Buffeted by severe competition from overseas, Nigeria’s health sector has been haemorrhaging talents for years. This national embarrassment is exemplified by the disclosure made by the Coordinating Minister of Health and Social Welfare, Muhammad Pate, that over 16,000 Nigerian doctors have left the country in the past seven years.
The doctors sought greener pastures in other countries, highlighting one of the significant challenges plaguing the health sector in Nigeria.
This alarming depletion requires prompt attention, an effective strategy, and a holistic approach.
At the seventh annual capacity-building workshop of the Association of Medical Councils of Africa held in Abuja on Tuesday, Pate noted that this troubling trend “represents a fiscal loss. The estimated cost of training one doctor exceeds $21,000 – a figure that reflects the magnitude of public financing walking out of our countries.”
He pointed out that the doctor-to-population ratio in Nigeria “now stands at around 3.9 per 10,000 – well below the suggested global minimum” standard set by the World Health Organisation.
Labour migration in the health sector is by no means new. In recent years, this has intensified due to poor remuneration, rising insecurity, inadequate health facilities, and Nigeria’s challenging work environment.
Across the country, many medical workers are languishing under excessive workloads, lack of professional development opportunities, and burnout.
Within Nigeria, there is an uneven distribution of skilled doctors. Doctors are significantly concentrated in urban centres like Lagos and Abuja, thus depriving citizens who live in rural areas of healthcare practitioners.
Taylor & Francis Online estimates that 82.8 per cent of general medical doctors, 81.6 per cent of specialists, 79.9 per cent of nurses, and 79.2 per cent of midwives are in urban areas.
Attracted by better economic prospects, improved working conditions, more opportunities for career growth, and superior research environments, thousands of healthcare workers are trooping out of the country to developed climes.
Six countries — the United States, the United Kingdom, the United Arab Emirates, Saudi Arabia, Canada, and Australia — have been identified as the leading migration destinations for Nigerian doctors and nurses.
A 2022 survey by the online resource PubMed revealed that 43.9 per cent of Nigerian physicians are contemplating emigration, with 36.8 per cent undecided about their future practice location.
Tragically, the departure of a substantial number of healthcare professionals has led to a worsening doctor-to-patient ratio, further straining an already overstretched healthcare system.
An estimate provided by Gavi showed that only 55,000 licensed doctors remain in Nigeria to serve a population which exceeds 230 million.
Not only is Nigeria losing ground in providing quality healthcare services to citizens, but this brain drain – referred to as japa locally – is also depriving the next generation of material and intellectual medical resources that ought to transmit knowledge to them.
Sadly, while the country’s health institutions lack sufficient trained personnel to cater to the teeming Nigerian population, graduates who should be filling these gaps are often frustrated by bureaucratic bottlenecks and poor investment, which restrict internship and housemanship placements to a privileged few.
Nigeria is paying a huge price for the mass exodus of its health professionals. Specialists—such as anaesthetists, oncologists, radiologists, and surgeons—have left the country in large numbers, resulting in widespread delays in diagnosis, cancelled surgeries, increased referrals abroad, and, in some cases, the shutdown of entire departments.
The shortage of skilled birth attendants and paediatricians has directly contributed to Nigeria’s alarmingly high maternal and infant mortality rates. According to the World Bank, these rates are among the highest globally, with Nigeria accounting for 20 per cent of the world’s maternal deaths.
In many public hospitals, patients often face months-long waits for tests, surgeries, or consultations.
In some rural areas, primary health centres are in a deplorable state, without doctors available, forcing many to rely on unqualified personnel.
Terrifyingly, the emigration of public health experts has weakened Nigeria’s capacity to manage epidemics, vaccinations, and health surveillance
This has compromised the country’s ability to respond swiftly to disease outbreaks such as Lassa fever and cholera.
Despite being one of the most important sectors of human life, the healthcare sector in Nigeria is in a shambles. The exodus of medical professionals from the country has reached the scale of a haemorrhage – a relentless and life-threatening bleed for the country’s healthcare line.
Despite their years of commitment to serving the country, many healthcare professionals go on strikes over unpaid allowances and lack of welfare. They are kidnapped and killed by insurgents or exposed to gratuitous violence by irate families of patients.
Amid the shortage of skilled health personnel domestically, many political elites seek medical tourism abroad, expending a huge chunk of financial resources.
Findings by The PUNCH based on figures from the CBN showed that Nigerians spent about $2.38 million (N3.7 billion) on foreign healthcare-related services from January to September 2024.
In the first quarter of 2023, Nigeria spent $1.04 million on foreign healthcare services, marking a 40.54 per cent increase from the same period in 2022.
In a bid to tackle the funding gaps in their health systems, African heads of state and governments under the African Union made a commitment in April 2001 to dedicate at least 15 per cent of their annual budgets to the health sector in what is now known as the ‘Abuja Declaration.’
While Rwanda and South Africa have met the commitment by allocating at least 15 per cent of their total budgets to health, Nigeria is yet to do so and is still far from meeting the target as the country’s health sector challenges keep increasing.
The Nigerian government should borrow a leaf from the book of Cuba. The country has managed to retain its medical professionals through a combination of ideological, institutional, and economic strategies.
The Cuban government provides free and high-quality medical education and invests heavily in training doctors. It then uses this to build loyalty and reduce student debt pressures.
Doctors who serve their country loyally may be selected for missions abroad, where they earn more in foreign currency, and many doctors are encouraged to stay because of social respect, job security, and a sense of purpose.
It is not too late for Nigeria to curb the brain drain in the sector. It is a complex yet urgent issue.
The federal, state, and local governments need to invest more in the sector and improve the working conditions of health professionals through the provision of better infrastructure and the upgrading of public health facilities to improve morale and productivity.
Governments and stakeholders need to improve security in hospitals, especially in conflict-prone areas. Health workers across the country need to feel physically safe. There should be an increase in remuneration and incentives for health workers.
Most importantly, governments should restructure the healthcare system to enable the mobility of graduate interns into the sector.
Health professionals should have access to specialist training, continual medical education, regular workshops, certifications, and conferences to reduce their need to go abroad to remain current.
The Nigerian government needs to rethink and reshape its health policies to enable it to effectively manage its valuable health workforce in ways that benefit the country first and foremost.
