Escalating brain drain crisis forces high retention costs on hospitals

The scramble for scarce clinical workforce occasioned by brain drain is forcing high retention costs on Nigerian hospitals as care managers rush to get a grip on the escalating health crisis.

Hospital executives are sidestepping formalities to reach unusual negotiations that sometimes mean multiple increments in pay, with patients at the tail end of such deals waiting to bear the bigger brunt in the form of a higher cost of purchasing care.

The competition used to be domestic and in favour of government-run health facilities against private hospitals because the former had the stronger financial muscle to retain experienced hands, from specialists to physicians and consultants.

But over the last four years, neither the public nor the private sector has been able to rival the incentives used by competitors such as Saudi Arabia or the United Kingdom to poach local talents.

What it means is that hospital executives like Adedamola Dada, chief medical director (CMD) of Federal Medical Centre Ebute-Metta, have had to turn to task shifting and flexible arrangements that allow for job hopping to keep certain services running.

The 288-bedded multi-specialist hospital he manages is manned by about 1,250 workers whose stability is not guaranteed.

Only 32 percent are clinicians, with the remaining 68 percent being non-clinicians.

However, from January 2021 to August 2022, a total of 152 left the system for foreign hospitals. His hospital lost 38 doctors, 42 nurses, 30 combined laboratory scientists, pharmacists and physiotherapists, and 42 others.

This occurred after restructuring was effected to reduce over-staffing in non-critical areas, an anomaly which at some point had the hospital operating with about 30 chartered accountants and some geologists, among others. Whereas it needed hands in to run its electronic medical records and information communication technology department.

Dada shifted some workers to these departments without layoffs and ensured all new recruitment was targeted at clinicians. Those who resigned from the non-clinical departments were not replaced since the hands were enough.

But now, the clinical workforce he worked hard to protect is fast depleting. When a consultant chemical pathologist wanted to leave the hospital recently, the CMD had to place him on locum, an arrangement that let him hold the two jobs. A locum staff member works in a hospital when the practice is short-staffed.

In another instance, he bargained with a practising laparoscopic surgeon in the United States to come in quarterly on a train and care basis. Laparoscopy is an operation performed in the abdomen or pelvis using small incisions with the aid of a camera.

“It is not just for her to come; she must transfer knowledge. I paired her with a young female general surgeon and said your duties will be to train and care. We had a two-year agreement and the last time she came, she admitted the trainee was good enough to handle the procedures. I backed it with technology,” Dada said while speaking on building an efficient and resilient workforce at the annual conference of the Society for Quality in Healthcare in Nigeria in Lagos.

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

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The United Kingdom and Saudi Arabia spend about $4,312 and $1,316 on each citizen, yet Nigeria keeps losing the health workers it needs due to higher remuneration and exposure to advanced technologies.

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

Based on data from the register of the Nursing and Midwifery Council (NMC) of the UK, 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.

About 6,068 medical doctors moved to the UK over the last seven years, according to the General Medical Council of the United Kingdom.

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

For Obinna Obi, a human resource professional in healthcare, the situation is a serious concern and an emergency that could hamper the country’s ability to deliver high-quality care.

He said 90 percent of hospital executives will experience a deficiency of specialists, general physicians, nurses, and other clinicians by 2030, citing a 2020 report.

Obi, who has for instance had to increase the pay of a consultant radiologist by 70 percent to retain temporarily, said the situation itself could degenerate to a point where the healthcare business cannot pay for itself.

And for a future where digitisation and automation of healthcare will require skills in sophisticated digital processes, Nigeria may not be prepared, obi warned.

“The western world is now our real competitors. It is no longer the local hospitals or local healthcare industry and the policy that they have developed is such that in the next 10 years this will be the status. We are not able to sustain our talents and the rate of inflation is hitting hard,” he said.

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