Health workers doubt government’s anti-japa incentive

Nigerian healthcare workers have expressed doubts over the Federal Government’s newly introduced incentive aimed at curbing the growing trend of professionals leaving the country, commonly referred to as ‘Japa.’

The ‘National Policy on Health Workforce Migration’ was introduced last month and promised to improve working environments, but it seems to have done little to boost the confidence of healthcare workers.

Dele Abdullahi, president of the National Association of Resident Doctors (NARD), said in an interview with BusinessDay that the plan does not adequately address their concerns, noting that health professionals are unconvinced about the government’s commitment to their welfare.

“We don’t have confidence in the policy or government’s commitment to improving our welfare. Many doctors are still eager to leave the country,” Abdullahi said.

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The NARD president stated that underlying issues driving doctors’ exodus have not been adequately addressed. He stressed the need for substantial investment in healthcare infrastructure to improve the ‘toxic’ working environment further.

Abdullahi said that while welfare improvement is important, providing modern equipment, and ensuring the overall development of healthcare facilities are key.

“The policy cannot stem japa; most healthcare establishments do not have the facility for doctors to work. This administration is over one year now, even the demands they met on ground, they are yet to make any major inroads into it”, he said.

He also mentioned the persisting economic challenges in the country, including inflation and rising costs of living, which force Nigerian health workers to migrate.

He questioned how many doctors who have left the country would be willing to return to such an environment, calling the policy a “political statement” rather than a practical solution.

He noted that doctors still have a long list of unmet demands and are unsure about the government’s commitment to implementing the policy. He said migration of healthcare personnel will persistent unless the government shows significant commitment by matching words with action soon enough.

He regretted that no doctor was included in the recent national minimum wage committee which negotiated the agreed N70,000 new minimum wage.

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“We still have a long list of demands that we are clamouring for. It’s not about remuneration, but creating an environment for doctors to thrive, the environment is toxic, and the current economic reality is not favourable.”

He also criticised the broad nature of the policy, arguing that it lacks specific and actionable steps.

The policy which aims to strategically address the fundamental problems of the shortage of skilled healthcare professionals in Nigeria, particularly in rural and underserved areas, focuses on incentives such as mortgage facilities, periodic review of healthcare workers’ salaries, benefits, pensions, and allowances.

The policy also focuses on health workers’ safety; capacity development; strengthening health workforce education and training; health diplomacy, ethical recruitment, and equality; research, innovation, and strategy.

According to the policy, Nigeria suffers from severe shortages of health workers, stemming from inadequate skilled professionals and the difficulty in deploying existing professionals in rural and underserved areas.

Nigeria has 0.363 medical doctors per 1,000 people, far below the World Health Organisation threshold of 4.45 healthcare workers per 1000 people for adequate health coverage. The country was the highest workforce-exporting country in Africa, with the UK, US, Canada, Australia, and Saudi Arabia as key destinations between 2021 and 2022.

Sandra Obi, a medical graduate from the University of Abuja said she would jump at any opportunity to leave the country for better working conditions.

Though she commended the move which she said was long overdue but expressed skepticism about its implementation. She is worried that the implementation may drag further due to systemic challenges that generally face the implementation of policies, including finance, and the lack of continuity in governance according to her.

“Doctors have been clamouring for better salaries and working conditions for years. Now that many are leaving, the government is only starting to understand the consequences. But will putting it on paper make any difference?” She questioned.

Samuel Ode, an Abuja-based medical doctor applauded the government for the policy but expressed concern about implementation. He said state governments, in particular, might struggle to domesticate and enforce the policy, while also noting that governments at all levels have not done well in implementing good policies.

“We have many doctors at the state level, so it’s not just at the federal level. Look at the minimum wage law for instance, how many states are complying? They always complain they don’t have money. So, what is the assurance that they will commit to the welfare of medical professionals?”

Read also: Nigeria develops policy to reverse health workers’ exodus

Aisha Aliyu, a nurse at the Federal Medical Centre, Keffi, said: “They have been saying this for long and nothing is happening. We are not paid what we ought to be paid. Our salary is not enough, yet the government is stopping us from going abroad. Our salaries cannot do anything, especially with the hike in transportation and cost of living. We have not seen anything on the new minimum wage.

In the hospital where I work, so many nurses are eager to go, those abroad are 100 percent better than us here. They have the equipment to work with; if I see the opportunity, I will leave without hesitating”, she said.

The exodus of Nigerian healthcare workers was further highlighted when the Nursing and Midwifery Council of Nigeria (NMCN) reopened its verification portal, allowing nurses and midwives to process their licences for international migration.

This move sparked jubilation on social media, with many healthcare professionals expressing eagerness to pursue opportunities abroad.

Data from the Federal Ministry of Health show that there was a huge jump in the number of nurses requesting verification to migrate from NMCN, with 52 percent of nurses and midwives who needed a letter of good standing to move choosing the United Kingdom as their new home, while 36 percent chose the United States of America.

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The council in February deactivated the verification portal, leaving several Nigerian nurses and midwives working abroad frustrated, especially those whose licences expired.

However, nurses are excited about the reopening of the verification portal though they are not happy with some conditions attached, including two years post-graduation and a letter of good standing. They said this may affect their abroad dreams.

“I think we’re still stuck in the previous issue. How will these hospitals allow you to start the process of leaving them “, Abdulyasari Faruq wrote on X.

Meanwhile, Faruk Abubakar, registrar of NMCN, who spoke with BusinessDay, acknowledged that the success of the national policy hinged on political will.

He said the council was also making efforts to increase the number of qualified nurses in the country. He informed that the council has so far registered 29,000 in 2024 and projects to register 40,000 nurses by the end of the year.