Confronting The Doctors’ Brain Drain

 By Cosmas Odoemena

It’s no longer news that Nigerian doctors are leaving the country in droves for greener pastures. According to the Nigerian Medical Association, of the 75,000 Nigerian doctors registered with the NMA, more than 33,000 have left the country, with 42,000 left to take care of more than 200 million people. It’s not only doctors that are leaving: nurses, physiotherapists, radiographers, pharmacists, medical laboratory scientists, etc. But this piece is focused mainly on doctors.

Brain drain among doctors is not a new phenomenon. In Nigeria, it has been ongoing for years. But it has never jolted the Nigerian healthcare system as it has now. This is because the number of doctors leaving has risen astronomically. Doctors are voting with their feet. Specialists, medical officers, retired doctors, and those fresh from medical schools are all leaving. In final-year medical school classes, migrating abroad after qualifying is what is trending.

Furthermore, the number of those writing postgraduate exams to specialise is reducing and those who manage to start, abandon it along the way to start afresh abroad. Every year, at least 2,000 doctors leave Nigeria for the United Kingdom, the United States, Canada, South Africa, Europe, the United Arab Emirates, Saudi Arabia, Kuwait, South Africa, Ghana, and some obscure countries.

The doctors who are abroad constantly pressure their colleagues who have stayed back to join them. Even when those in Nigeria remain resolute, the ones abroad will not give up. Some abroad query the mental status of their colleagues still in Nigeria. They test their resolve to stay and salvage it. They remind them of the poor working conditions, low wages, insecurity, poverty in the land, and general despondency. But one question that melts those remaining in Nigeria is: “Have you thought of the future of your children?” They tell you where they are their children are attending good schools and taken care of by the government. The government gives them an allowance per child. And whenever these children graduate from the universities, there are jobs. They conclude: “So, it’s not about us, it’s about the children”.

Still, some, with a heavy heart, stay back giving themselves unrealistic time for things to change. If the endless wait for things to “change” has not nudged those doctors back home to nibble at the emigration bait, another thing has. The shortage of doctors is putting a lot of work pressure on the few doctors, with the attendant exhaustion, burnout, stress, and other deleterious effect on their health. And when they have had enough, they throw in the towel.

The effect on the healthcare system is unquantifiable. What has helped some states is private hospitals which not everyone can afford. But even now, the private hospitals are also feeling the pinch. With private hospitals, there is a high doctor turnover. Where the medical director cannot get a doctor to work for him, he works round the clock. It is taking a toll on many an MD’s health. Some have closed their private hospitals to relocate abroad. While all this is on, quacks and charlatans fill the gap. No wonder, Nigeria’s health indices have continually been abysmal.

It’s either government is playing the ostrich or it is perplexed and does not know what to do. India once experienced it but its government took the bull by the horns and today its healthcare system is not only one of the best in the world, it is also a foreign exchange earner in medical tourism. It is this same Nigeria only a few years ago where Nigerians left abroad to come back home to take up higher paying jobs in the banking sector, telecoms, human relations, oil and gas, and other great startups. Deep inside, Nigerians abroad know there is no place like home. They would readily stay back if the conditions were right.

The first thing to do is to declare a state of emergency in the health sector. Convene a summit involving stakeholders. There should be a health sector Marshall Plan. It must be said that as long as doctors, nurses, and other healthcare workers are still under government health ministries like civil servants, their wages will remain low compared to those abroad. A new entity called Nigeria Healthcare Workforce Agency should be created to take care of the recruitment and remuneration of doctors and other allied healthcare workers. Each state and the Federal Capital Territory should have theirs and it should be backed by law. It will have a special budget.

In addition, the budgetary allocation to health has to increase. In the 2023 budget, it’s just 5.75 per cent and a far cry from the World Health Organisation’s recommendation of at least 15 per cent. Government at all levels must rank health as the number one priority before security. Now, Nigerian doctors retire at 60 to go abroad to continue to work, where there is no age or sex discrimination. Government must as a matter of urgency consider increasing the retirement age of doctors to 70 years. And ditto for allied professionals. And when they retire, they should earn their full salaries until death as is done for Nigerian professors.

Children of doctors and allied workers can be sponsored from kindergarten to secondary school and possibly up to the university level. In addition, paid overseas annual vacation for doctors and their families as it is done, especially in the Middle East, will not be a bad idea. This will demystify going abroad. Then make good the overseas attachment for resident doctors. Interest-free loans as India did for their doctors. Special housing and car loans where the government pays a reasonable part of it. If political officeholders in Nigeria are better paid than their counterparts in other climes, then, there is a moral justification to pay Nigerian doctors what they will get abroad. This is in addition to well-equipped hospitals in a conducive environment.

Whatever it will take to heal our sickly healthcare system must be done. And must be done quickly too, while the “resolve” of doctors at home can still hold out!

*Dr. Odoemena, a Consultant Family Physician and Fellow of the West African College of Physicians ,wrote from Lagos.