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As Nigeria continues to lose hundreds of doctors annually to brain drain, a large number of them to the United Kingdom (UK), experts say that the country is not training enough doctors nor is it retaining those currently in practice due to many factors that need to be quickly addressed. SADE OGUNTOLA writes.
THE Nigerian healthcare sector has faced a series of challenges, resulting in an alarming deterioration in health service delivery. One of such is the declining number of medical practitioners, especially doctors. The ‘Women and Men report 2021’ found that a total of 39,912 doctors were available in Nigeria as of 2017. The number increased to 44,021 in 2018. But this number reduced drastically to 24,640 in 2019.
Nigeria has about 72,000 medical doctors registered with the Medical and Dental Council of Nigeria, with only approximately 35,000 practising in the country. While the country is yet to meet international standards in doctor/pharmacist/nurse-patient ratio, the best available are lost to brain drain.
A recent NOIPolls reports that the “continuous migration of trained medical personnel had further worsened the physician-patient ratio in Nigeria from 1:4,000 to 1:5,000, contrary to the World Health Organization’s recommended 1:600.
According to NOIPolls, reasons for the continuous brain drain have been cited as high taxes and deduction from salary (98%), low work satisfaction (92 %), poor salaries and emoluments (91 %) and the knowledge gap existing in the medical practice abroad (47 %).
Professor Oluwabunmi Olapade-Olaopa, the immediate past provost of the College of Medicine, University of Ibadan, however, said it is a wrong impression to judge the continuous emigration of doctors by the number of doctors still on the ground in Nigeria.
According to him, “they are mostly medical officers of health. The majority of doctors in training as medical specialists (residents) are leaving in droves. You cannot compare a doctor that has additional training of several years with someone who just graduated from medical school. So, the opinion that we have general doctors around to take care of us as a country does not suffice.
“Doctors are not applying to work like before. You can ask at UCH, Ibadan. At the last call for an interview, how many people turned up? How many took up the appointment and of course the number of those appointed that eventually resumed.”
Olapade-Olaopa, a urologist at the University College Hospital, added: “All our registrars are going; 18 months ago, I had 16 senior registrars, now they are two.”
A study on the trainer’s and trainee’s perception of residency in Nigeria and its influence on brain drain also indicated that the top reason for emigration for trainees already abroad was to improve the quality of their training while the top reason for trainees planning to emigrate was to get better training.
These groups were specifically for doctors who had their basic medical education in Nigeria and are presently working in Nigeria or outside the borders of Nigeria. The majority (93.75%) were between the age of 25 and 44 years. About 84.21% were between five and 15 years post-basic medical degree.
About 14.6% of respondents were working abroad at the time of the survey, whereas 85.4% were residents of Nigeria. Seventy-two % (18) of these doctors working abroad were in training when they left Nigeria, whereas 20% (5) had completed their postgraduate studies. It was a 2022 study in the Nigerian Journal of Medicine.
Back in 2006, a study put the loss to every doctor that leaves a developing country at over 1.8 million dollars, as the nation on average spends about 65000USD to train a single medical doctor.
Professor Augustine Adeolu, a neurosurgeon and a medical doctor since 1992, says that brain drain has steadily increased although its effect is yet to be fully felt by Nigerians.
“Currently, more than 30 percent of my classmates in the medical school are practising outside Nigeria. The percentage increases with years of medical graduation. If you ask the crop of medical students in training, up to 50 percent wants to leave after their training,” he said.
He said the impression that only economically buoyant doctors leave Nigeria is also wrong.
“More junior doctors are moving than specialists. They are employed before they even leave Nigeria. In the UK, they don’t have to be a specialist; once they pass the examination, some agents employ them and make arrangements for them to move,” he noted.
The president of the Ibadan College of Medicine Alumni Association (ICOMAA), Professor Dipo Otolorin, said that Nigeria never had enough doctors to cater for its population and the available doctors are unequally distributed.
Professor Otolorin, noting that there are more doctors in Lagos or Abuja compared to the whole of northern Nigeria, declared “there are states in Nigeria with fewer than 40 doctors to a population of 5 million.”
He linked the dearth and unequal distribution of doctors across Nigeria to the poor condition of service, poor career progression, insecurity, poor pay of doctors and lack of basic social amenities in many parts of the country.
Professor Otolorin declared that despite Nigeria not having enough doctors in its services to cater for its population, the government looks at the employment of doctors as increasing recurrent expenditure and some state governments replace some doctors that leave with community health extension workers to work as nurses and doctors all because they want to pay less.
“We don’t even seem to value what we have. As it is said, a minister of labour and productivity was quoted to have said that doctors emigrating would generate foreign exchange for Nigeria. Is that going to help the poor people who are sick, for a country with one of the highest maternal mortality globally?” Otolorin wondered.
Dr Gbolahan Obajimi, a former Medical and Dental Consultants Association of Nigeria (MDCAN) vice chairman, UCH branch and subdean for undergraduates at the Ibadan College of Medicine, pointed out that although there are jobs for doctors in Nigeria, often many are not qualified to fill the vacant positions and some only want jobs that offer flexibility so that they could have further training.
He noted that the dearth of doctors also affects private medical facilities, as there are many resigning due to the worsening economic situation of Nigeria, job dissatisfaction and better job options.
Dr Obajimi said not only is Nigeria not training enough for its needs, but junior doctors in many teaching hospitals also are temporary staff and once they leave, the process of filling the vacancies had many challenges, including an embargo on employment and junior doctors’ lack of interest in the available positions.
He said, “Years back, before you came into residency, you would have passed the primary examinations, and they would select from those who had passed through another competitive interview. Now, you don’t need to have passed this examination to come in.
“It tells you that they are not finding people interested in undergoing specialist training. People that register for postgraduate examinations to become medical specialists have reduced.
“The system is a conveyor belt; some exit in five years, some earlier than that. But now the bottom is not being filled. In my department, obstetrics and gynaecology, we have more senior registrars and house officers working; so when the senior registrars finish and leave, how do we cope? If the situation continues at this rate, it will be very disastrous.”
According to Dr Obajimi, this has contributed to increased waiting time for those seeking to have specialist care.
“Currently, the waiting time to see me for consultation at the clinic once the case is not an emergency is now three months, because I am overbooked. For some doctors, it is six months at the minimum.”
Despite the shortage of doctors for medical services in Nigeria based on WHO specifications, Professor Mayowa Owolabi, the immediate dean of the Faculty of Clinical Services at the University of Ibadan, said the quota of doctors that been churned out in the last three years has reduced due to the COVID pandemic and industrial strike by the Academic Staff Union of Universities.
According to him, currently, the number of doctors that have emigrated in the past three years is far above the number trained in the country and the quota for training couldn’t be increased because quality cannot be jeopardized and training facilities have not increased.
Professor Owolabi added, “Our doctor to patient ratio is abysmally low; before we can meet up with what is required as a minimum, we have to increase the number at least by 10 folds, so we shouldn’t even lose any.
The general belief is that that the migration of doctors is mostly for economic reasons, but evidence seems to suggest otherwise. Government could increase the level of employment ostensibly to retain doctors, but the ongoing brain drain may further be arrested with improvement in training in the country. This will in turn result in improvement in the health of Nigerians.
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