Amid the economic challenges plaguing Nigeria, fewer individuals are seeking medical care due to the soaring costs of hospital admissions, medications, and diagnostic tests.
However, for those who do make it to hospitals, the journey to secure a doctor’s appointment has become arduous and lengthy.
Booking consultations, especially for non-emergency cases in certain government hospitals, has become increasingly burdensome.
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Patients face extended wait times and endure month-long waits for in-person consultations with specialists.
“The administrative staff couldn’t find an earlier date to book the reporter. She said only 10 patients were booked daily and that the entire month of March through mid-April were all booked.”
When Aarinola Arabi visited Isolo General Hospital initially seeking help for eye issues in January 2020, she was given an appointment three months later, with no interim assistance provided.
The onset of the COVID-19 pandemic in March 2021 redirected hospitals’ focus towards emergency cases and pandemic response, further complicating access to routine health care.
When Aarinola returned over a year later for secondary infertility concerns, she encountered a five-month wait for a gynaecologist appointment. Frustrated by delays and deterred by the high costs of private healthcare, she took a break in her pursuit of timely care.
In February 2024, attempting to revisit her case at the hospital, Aarinola faced additional obstacles due to a digital record transition that saw her records at the hospital lost.
“I asked if I could at least fix the registration part so that I won’t have to begin from scratch the next time I come, and the official declined. He insisted I come the following day, which happens to be a Friday again. They told me earlier that I could not be registered on a Friday,” the 50-year-old said while narrating her ordeal to BusinessDay.
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On the second visit on March 7, at 10 a.m., she was told that the list of patients to be seen had already been compiled.
Mrs Arabi is one of a growing group of dissatisfied patients grappling with inadequate healthcare access despite residing in urban areas believed to have abundant medical facilities and modern medical technology.
The need for more timely care is also worsened by a shortage of healthcare providers relative to patient demand. In Lagos alone, there are approximately 7,600 doctors, while Abuja boasts around 4,700 doctors, data from the Federal Ministry of Health revealed.
This dilemma tragically played out in the case of Itunu Oladepo, a 29-year-old graduate of Tai Solarin University of Education, Ijagun Road, Ijebu Ode, Ogun State, who passed away on January 25, 2024, at Alimosho General Hospital, Igando, a suburb of Lagos State.
Initially attributing his symptoms to familiar malaria and typhoid signs, Oladepo delayed seeking care until his condition deteriorated, necessitating a referral to Alimosho General Hospital.
Upon arrival as an emergency patient, Oladepo faced a two-hour delay due to bed shortages and slow triage procedures before being admitted.
Subsequent medical evaluation revealed a complex diagnosis of hypertension and acute kidney injury induced by sepsis.
Oladepo succumbed to his condition the following morning, leaving his mother with only one surviving child out of six.
“I am almost empty. He was the only graduate among my children, as was my surviving son. When I walk through the kitchen and see how idle his food flask is, I’m shattered. This is someone who could have survived if we knew about his diagnosis early.” Awash in grief, Funmilade Oladepo, 58, recounted to this reporter what she encountered while navigating the process of obtaining her son’s death certificate.
Gridlocked care:
To gain firsthand insight into the challenges faced by patients like Oladepo, this BusinessDay reporter visited Isolo and Alimosho general hospitals.
The waiting areas at both hospitals were marked by sombre crowds of patients, their families, and stressed administrative staff, with patients grouped based on urgency, often resulting in non-emergency cases facing significant delays in accessing care.
At Isolo General Hospital, after a lengthy registration process and medical assessments, the reporter consulted with Dr. Dawodu regarding secondary infertility concerns. Recommendations for further tests and specialist appointments were made, but bureaucratic hurdles hindered prompt scheduling, with appointments unavailable for months due to overwhelming demand.
The administrative staff couldn’t find an earlier date to book the reporter. She said only 10 patients were booked daily and that the entire month of March through mid-April were all booked.
To clear the reporter’s doubt, she casually chipped in, “Even the president can’t help you secure an appointment if he comes with you.”
After flipping back and forth through her records, she booked the reporter for April 29, two months later.
At the Alimosho General Hospital, the reporter could not access a general doctor the same day she visited. As of 11 a.m. on March 1, the administrative staff handling patient registration told the reporter she could not book a consultation with a general doctor until 12 days later.
The overarching issue lies in the clash between escalating healthcare demands and declining service capacity. Hospitals are operating with lean resources as they reel from a shortage of workforce, worsened by the significant loss of health professionals to mass emigration abroad.
Disincentive:
Amid the current challenges of high fuel prices and general hardships, BusinessDay found that some public hospitals in Lagos are unable to power generators, even during the nighttime.
Patients and medical workers often wait outside for care, creating an unconducive working condition that most health workers dread.
In health centres such as the Mushin General Hospital and the Maternal and Child Care Centre, Itire, Mushin, there is a lack of consistent electricity and water supply, affecting patient care and staff operations.
The situation has deteriorated in recent weeks, with generators only activated for emergencies and sometimes not even then, a source familiar with the working condition told BusinessDay.
