Beyond better pay: Why health professionals leave Nigeria in droves

There is a massive exodus of Nigeria health professionals out of Nigeria. This trend has become worse post-Covid-19. Advanced economies are in short supply of health workers. Africa, especially Nigeria, is a fruitful breeding and hunting ground. According to the Nigerian Association of Resident Doctors (NARD), only 10,000 doctors are left in Nigeria.

A recent report has it that 35,000 health professionals, mostly doctors, have left Nigeria, with the UK and the United States of America as preferred destinations. The brain drain in the health sector is worrisome. This trend has continued endlessly. Salaries and welfare packages are major factors in the exodus. While this is true, several other factors are responsible for the massive brain drain in the sector.

The security challenge in Nigeria is a critical factor for the exodus.

Health workers are soft targets for terrorists. They adopt them to treat their members or “special” victims who require medical attention. Health professionals are considered “Grade A” victims due to their multiple benefits in the hands of criminals. Dr. Chinelo Nwando, who died in the Kaduna Train attack, remains a landmark example that essential workers in the health sector cannot be guaranteed safety in doing their jobs. A retired and renowned medical doctor in Port Harcourt, Dr. Alexander Akani, was kidnapped twice within 36 months.

In October, several doctors and nurses were kidnapped at Abdulsalami Abukabar General Hospital, Gulu Lapai, in Niger State. There are endless cases of similar cases across the country. In the words of Juan Somavia, occupational safety is vital to the dignity of work. Health professionals are leaving Nigeria for their safety and that of their families.

Lack of government commitment to improve Nigeria’s health sector. Nigeria’s annual budget for health is nowhere near the 15 per cent agreed upon by African leaders in the Abuja Declaration in 2001. In 2022, N711 billion ($1.7bn) was budgeted for health, representing a meagre 4.2 of the entire budget.

Surprisingly, this figure will cater to the health needs of over 200 million Nigerians (approximately N3,500 per head). It is more surprising that 72 percent of Nigeria’s health budget in the last 11 years was spent on salaries and office maintenance, according to data from the Budget Office of the Federation.

African countries like South Africa and Rwanda have health expenditures averaged at 10-12 percent. Medical tourism by the ruling class shows a lack of support, trust and faith in Nigeria’s health sector.

Nigeria’s minister of health, Dr. Osagie Ehanire, says Nigeria loses $2 billion annually to medical tourism, a figure higher than Nigeria’s total health expenditure in 2022. These challenges have contributed to health professionals in Nigeria losing faith in the government’s ability to grow the sector. As a result, professionals leave to seek succour abroad.

Lack of government support for research and foundational career development for health professionals contributes to a brain drain in the sector. Medical research is grossly underfunded in Nigeria. Health researchers lack the necessary facilities to carry out ground-breaking studies to advance medical development. It was evident during the outbreak of the COVID-19 pandemic in 2020.

Only five testing centres existed in Nigeria during the COVID-19 outbreak. Pfizer and BioNTech announced South Africa as its destination for producing COVID-19 vaccines in Africa. Healthcare funding and medical research were leading factors for such decisions. Investment in research is key to addressing challenges. Health professionals have decried the lack of financial support during their training at universities and medical schools.

The high cost of these professionals with little or no scholarships would imply that parents and guardians would spend more to train their wards. To guarantee a good return on investment, health professionals opt for advanced countries with greater regard for the welfare of health workers.

Systemic challenges and bureaucratic squabbles in the health sector are enormous challenges. In a recent dialogue organized by the development Research and Policy Centre (dRPC), the Nigerian Medical Association (NMA) President, Dr Ojinmah Uche, disclosed that Nigeria now has a ratio of one doctor to 10,000 patients. In rural communities, the figures are even worse. In some states in Southern Nigeria, it is one doctor to 30,000 patients, while in the Northern part of Nigeria, it is a doctor to 45,000 patients.

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In contrast, the WHO recommends 23 doctors, nurses and midwives for 10,000 patients. These figures are responsible for the exodus of health workers from Nigeria due to workload. Nurses, pharmacists, and other health workers constantly compete with doctors.

Other health workers allege continuous marginalization and favouritism by the government to doctors in salaries, allowances and appointment to management positions. Other health professionals seek opportunities in developed economies with a more open and progressive system that allows for equal leadership positions and other incentives for all health professionals.

The government must address the challenges of insecurity in Nigeria. Health professionals need assurance of safety to do their jobs. In addition, the government must increase funding for health infrastructure and medical research. This would attract more investment in health.

The inability of financial institutions in Nigeria to assist the health sector needs to be addressed. More financial support is required to train more health professionals in Nigeria and boost their ratio to patients. The government must wake up to its responsibilities to reverse this ugly trend.

Alikor is a health economist & policy analyst at the Nextier Group