The Minister of Health, Osagie Ehanire, got it all wrong recently when he reportedly said that there are enough medical doctors in the country and that the Federal Government would replace doctors who resign and leave for greener pastures. With medical professionals moving abroad in droves and a shambolic health care delivery system, this is insensitive. It reflects the flippant mindset of Nigeria’s current national leadership. The President, Major General Muhammadu Buhari (retd.), should rebuke the minister, shake up the health system and pursue effective policies to retain medical personnel in the country.
“We have heard complaints of doctors who are now leaving the system, but there are actually enough doctors in the system because we are producing up to 2,000 or 3,000 doctors every year in the country and the number leaving is less than 1,000,” the News Agency of Nigeria quoted Ehanire as saying. This claim is patently false and suggests ministerial incompetence. Officials who reason like this are part of the problem; they should be swept out of office.
It is worrisome that Ehanire, a medical doctor, whose remit is to improve the health system, including retaining and recruiting as many medical professionals as practicable, talks so carelessly. He is however not the only regime minister to trivialise weighty issues.
In 2019, the Minister of Labour and Employment, Chris Ngige (also a medical doctor), had pursued the same shallow line of argument: “I am not worried about doctors leaving the country. We have a surplus. If you have a surplus, you export… It is my area, we have excess.” Ngige repeated this puerile jibe in 2021 during a meeting with states’ health commissioners.
Governance should be driven by scientifically verified facts to undergird planning and finding solutions to challenges. The harsh reality is that Nigeria is short of doctors. The President of the Nigerian Association of Resident Doctors, Dare Ishaya, disclosed that six out of 10 resident doctors plan to leave the country.
The Nigerian Medical Association noted that “by the last analysis we had, we had between 20,000 and 25,000 doctors in Nigeria and this number is supposed to take care of 200 million people. So, we have a ratio of one doctor to between 4,000 and 5,000 patients. Meanwhile, the World Health Organisation recommended one doctor for 600 patients.”
Project PINK BLUE, an NGO, stated that Nigeria would have a shortage of 50,120 doctors and 137,859 nurses by 2030 due to the mass emigration of health workers. It said the density of physicians to a patient is four doctors per 10,000 patients, and 16.1 nurses and midwives per 10,000 patients.
The Nigeria Health Watch said 80,000 doctors were registered with the Medical and Dental Council of Nigeria as of June 2021, out of which only about 35,000 are practising in the country and serving over 200 million people. The others practise overseas, with over 4,000 in the United States and 5,000 in the United Kingdom; some have moved to other professions. The UK’s General Medical Council licensed 266 Nigerian doctors in June and July 2022, translating to three Nigerian doctors licensed per day. A total of 10,096 Nigeria-trained doctors have migrated to the UK.
These figures do not include other Nigerian doctors who did not undergo medical training locally. Nigeria currently has the third highest number of foreign doctors working in the UK after India and Pakistan.
The National Primary Health Care Development Agency reports that only 43 per cent of Nigerians have access to quality primary healthcare services. The OECD says that while India attained the UN-prescribed standard in 2018, Nigeria has a paltry 0.3 doctors to 1,000 citizens, compared to 1.8 for China, 2.6 for the UK, 2.8 for the US, 4.3 for Sweden, and 5.83 for Italy.
The country needs many more medical workers. It is currently battling several disease outbreaks, including Lassa fever, monkeypox, malaria, maternal and infant mortality, and cholera. Meanwhile, it has decrepit health infrastructure, blighted by inadequate equipment and facilities, power shortages and frequent industrial unrest.
Significantly, it is some of the finest professionals that are leaving because candidates undergo rigorous qualifying tests by the recruiting foreign countries; only the best meet their criteria.
Last year, Saudi authorities directly came shopping for Nigerian doctors to revitalise their own healthcare system to which hundreds of doctors, including consultants, specialists, and other related experts with varying years of experience, responded.
Instead of remedial measures to improve the system and retain the fleeing professionals, the Buhari regime responded brutishly by sending operatives of the State Security Service to disperse the applicants at the Abuja venue. That brazen violation of human rights did not stop the recruitment; the recruiters simply reverted to their discreet mode.
The federal and state governments should take intelligent measures to upgrade health care services and retain a skilled and motivated professional workforce. Equipment is lacking, the working environment is filthy, and the administration is incompetent, nepotistic, and corrupt.
They should address pay and compensation issues that cause frequent work stoppages. In many states, medical personnel are owed salaries and allowances. The government fails to honour agreements it signed with unions on pay, funding, training, and equipping the hospitals. Budgetary allocations for health are low.
To become the medical, pharmaceutical and biotechnological hub that it is today, reported the medical journal, Lancet, India poured investment in medical facilities, training, and research. Its Ministry of Skill Development and Entrepreneurship unfolded a plan in July 2021 to export 300,000 surplus healthcare personnel by 2022.
Public officials know the system is rotten but do nothing to transform it. The BBC estimates that Nigeria spends about $1 billion annually on medical tourism, particularly to India. Selfishly and without shame, Buhari and state governors routinely jet abroad at public expense for their health care needs.
In the 23 years of civil rule, the federal and state governments have not built a single state-of-the-art hospital. A real estate consultancy, Knight Frank, estimates that Nigeria requires 386,000 additional beds and $82 billion of investment in healthcare real estate assets to reach the global average of 2.7 beds per 1,000 people. A joint WHO/UNICEF report revealed that 32 per cent of health care facilities in Nigeria lack basic sanitation services.
Buhari and the governors need to invest heavily in health, with emphasis on primary health care and development of some top-rated tertiary hospitals across the country. They should address the brain drain through good remuneration and allowances. The work environment should be made attractive with the necessary equipment and funding. Officials with Ehanire’s and Ngige’s retrogressive mindset should be shoved aside.
