Cuba’s brain gain: How Nigeria can profit from doctors’ exodus

Cuba, an island of over 11 million in Latin America, was once at the base of basic healthcare measures before it worked out a strategy that spun it into an island of doctors, surplus enough to rake in export earnings from foreign medical missions.

The largest share of Cuba’s export earnings accrues from incomes gained through a programme that ships about 50,000 health workers to more than 60 countries across the world.

The Caribbean government earns around $8 billion a year in revenues from deploying healthcare professionals to foreign governments, reports show.

It faced a challenge similar to the current woes of Nigeria’s healthcare sector, with its doctors fleeing to the United States for higher pay, rejecting the idea of Fidel Castro’s revolution.

The migration crashed Cuba’s ratio of physicians to patients from 9.2 doctors per 10,000 people in 1958 to 5.4 by 1962, according to a study on ‘Cuban Public Healthcare: A Model of Success for Developing Nations’.

The Cuban infant mortality grew from 33.4 in 1958 to 46.7 in 1969 as nearly half of Cuba’s 6,912 doctors left the island after the revolution.

However, different from Nigeria’s case where an indirect subsidy of medical training of health workers benefits richer countries to the detriment of its domestic needs, Cuba went back to the drawing board.

One of the first measures it took was to create a level-playing field that eased access for the poor class to gain admission into medical schools, with the government paying the bills for all of the costs associated with their training.

Cuba gradually built a fresh crop of doctors, which began to reflect on its health indicators. The physician-to-patient ratio improved to 36.1 doctors per 10,000 people in 1990 and by 2007, it had a better doctor-to-patient ratio than that of the US or Western Europe: 64 doctors per 10,000.

Cuba’s ratio today is double the numbers found in many developed nations, with a doctor for every 150 people. Africa’s most populous nation, Nigeria, has a ratio of 4 doctors per 10,000 people.

By the mid-1970s, Cuba had brought down its infant mortality rate to 28. It fell further to 15 by 1984.

The government ensured that doctors were available to both city dwellers and those in the hinterland through an urban-rural balance scheme that saw new constructions of health facilities rise in the rural areas.

Another step it took was to focus healthcare on consultation with patients and local communities, disease prevention, and directing scarce resources towards the groups most in need, especially expectant mothers, infants, children, and the infirm elderly.

In 1984, it began the implementation of a basic healthcare team of a doctor and a nurse approach, with each team unit caring for about 80 to 150 families.

By 2009 and 2011, Cuba could offer 5.1 beds per 1,000 people, a better rate than the 2.1 level in Latin America and the Caribbean, and even better than the 3.0 rate found in the USA.

Many beds were left unused in the year 2000 as the bed occupancy rate was at 69.4 percent. With the healthcare system focused on prevention and the doctor, nurse, and public healthcare worker teams keeping in steady contact with their communities, the need for hospital beds is reduced.

Cuba, after settling the health needs of its people, began to champion medical missions to different countries. It had agreements with governments for a certain number of years to deploy doctors in areas of need. Doctors get paid by the Cuban government, while movement and hosting costs are often taken up by the receiving country.

By the mid-1980s, it was producing doctors specifically to staff its overseas deployments. The number of Cuban health professionals serving abroad rose from 5,000 in 2003 to 25,000 in 2005 and to over 40,000 by 2007.

In 2013, Brazil’s President Dilma Rousseff brought in some 7,400 Cuban doctors to tend to people in poor regions, after her efforts to attract Brazilian physicians to serve in these zones failed to fill even a fraction of the needed postings.

Analysts say in addition to policies that attract private sector funds to healthcare including taxation and levies, Nigeria can toe Cuba’s path to squeeze out gain from the brain drain going on and generate more earnings.

Olamide Brown, founder of Flying Doctors Healthcare Investment Group, said Nigeria needs to be able to do more with less since it can afford budgets controlled by the countries luring away its doctors.

“We have a huge brain drain problem. Why not change that into a brain gain opportunity by making trade deals with countries that need doctors in exchange for a fee. Countries like Cuba and the Philippines have done this and it is a source of income to them,” Brown told BusinessDay.

“The real wealth of Nigeria is not in the ground or from oil. It is actually from our people. We need to see how we can leverage the skills of our people to bring prosperity to the country.”

Nigeria, home to over 82 million poor with health expenditure per person of $71, is offsetting the cost of healthcare delivery for countries such as the United States, a country capable of $10,921 in health spending per individual.

The United Kingdom and Saudi Arabia spends about $4,312 and $1,316 on each citizen, yet Nigeria keeps losing the health workers it needs because those countries have more advanced healthcare facilities and working provisions.

Instead of a robust health workforce that is equipped enough to drive up doctors to patient ratio, raise life expectancy and flatten maternal and child mortality rates, the country keeps grappling with a lean structure that continues to bleed from workers’ migration.

Data from the register of the Nursing and Midwifery Council of the UK show that the number of Nigeria-trained nurses rose year-on-year by 68.4 percent to 7,256 in March 2022 from 4,310 in the same month of last year.

Apart from the number being the highest, it also ranks third by country of training outside the European Union/European Economic Area.

Losing skilled manpower without a sustainable plan for replacement is a stressor that analysts say is worrying.

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