Nigeria’s medical haemorrhage: Stopping brain drain before it’s too late

With over 200 million population, Nigeria has a maternal mortality ratio of 814 maternal deaths per 100,000 live births – an appalling figure that puts us among the top contributors to global maternal deaths. The health care system in Nigeria is facing multiple challenges and at its centre are dedicated doctors who toil endlessly to […]

With over 200 million population, Nigeria has a maternal mortality ratio of 814 maternal deaths per 100,000 live births – an appalling figure that puts us among the top contributors to global maternal deaths.

The health care system in Nigeria is facing multiple challenges and at its centre are dedicated doctors who toil endlessly to provide service to their communities. The neonatal mortality rate is equally worrying at 34 per 1,000 live births. Even more devastating is that Nigerian women have a 1-in-22 lifetime risk of dying during pregnancy, childbirth or postpartum, compared to developed countries, where the lifetime risk is 1 in 4,900.

Nigerian doctors, despite their intrinsic value to society and essential service to ensuring public health, are among the lowest-paid in the world, earning pittance compared to what their counterparts at the same level earn in developed nations and even some underdeveloped ones.

This unfairness does more than just greatly demoralise and desensitise our medical workforce; it also promotes the “brain drain” trend, which has been crippling our health care capacity.

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As someone with one foot in clinical medicine and another in global public health, I have been exposed to the sad state of Nigeria’s health care system from multiple vantage points. Often, I witness firsthand, the challenges and obstacles faced by doctors. Whether working hospital calls, providing technical assistance or developing national health policies or strategies, one thing has always stood as a forbidding shadow: the grossly unfair pay to doctors, which drives talent from the clinical field and nation.

The numbers are as shocking as they are unacceptable. A new graduate doctor in Nigeria earns approximately N200,000 ($133) and N250,000 ($166) in state and federal respectively as a medical officer. Even consultants struggle with meager salaries of about N700,000 ($467) a month. The annual earnings of physicians with similar qualifications in other countries are much higher in Egypt and Kenya, with South African doctors earning more, with entry-level doctors earning around R900,000 annually, over 30 times more than their Nigerian counterparts.

It is a cruel paradox that those entrusted with safeguarding our health are themselves unable to live with dignity and financial security.

Many factors, such as low salaries, challenging working conditions and limited career growth prospects push talented doctors to seek for better opportunities abroad. As a result, Nigeria loses skilled health care professionals who could significantly impact maternal and neonatal health outcomes.

In the past eight years, over 5,000 doctors have migrated internationally, stripping our health system of valuable expertise. According to the Nigerian Medical Association, only about 30,000 medical doctors actively practise out of the approximately 80,000 registered with the Medical and Dental Council of Nigeria since 1960. This alarming gap translates to a doctor-to-patient ratio of 1:6000–9000, far from the World Health Organisation’s recommended 1:600 ratio. Each departing doctor represents a devastating loss of institutional knowledge, eroding mentorship pipelines and quality of care in a vicious cycle.

Rural and underserved communities have been hit particularly hard; much of the population loses access to basic primary care. There is no way we can address the high maternal and neonatal mortality without a robust cohort of medical professionals. This is a professional and economic tragedy borne of an environment that undervalues the critical roles of doctors and fails to leverage that expertise for its intended purpose of enhancing public health.

Yet the bleeding of medical talent is not confined merely to departures abroad. Equally, insidious attrition occurs domestically as overworked, underpaid doctors are compelled to abandon clinical practice for more tenable opportunities in non-medical fields. The new generation of Nigerian medical graduates is facing the difficult trade-offs confronting them. It is a dilemma no doctor should face so early in their career.

For those with means or wider opportunities, the equation tilts heavily towards exits. A young European-trained doctor I know is considering returning to practice medicine there because of better workplace conditions, reasonable hours and higher compensation befitting their skills.

It is a familiar story playing out across Nigeria as our investment in training world-class medical talents ends up subsidising other nations’ health care systems.

The ethical and strategic necessity of urgently addressing doctor salaries extends beyond just fairness. Low compensation is actively undermining Nigeria’s socioeconomic development at a macro level by compromising productivity and impeding human capital accumulation. A 2001 World Health Organisation’s study calculated that every $1 invested in strengthening health systems generates between $9 to $20 in full-cost economic benefits through a range of factors like facilitating workforce participation.

More importantly, the resulting substandard health care access that drives the talent exodus in the first place perpetuates a vicious cycle. We are robbing the country of precious human potential and the societal dynamism that accompanies healthy, productive populations. So long as medical school graduates must contemplate career changes before even commencing clinical practice due to financial unviability, the hemorrhaging of medical talents will persist at catastrophic levels.

Competitive salaries are essential to retain and attract doctors. Adequate compensation not only acknowledges their expertise but also motivates them to stay committed to their noble calling. We need only look to our continental peers to see the transformative impact that prioritising health care investment can yield.

I implore the federal and state governments and all stakeholders in Nigeria’s health system to give utmost priority to a complete overhaul of medical compensation in Nigeria.

This is not an expendable line item, but a necessary one for us to realise our developmental objectives as a country. Health care allocations need to be increased or tuned up on budgets so as to shift funds towards modern facilities, equipment, optimised procurement processes, and most importantly, competitive salaries for our doctors and nurses.

We cannot allow this unsustainable attrition to persist. The ethical choice before us is clear: we can either get serious about making Nigeria a viable place for doctors to practice, by offering safe, well-resourced settings with proper compensation befitting their training and importance or remain stuck in a perpetual scarcity cycle as health care capacity atrophies from the relentless talent exodus.

One path leads towards realising our immense potential as a country, the other resigns Nigeria to deteriorating health outcomes and economic stagnation stemming from a crippled health care workforce.

Increasing doctor salaries to globally competitive levels is just one component of the reforms needed, but it is perhaps the most fundamental step in retaining and attracting skilled medical talent to build a robust health care workforce. With the right initiatives, strategies, policies and funding commitments, Nigeria can reverse the outflow of talent.

Our doctors have answered the highest calling to safeguard public health. Now, it is time for us to answer their justifiable calls for fair compensation and create favourable conditions that empower them to fulfill those noble duties. The urgency could not be more dire; and the time to act is now.

 

Dr Halimah resides in Kano, and can be reached on [email protected]