Retaining skilled healthcare professionals in Nigeria

By Obidike Okafor and Olanrewaju Fashola

Globally, the right to health of millions of people is increasingly under threat. According to the World Health Organisation’s Council on Economics of Health for All, at least 140 countries have recognised health as a human right in their constitutions. However, many of these countries are not translating this recognition into legislation and practice, resulting in inadequate health coverage for their populations. As of 2022, approximately 4.5 billion people, which is over half of the world’s population, were not fully covered by essential health services.

The adequacy of human resources for health (HRH) is an indispensable element in realising universal health coverage. Effective HRH is further characterised by the equitable distribution of an optimal skill mix, a sufficient support system, and the entrenchment of decent work. Many low-income countries generally experience greater shortages of HRH than developed nations, despite having greater health needs. The discrepancy is further sustained and widened by the continuing international migration of health workers from the former to the latter. WHO predicts a worldwide shortage of 10 million HRH by 2030, three-quarters from Africa and the Eastern Mediterranean.

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Q: “Effective HRH is further characterised by the equitable distribution of an optimal skill mix, a sufficient support system, and the entrenchment of decent work.”

In Nigeria, the health sector is incapacitated by a cocktail of challenges, including mismanagement, corruption, and poor infrastructure. As a result, the nation has a very poor health outcome, with some of the worst healthcare statistics in the world, ranking 163 out of 191 on the WHO overall efficiency system in 2022. The efficacy of the nation’s healthcare can be assessed through several indicators, but a recent scourge affecting the capacity of Nigerians to receive adequate healthcare delivery as a human right is the mass exodus of medical professionals in search of greener pastures or better working conditions. Despite the WHO’s introduction of a safeguard list to stop poaching, the brain drain syndrome persists.

The mass exodus

Nigeria’s health sector is in a precarious state as her HRHs are departing the country in droves in search of greener pastures or better working opportunities abroad. Their motivations vary, including dissatisfaction with working conditions, low wages, and a lack of opportunities for career advancement. Despite the deprivation of the nation’s healthcare delivery system, Nigeria educates a robust workforce of graduates, including doctors and nurses, making them desirable workers in the UK, USA, Canada, and the Gulf countries.

In 2024, the Nigerian government revealed that the nation has lost over 16000 doctors to brain drain in the past five years, leaving only 55000 licensed doctors to serve the over 200 million population. This means that there is a ratio of 1 doctor to 5000 patients, far below the WHO’s recommended ratio of 1:600 and relatively compared to developed countries with 1:254. The National Health Service in Britain report further shows that the percentage of African clinical staff working with the service increased from 1.9 percent in 2016 to 3.8 percent in 2023.

In addition to the exodus of doctors, about 75,000 nurses have left the country since 2017, according to the National Association of Nigerian Nurses and Midwives, leaving the ratio at 1 nurse to 1160 patients. More so, according to the Nursing Council, about 15,000 nurses left Nigeria in 2022 to take up jobs abroad. The number of Nigerian nurses in the UK has exploded, more than doubling between March 2021 and March 2023, according to the UK’s Nursing and Midwifery Council. The consequence for the nation is fewer, more exhausted nurses delivering less care, creating a negative feedback loop of worsening conditions for nurses that pushes them even more to leave.

Source: Extracted from Quartz Africa | The Nursing and Midwifery Council, 2023.

Push and Pull Factors

The reasons for this mass exodus of highly skilled healthcare professionals have been broadly classified into pull and push factors. The pull factors are the incentives and the positive structures available in developed countries that provide the promise of a better life and opportunities for healthcare professionals. These include, but are not limited to, prospects for career development, better remuneration packages, improved working conditions, and an improved quality of life.

The push factors are the negative realities in developing countries that tend to force healthcare professionals to scavenge for opportunities outside the country. In Nigeria, widespread dissatisfaction among healthcare professionals stems not just from poor pay but also from the sector’s limited career path and its deplorable working conditions. Tellingly, the high level of economic inequality also plays a part in these conditions. The elite will always take solace in their abilities for outbound medical tourism, where they can get proper healthcare abroad or in well-equipped private hospitals. The implication is that more than 40 percent of Nigerians living below the poverty line will overwhelm the understaffed and ill-equipped public medical facilities.

Other key push factors include the cost of living crisis, surging inflation, and gross underinvestment in the sector.

Read also: Experts outline ways to address healthcare challenges in Nigeria

Paths to healing

The brain drain syndrome has broader societal implications, impacting healthcare and the overall well-being of the population. To ensure quality healthcare services as a fundamental human right, it is essential to address the underlying push factors causing the brain drain. A united effort is required, with the government taking the lead in improving the quality of work and life for healthcare providers to retain them. These include:

Investment in health technology and telemedicine: Boosting investment in healthcare can create an environment that will retain and lure back skilled professionals. Many of our hospitals are overwhelmed with patients and their caregivers because we have yet to fully explore the potential of telemedicine and other emerging health technologies. We also need to urgently fix basic healthcare service issues that can aid service delivery.

Improved healthcare financing mechanism: It is not sustainable for the government and individual citizens to bear the cost of healthcare without appropriate funding mechanisms such as healthcare insurance. The need to also ramp up health insurance coverage for the informal sector will be a game changer in financing the cost of healthcare and remunerating professionals appropriately.

Fixing healthcare infrastructure: Fixing the healthcare infrastructure is a critical step in enhancing service delivery. The decision of medical professionals to stay or leave will depend on the quality of life available to the people they care about. Arresting the trend will remain tough if the power supply remains epileptic, there is no access to broadband internet, and the potholes on the road mean threats to life, amongst others.

Improve HRH training capacity: Right now, the nation has a greater need for healthcare professionals than it can produce (not counting those who are leaving). Clarity on the gaps and precise forecasts on how to reduce the gaps are essential components of any plan to close the HRH gap in Nigeria. We have two options: either train them locally or import HRH (like the industrialised nations). We support the former since it is more natural and may provide Nigeria with income in the form of remittances.

In sum, ensuring health rights in the face of this crisis requires a multi-faceted approach, including better incentives for healthcare workers, investment in healthcare infrastructure, and international cooperation.

Contact: Nike Alao- Chief Research Officer (+2348034856676)