The directive to limit generator use came from higher authorities due to fuel shortages and financial constraints, BusinessDay learned.
Workforce crisis:
The federal government is actively addressing health professionals’ challenges, with around 300,000 professionals working in the country as of March 2024, according to Health and Social Welfare Minister Muhammad Ali Pate.
Despite this workforce, only 55,000 licensed medical doctors out of the 90,000 registered doctors remain in Nigeria to cater to a population nearing 220 million.
The exodus of healthcare professionals worsens the workload for those who stay behind, resulting in a doctor-to-patient ratio of 2.5 per 10,000 individuals nationwide.
In regions like Lagos with a higher concentration of doctors, the ratio slightly improves to 3.17 doctors per 10,000 people based on a population estimate of 24 million by the Health Facility Monitoring and Accreditation Agency (HEFAMAA).
Comparing these figures to the World Health Organisation recommendations of one doctor for every 500 patients and one nurse for every 400 patients reveals significant shortfalls.
Data from the National Association of Nigerian Nurses and Midwives indicates that currently, only one nurse is available for every 1,660 Nigerians.
Pate highlighted the critical shortage and imbalance in the healthcare workforce composition, emphasising the need for a robust approach to address the challenge.
“The issue overall in terms of health professionals is that they are insufficient. There is an imbalance in terms of the skills mix, and there are huge maldistribution issues,” Pate said during a televised interview.
“We have been losing many doctors that have been trained here. We have to look at it holistically, not only from the angle of doctors but other cadres that are important in the delivery of healthcare.”
Brain drain:
In the UK, there has been a significant increase in the number of Nigerian-trained nurses who have started working there.
A recent report from the UK Nurses and Midwifery Council revealed that in the six months leading up to September last year, 12,099 nurses from Nigeria joined the UK workforce.
This is a huge jump compared to the 1,670 nurses who registered during the same period in 2022.
The report also highlighted a general trend of more professionals, not just from Nigeria but from various countries, joining the UK nursing register.
The number of new internationally educated nurses has been steadily increasing, with 15,036 joining in the last six months alone. Interestingly, the percentage of Nigerian nurses among these new joiners was around 9.69 percent.
The report emphasised that there has been a growing interest from nurses educated in countries on the UK’s red list, where active recruitment is restricted.
This includes countries like Ghana, Zambia, and, notably, Nigeria. The increase in the number of nurses from these countries reflects a broader trend of international recruitment in the UK healthcare sector.
In the UK, despite guidelines advising against actively recruiting healthcare workers from countries on the “red list,” like Nigeria, the healthcare sector faces a shortage of staff due to increasing demands. The National Health Service (NHS) is under pressure to fill these gaps.
During the COVID-19 pandemic in 2020, the UK saw a sharp rise in the need for healthcare workers. To address this, the government made a commitment to boost nurse numbers by 50,000 by 2025.
They also provided additional financial support of £5,000 to help with living costs for healthcare workers.
In response to the shortage of skilled workers, the Health and Care skilled worker visa was introduced during this period to encourage international healthcare professionals to apply and work in the UK.
This initiative aimed to attract talent from around the world to support the healthcare system in meeting the increasing demands for services.
Efforts in bridging the gaps in Nigeria’s Healthcare sector:
The critical shortage of healthcare professionals in Nigeria has prompted the government to initiate various measures aimed at bolstering the workforce. Tunji Alausa, Nigeria’s minister of state for health and social welfare, has outlined plans to collaborate with the National Postgraduate Medical College to train specialists in crucial areas like interventional cardiology, electrophysiology, and robotic surgery.
Moreover, the delegation of waivers by the president seeks to facilitate the recruitment of new staff in teaching hospitals and federal medical centres to counter departures from the health system.
However, concerns have been raised by the Nigerian Medical Association (NMA) regarding the effectiveness of these plans.
Uche Ojinmah, NMA president, stressed the need to focus on expanding training capacities, improving equipment resources, and increasing faculty numbers to enhance educational outputs.
The Private Sector Health Alliance of Nigeria (PSHAN) has also been actively engaging in partnerships to enhance healthcare systems and outcomes in Nigeria.
Through initiatives like Adopt a Primary Health Care Facility (ADHFP), PSHAN is addressing gaps in primary health care delivery across the country.
Tinuola Akinbolagbe, PSHAN’s CEO, revealed that the ADHFP had secured over N20 billion in commitments from the private sector to revamp 120 primary healthcare centres (PHCs) in various local government areas.
Notable foundations like the Aliko Dangote Foundation, Jim Ovia Foundation, and MTN Foundation have adopted multiple PHCs in different states, showing significant private sector involvement in addressing healthcare challenges.
Akinbolagbe highlighted the need for private sector support in addressing healthcare deficits by offering competitive salaries, benefits, professional development opportunities, and non-financial incentives.
He also highlighted the potential for technology, research, and improved working conditions to combat brain drain and improve healthcare delivery in Nigeria.
