As President Bola Tinubu, on Wednesday, marked his one year in office, leading stakeholders in the health sector have identified brain drain as a major obstacle hindering quality healthcare delivery to Nigerians. Evaluating the President’s first anniversary, the senior health professionals and leaders said Tinubu has commendable health policies coupled with the appointment of a seasoned health professional as the minister of health but has yet to curb the massive brain drain bedevilling the sector.
Although they argued the President cannot stop Nigerian-trained doctors and other health workers from migrating abroad, the physicians said Tinubu can reduce the trend with improved remuneration and working conditions. According to them, unless the President addressed the push and pull factors, there might be no end in sight to the massive brain drain in the health sector, which they said had led to the closure of departments in some tertiary hospitals besides the lack of access to specialists care by sick Nigerians.
The President, who took over office on May 29, 2023, riding on his policy document tagged the ‘Renewed Hope Agenda’ said healthcare is back on the front burner. Tinubu said his administration is prioritizing and improving Nigeria’s health sector through massive investments and an increased allocation of funds to the sector. Describing health as a fundamental human right, Tinubu announced plans for a comprehensive revamp of physical infrastructure, and equipment, and the re-training of front-line health workers starting in 2024.
Many believed that the Renewed Hope Agenda Tinubu’s administration and the appointment of Prof Ali Pate as the Coordinating Minister of Health and Social Welfare points to the government’s commitment to addressing the issues that make Nigerian health professionals leave for other countries. Pate’s appointment was well applauded by health sector stakeholders due to his track record as a globally recognized medical professional. On assumption of office, Pate unveiled his four-point agenda to revive the sector with a pledge to reverse the brain drain in the health sector.
He said the current administration was working assiduously to reverse the brain drain and significantly improve the health sector and encourage medical workers to be proud to work in Nigeria. The minister said deliberate policies and program would be designed and implemented to address poor funding, brain drain, lack of facilities, obsolete equipment, and shortage of workers, especially in rural areas. But one year into office, some leaders in the health sector, who critically examined the performance of the President in the sector told PUNCH Health-wise in an exclusive interview that Tinubu has good policies, especially in the area of funding but needs time to implement them
They, however, urged him to take urgent action against brain drain, which they said had assumed a worrisome dimension as hapless patients bear the brunt with some dying needlessly due to lack of access to specialists.
Speaking with our correspondent, a past President of the Nigerian Medical Association, Prof Mike Ogirima, said the massive migration of Nigerian health workers to foreign countries, mostly in search of greener pastures, has taken its toll on the few doctors left in the system. Ogirima, a Professor of Orthopaedics and Trauma Surgery, who gave the President and his health ministers a pass mark for their performance in the health sector, said the shortage of medical personnel in Nigerian public hospitals did not suddenly happen.
He said, “They have a pass mark because the minister of health is well exposed, well trained and he has mapped out his strategies which he is implementing systematically to get results. “The main challenge is the brain drain which is popularly known as japa syndrome. I think the health sector is the worst hit. As a professor of orthopaedic surgery, for example, there are surgeries I did 20 years ago to teach my younger ones –the residents. Because the younger ones are not available, I am back doing those surgeries now. “So, there is brain drain; there is fatigue of health workers and that is why the health workers are frustrated in terms of the limited number of human resources.”
According to Ogirima, currently, Nigeria has a doctor-to-population ratio of one doctor to 8,000 population, instead of one doctor to 600 people as recommended by the World Health Organization. “That is why when you go to the hospital, the doctors you meet there are tired”, he added. The mass exodus of healthcare professionals, especially doctors, pharmacists, and nurses has been a burning issue in the country which has left the nation’s health sector in a precarious state.
The consequences of this phenomenon are dire and have led to a shortage of healthcare professionals, compromising the overall quality of healthcare services in the country. The minister of health in September 2023 said the country still needs about 400,000 health workers to cater to the healthcare needs of Nigerians effectively. On the issue of funding Ogirima, who is also the Provost, College of Health Sciences, Federal University Lokoja, Kogi State, said, “The National Health Insurance Authority is doing a lot of things to increase coverage from the present seven per cent. “We need more sensitization; it is the only chance we have to sustain services. So they must sensitize the populace that it is a compulsory program. Everybody must key in.
With monitoring of services rendered, the minister should come up with strategies to evaluate the specialists—the doctors, nurses, and other health workers on the quality of the job done and the amount of energy spent and they should be well remunerated. Of course, the minister of health is trying on the issue of remuneration and that is why overall, I will score him a pass mark.” The don urged the government to make health insurance effective describing it as a game changer.
In the area of brain drain, Ogirima advised the Federal Government to critically look at the factors that attract Nigerian-trained health professionals to developing countries and holistically address them. “They have to look at what is attracting them, what we call the pull or push factors. The working environment must be improved and there must be availability of working tools. We need to look at health insurance, it is going to be the game changer. It is the game changer everywhere so that we can reduce out-of-pocket healthcare payments to the barest minimum”, the surgeon said.Nigerian-trained healthcare professionals migrate to United Kingdom Canada, the United States, Saudi Arabia, Australia, and other developed countries.
A 2017 survey by the Nigerian Polling organization in partnership with Nigeria Health Watch revealed that about 88 per cent of medical doctors in Nigeria were seeking work opportunities abroad at the time. A former President of the World Medical Association, Dr Osahon Enabulele said there was some urgent need to save Nigerians from catastrophic out-of-pocket payment for healthcare and rescue some health facilities from the complete absence of healthcare workers.
Enabulele, a past president of NMA, explained, “ It is no longer news that in some hospitals even in big-time hospitals you have several departments being closed down because of the whole challenge of the japa syndrome- the whole brain drain phenomenon. How do you talk about healthcare security? “How do you talk about the safety and security of healthcare workers who are supposed to be at the point of care in terms of delivery services? “So, we have an emergency on our hands. But I think the Federal Government has gotten it right in terms of committing itself to undertake some levels of rescue operations to redirect the futures of the healthcare system.”
The chief consultant physician urged the Federal Government to walk the talk and address the challenge of brain drain in the health sector. “They need to walk the talk and I think that is very important to turn around the healthcare futures of our country”, he stated.
