‘Exodus of doctors likely to continue’
Nigeria is losing doctors to other countries. What can Nigeria do to reverse this trend?Unless African governments are able to drive equipoise between the push and pull factors, we will continue to have this spiralling phenomenon of people leaving in droves, whether from Nigeria, Ghana, Sierra Leone or other places to western economies where the […]
Nigeria is losing doctors to other countries. What can Nigeria do to reverse this trend?
Unless African governments are able to drive equipoise between the push and pull factors, we will continue to have this spiralling phenomenon of people leaving in droves, whether from Nigeria, Ghana, Sierra Leone or other places to western economies where the conditions are better.
The pull factors are those factors pulling them into America. The push factors are those factors pushing them away from Nigeria. The workplace condition of medical and dental practitioners is completely deplorable, especially within the primary and secondary care facilities where state and local governments are supposed to be more alive to their responsibilities of catering for the health of their people through investment in modern facilities.
As a result of the workplace condition, which impact on job satisfaction, they end up getting disenchanted with the system and looking for the next available place that will give them some better workplace environment to practice, not necessarily because of the income.
You find Nigerian doctors, the moment they step abroad, they excel because already the intellect is there, and all they need is to get acclimatised to the new technology, and there they go.
Secondly, this issue of insecurity, the challenge of insecurity, which has not been substantially addressed, is one new push factor that is making our people leave in droves. For those of us who have chosen to remain here, I think we should be celebrated. Some of us have not travelled out in spite of the opportunities that beckon on us because of our commitment to our fatherland. You don’t blame anybody who emigrates for reason of wanting to have a secured life, a more prosperous job and a good workplace environment.
The Nigerian government beyond paying lip service to health human resource motivation must really invest in health human resource development in our country, in terms of infrastructure, development of health human resource-in terms of appropriate remuneration. A salary scale gotten by doctors in 2009, as I speak to you some states are yet to implement it.
Even within Nigeria there is internal brain drain, where people are moving from one state to the other. It is either on the fact that you do not have an appreciable remunerative package or you have a highly insecure state, as you have in the north, where some of our members are moving everyday from those areas to the southern parts of Nigeria.
They need to also invest in capacity building. How many state governments are sending their doctors for training? The day you stop learning is the day you start dying. Most state governments do not have any serious programme to continually build the capacity of their doctors and other health workers.
Research investment in Nigeria today is almost at a zero level, and no economy, country, medical institution can grow without research, because it is from research you derive invention, new innovation, new product that will impact positively on the life of the people.
How many doctors are registered or licensed in Nigeria?
Since the inception of the Medical and Dental Council of Nigeria (MDCN), around 71,740 medical and dental practitioners are currently on the register of the MDCN. Out of this number, around 27,000 are currently practising in Nigeria, so there is a huge gap. That gap can be explained by the fact that you have over 3,000 doctors in Britain and over 4,000 in the public health system of America, not to talk of other countries-Australia, France, Germany. Of course some have died along the line; some have even gone out of the profession because of the very despondent situation in the hospital environment where it looks like everybody is struggling for your job.
So that level of satisfaction is no longer there. Some have gone out because they no longer get inspired by the kind of practice they find here in our country.
How does that affect the health sector?
You have less practitioners attending to a heavy population that Nigeria has. The challenge in health human resource is very real in Nigeria, as you have in other African economies. The few that we have are challenged, even the facilities are overstretched, so you have less Nigerians having access everyday to quality healthcare. It is either you go to the hospital and you have long waiting queues, because you have few specialists struggling to look after several thousands of patients.
At the end of the day, that may make people a bit discouraged and resorting to other avenues that may even complicate their conditions-in other words, patronising those who claim to be doctors, who put on white coat and claim to be doctors. At times, you have one doctor seeing over 60, 70 patients in a day, and that is tremendously unacceptable. That creates some negative impact on health care delivery. You don’t have enough human resource expertise and the expertise that you have are even leaving the country.
Cases that ordinarily would have been handled by experts that were trained in Nigeria are not being handled. The health human resource deficit in Nigeria is very real, and is why the NMA is asking government to do more to sort out this problem. Currently in 2013 budget, there is an unprecedented gross underfunding of the residency training programme-that is the programme that even throws up experts. Whereas one would have thought that we would be prioritising that kind of training programme so that we have less people travelling abroad to look for experts to take care of them, that is not being done.
If a doctor is seeing over 70 patients a day, shouldn’t he get better? What’s the implication for him and the patient?
Any patient who comes after a doctor has seen at the most 25 patients is at risk of not having the kind of quality care he expects to have. In life, there is diminishing returns. The standard is that a doctor should qualitatively see a number of patients within a time frame. We expect that in day, within the hours of consultation, a doctor should not see more than 30 patients. The situation is that the same doctor is seeing over 60, 70 patients. It does not give him the opportunity or the right frame of mind the next day to see more patients qualitatively. The doctor is a human being. He has his own issues, physiology to look after. If he is stretched beyond his level, the patient may even be denied further services. The time he has spent seeing over 100 patients, he may lose it by breaking down, having to fall ill-and a good number of them are actually going through that. We are having more doctors falling ill, some of them getting exhausted and kicking the bucket. It is very unfortunate.
One of the reasons for poor utilisation of facilities is this lack of confidence in the system. A patient who has waited a long time on a queue today will not want to utilise that same facility tomorrow. So the onus is on the government to appropriately invest enough resources for the recruitment of health human resource in a way to meet with average expectation rather than stressing the few number of doctors we have now, for which they don’t even adequately remunerate.