are worse as they have one doctor to 50, 000 patients. In some rural areas, patients have to travel more than 30 kilometres from their abodes to get medical attention.

Regrettably, Nigeria’s universities produce less than 3,000 doctors each year, while the vast majority of these graduates seek greener pastures abroad.

According to the Chairman of the medical association in Lagos, Dr Olumuyiwa Odusote, more than 40,000 of the 75,000 registered Nigerian doctors, were practising abroad while over 70 per cent in the country were thinking of picking jobs outside.

He also disclosed that over 100 doctors resigned from the University College Hospital, Ibadan, in 2017 while about 800 doctors resigned from Lagos State hospitals in the last two years.

BH findings revealed that out of the 35,000 registered doctors, 70 percent practise in urban areas where only 30 percent of the Nigerian population resides, while the larger population in the rural areas don’t have enough doctors to attend to them.

The alarming statistics, according to concerned players in the health sector, indicate that the nation’s doctor-patient ratio is among the worst in the world currently hovering above 50,000 patients to one doctor rather than the recommended 1:600 ratio.

Unfortunately, while the country will need 10, 605 new doctors annually to avert health challenges and meet current population growth rate of 3.5% yearly, according to the Nigeria Health Watch, the few ones in the nation’s hospitals are daily leaving the shores of the country in search of greener pasture abroad.

Check across hospitals in the country shows that it takes an old patient two hours on the average to see a doctor, while it takes three hours for new patients to be attended to.

Scary but corroborated information obtained in the course of writing this report confirmed that over 100 doctors have resigned from the University College Hospital (UCH) this year alone; 800 doctors have resigned from Lagos State hospitals in the last two years, 100 in October alone; Kebbi State has been unable to employ a single doctor in two years despite multiple adverts for employment; over 200 doctors and nurses have resigned from Ladoke Akintola Teaching Hospital, Ogbomosho this year.

The story is the same across the country.

Commenting on the sad development, the Chairman of the Lagos State chapter of the NMA, Olumuyiwa Odusote, said that only improved funding in the nation’s health sector could check the ugly trend.

“The health crisis in Nigeria is unprecedented as the mass exodus hits an alarming proportion. Already, it takes a new patient two to three hours to see a doctor.

“Over 100 doctors have resigned from the University College Hospital, Ibadan, this year. About 800 doctors resigned from Lagos State hospitals in the last two years, and over 50 in November alone.

“Kebbi State has been unable to employ a single doctor in two years despite multiple adverts for employment. Over 200 doctors and nurses have resigned from Ladoke Akintola Teaching Hospital this year.

“Seventy percent of Nigerian doctors are making plans to leave for foreign lands and are taking exams to that effect.”

Odusote said that in 2012, more than 1,000 doctors wrote primaries for the West Africa College of Physicians to gain admission into Nigerian teaching hospitals, but in 2017 only 236 doctors sat for the same exam.

On the contrary, 660 doctors sat for the Professional and Linguistic Assessment Board Examination (PLAB), which would enable them practise in the United Kingdom.

“Our healthcare system has been neglected for an extended period, evidenced by lack of funding, under-supply, inefficiency, decrepit equipment, poor quality, needless deaths and unhappy workforce.

“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 to sleeping wards. The nation needs 303,333 medical doctors now and 10,605 new doctors annually to provide good quality patient care,” he lamented.

He expressed disappointment at the 2018 budgetary allocation to the health sector, which is a paltry 3.9 percent of the total budget, far less than the 15 percent that was agreed at the Abuja declaration of 2011.

“NMA will nonetheless, continue with advocacy for improved healthcare financing through universal health coverage and full implementation of the National Health Act, 2014,” Odusote promised.

Another medical doctor who spoke on the situation, Bayo Adeseun of Calvary Hospital, Ikeja, said that any further brain drain would paralyze clinical and other health services in the country.

“The consequences will further heighten mortality and morbidity in a country where life expectancy has fallen from 70 years to 47”, he said.

However, findings show that the continues brain drain was due to several factors, made worse by several years of harsh economic policies, which had led to chronically under-funded health systems.

Though, medical doctors are the highest paid in the nation’s public sector, the poor state of public health institutions and the lure of making more money working in foreign hospitals is

daily encouraging them to run abroad.

For example, the lowest pay a fresh medical doctor from medical college earns range between N160, 000 to N170, 000 per month. It is however a bit lower in private hospitals, where new doctors earn between N100, 000 to N120,000, except in the big and established ones that pays handsomely.

According to NOIPolls, the reasons for the looming brain drain in the health sector include “Challenges such as high taxes and deduction from salary (98 percent), low work satisfaction (92 percent), poor salaries and emoluments (91 percent) and the huge knowledge gap that exists in the medical practice abroad (47 percent) amongst others.”

The President, Association of Resident Doctors, Lagos University Teaching Hospital (LUTH-ARD) chapter, Omojowolo Olubunmi, said “Some doctors travel abroad because they want to practice were they have facilities to practice what they have learnt and in foreign countries doctors are treated better”.

A public health expert based in Lagos, Doyin Odubanjo, blamed the mass exodus of doctors on their working conditions and remuneration.

“The days when doctors are counted among the middle class is over. What is the state of your hospital as a whole, what is the hospital look like, do they have comfortable doctors homes, you go down to do they have comfortable equipment to work with, the diagnose tools, many are not working,” he lamented.

He advised the Federal Government to overhaul the entire health sector and prioritise in yearly expenditure plans. This, he said, should also include better remuneration and welfare package for doctors.

According to a professor of medicine and Chairman, Association of Colleges of Medicine of Nigeria, Folashade Ogunsola, it will take the country 100 years to have all the doctors it needs to meet WHO requirement assuming none travels abroad.

“For those that travel abroad to practice, we have five thousand in United State of America (USA), three thousand in United Kingdom (UK) and others scattered all over the world. There is no country in the world that you will not find one or two Nigerian doctors,” she said.

To make the already bad situation worse, the specialist needed to handle specialised cases are lacking in the nation’s tertiary health centres. Many Nigerians daily succumb to their illnesses due to lack of specialists.

According to the National Postgraduate Medical College of Nigeria, the institution at the apex of medical education in Nigeria with the responsibility of conducting professional postgraduate examinations and producing specialists in all branches of medicine and dentistry, there should be one consultant to about four resident doctors.

In other words, where there is one specialist (consultant), four resident doctors should be under him or her, for training and these doctors can only undergo this training in the institutions accredited by the NPMCN.

Findings however, show that in some of the about 200 institutions, comprising federal and state tertiary health institutions, University Teaching Hospitals, Federal Medical Centres, some state health management boards and some private institutions, the number of resident doctors employed and attached to a consultant is as low as one, instead of four. And it is very rare to see any of the institutions take the maximum number allotted to them.