The crisis in the health sector has assumed an alarming proportion amidst the growing exodus of qualified medical personnel from Nigeria. Recent reports of facility shut down by leading health institutions across the country call for deliberate steps to stem the trend of brain drain and the attendant consequences for the healthcare system. No fewer than five facilities comprising some 150-bed space at the Lagos University Teaching Hospital and a section of Obafemi Awolowo University Teaching Hospital (OAUTH) were reportedly shut down in the fourth quarter of 2023 owing to manpower shortage.
Reports indicate that some public health institutions across the northern part of the country notably in 10 states comprising Kaduna, Gombe, Borno, Plateau, Bauchi, Niger, Sokoto, Nasarawa, Benue and Kebbi are seriously affected by acute shortage of qualified manpower. Continued exodus of medical personnel; particularly doctors and nurses has taken a toll on the public healthcare system across the 52 federal health institutions in the countries. It is indeed a national embarrassment that skilled health personnel are forced to migrate to foreign countries for greener pastures while public health facilities are shutting down across the country. Dearth of medical personnel constitutes serious threats to the healthcare system in all ramifications. Therefore, the recurring exodus of health care professionals has assumed a worrisome dimension to warrant holistic response from the government. This unpleasant trend must therefore be halted without further refutation or prevarication.
While deplorable state of public health infrastructure and poor remuneration have over the years fueled exodus of health personnel from the country, the situation, however, appears to have been worsened by the Japa Syndrome which boils down to increasing sense of despondency amongst Nigerians regarding the uncertainties of socio-economic milieu in the country. The brain drain syndrome which began in the wake of the structural adjustment programme (SAP) policy of the 80s has snowballed into a level that should no longer be considered an emergency but a disaster deserving urgent intervention to salvage the health care system. It is recalled that the immediate past Minister of Labour and Employment, Dr. Chris Ngige made what would appear convenient excuses for the exodus of medical doctors from the country; insinuating that the country stands to benefit from the Diaspora remittances repatriated by Nigerian doctors practising abroad. As it stands presently, the acute shortage of medical professionals in the Nigerian health sector now calls for a rethink of whatever motivation that may have Diaspora remittances attractive as there has to be a positive balance in the evaluation of loss of medical manpower to foreign countries in the overall state of the country’s health sector.
The need to consciously reappraise the funding of the health sector to redress the fast-degenerating standard and accessibility to healthcare in Nigeria cannot be overemphasised. Over a decade after the April 2010 Abuja Declaration by the African Union which commits governments of African countries to dedicate at least 15 per cent of their annual budgets to the health sector, Nigeria is yet to demonstrate appreciable commitment to the pledge. The N1.3 trillion allocated to the health sector in the 2024 budget signed by President Bola Tinubu on January 1, 2024, represents less than five per cent of the total N28.7 trillion budget and only a repeat of the paltry trend in the last five years. Substantial improvement in budgetary allocations to the healthcare sector at national and sub-national levels is required to reverse the trend of infrastructural inadequacy and shortage of personnel in public hospitals.
Understaffing of health personnel, subjects the system to unwarranted negative backlashes which include poor healthcare services as well as lack of diligent management and sanctions for wrongdoings. Unfortunately, medical personnel with exceptional commitment to duty are often not acknowledged as expected or rewarded appropriately owing to a dysfunctional system created by a crisis of management. The high number of patients in public hospitals daily often overstretches the number of available doctors and nurses who understandably are under enormous pressure with negative impact on their wellbeing and the undesirable implications of induced corruption as those in need of healthcare go to any length to offer incentives to get the attention of few medical personnel on duty. The existing reward system in Nigeria’s public healthcare sector needs to be revisited to ensure that the environment is suitable to attract and retain the best brains to serve as disincentive to doctors’ exodus from the country. There is the need to pay attention to the retention of more qualified health professionals; particularly doctors and nurses in the country to keep public and private hospitals sufficiently staffed and properly managed.
Enacting a law to restrict trained doctors and nurses from leaving the country may appear desirable but that should not be conceived as the ultimate measure or lasting solution towards curbing the exodus of medical professionals. The ultimate solution lies in a holistic approach to addressing the hydra-headed challenges of lack of incentive for manpower training, inadequacy of modern infrastructure, conducive work environment, poor remuneration and reward system. It has become imperative to prioritise policies and action plans that will reposition the health sector and restore the dignity of the country. There is the need to create the necessary enabling environment through requisite budgetary allocations to the healthcare sector as well as incentive that will drive investment for improved healthcare as a social service. Governments at both the national and sub-national level must demonstrate commitment to enforcement of prohibition of medical tourism which requires examples from top political office holders in the country. It would amount to contradiction to accuse medical personnel leaving the country of lack of patriotism when public officials who are supposed to ensure that the environment for practice in Nigeria is conducive are more interested in medical tourism over and above improving existing facilities at home.
Notwithstanding, doctors trained in Nigeria owe the country the responsibility of giving back despite the prevailing disincentive in the country’s socio-economic ecosystem which affects virtually all sectors where professionals are still doing their best possible to ensure the system is kept afloat. Medical doctors are therefore enjoined to remain committed to their profession in tandem with the expectation of their Hippocratic Oath.
By Editorial Board