Africa: Nigeria groans as medical professionals’ emigration worsens
Nigeria is among the top 13th African countries that their citizens want to emigrate to Europe and other nations on account of poverty and or hardship with 31 percent rate, says a survey conducted by Afrobarometer. While migration can have positive effects –filling labour gaps in destination countries and producing remittances to help families back home –it can also have negative consequences. Analysts have pointed to its drain on emerging economies and populist movements in the West have decried immigration as a threat to domestic employment, security, and national culture.
Recently, it was reported that no fewer than 5,405 Nigerian-trained doctors and nurses are currently working with the National Health Services (NHS) in the United Kingdom (UK). The figure, released by the British Government, revealed that Nigerian medics constitute 3.9 per cent of the 137,000 foreign staff of 202 nationalities working alongside British doctors and nurses.
In search for better conditions, medical professionals leave the country and this development has worsened the physician-patient ratio in Nigeria from 1:4,000 to 1:5,000, contrary to the WHO recommended 1:600. The physician-patient ratio in the U.K. is 1:300.Economic loss due to emigration of doctors shows that approximately 18,960 medical doctors from 14 African countries work in developed countries.
About 54.2 percent of them work in the United Kingdom, 28.3percent work in the USA, 10.3 percent work in Canada, 4.8 percent work in Australia, 1.4 percent work in Portugal and 1 percent work in Germany. The Nursing and Midwifery Council (NMC) the regulatory body for nurses, midwives and specialist community public health nurses throughout the United Kingdom, recorded that about 18,349 nurses from the African region were registered with the NMC between 1989/90 and 2004/2005. Approximately, 50.4 percent were from South Africa; 14.5 percent from Nigeria; 12.6 percent from Zimbabwe; 7.2 percent from Ghana; 4.3 percent from Zambia; 3.5 percent from Kenya; and 7.4 percent from six other countries. Although the actual number of emigrants may be less than those figures, they nevertheless gave an estimate of numbers of potential emigrants.
Dr. Oluwaseun Akinbobola CEO, Beaconhill Smile Clinics -Africa’s 1st 7-Day Dental practice says that Nigerian doctors are “leaving town” and it is causing anxiety. A recent report said over 200 Nigeria doctors, young, male and female were interviewed in Abuja by some Saudi Arabian officials. A Consultant Urological Surgeon with the University of Benin School of Medicine and Teaching Hospital, Dr. Samuel Osaghae and a Consultant Neurological Surgeon, Brain and Spine Surgery Consortium Abuja, Dr. Biodun Ogungbo, lamented the absence of robust practice environment to keep doctors within the shores of Nigeria.
“It is not as if Nigeria has enough doctors in respect of her population, after which the excess number could find their ways overseas in search for better working environment,” Ogungbo had said. In his views, Akinbobola said: “In my candid opinion, brain-drain is not peculiar to Nigeria alone. It is a trend that occurs all over the world because medicine is a profession that is global in nature.
“However, the rate at which doctors are exiting Nigeria has reached red alert limits and this can be attributed to the fact that though there is a real need for doctors in Nigeria, the demand for doctors is non-existent.”His opinion is that the government needs to instill confidence and show the will to improve healthcare services in Nigeria by signing necessary health acts and bills, increasing funding of the health sector and ensuring the funds are well managed.
“In 2001, Nigeria hosted Heads of states of the African Union (AU) and all leaders jointly pledged to commit at least 15 percent of their annual budget towards healthcare. It’s on record that till date, our healthcare budget has never exceeded six percent of the total budget. “It is obvious that healthcare is not a priority in our nation as most decision makers will rather travel abroad when the need arises. Until we prioritise healthcare I don’t believe this dramatic exodus of doctors will end. You cannot fix a health system you don’t believe in.
Speaking off the cuff, he noted that seven out of 10 doctors trained in Nigeria are either out or on their way out to destinations such as Europe, USA, Canada, Australia, Saudi Arabia and South Africa. Those countries, he said, have eased the process of receiving foreign doctors. According to him, the World Health Organisation (WHO) recommends 1:600. So, with a population of 180 million citizens in Nigeria, “we would need 300,000 doctors but I doubt we have up to 50,000 currently practising in the country.”
The top of the reasons for the emigration include poor salaries and irregular payments, lack of investment in medical equipment, insecurity and lack of value attached to the doctor in Nigeria. Still lamenting the situation, a resident doctor in LUTH who prefers anonymity told The Guardian: “Two resident doctors left our hospital last year, one to UK and the other to Canada. The British National Health Service (NHS) is recruiting medical personnel to fill up deficit in their healthcare. Many doctors are presently writing or preparing for UK board exams. It is not just doctors, but nurses, pharmacist and others.
“We need an effective universal healthcare coverage for all Nigerians, as the present health insurance doesn’t cover everyone. We also need increased remuneration for doctors and health workers to reduce the pay gap between developed countries and us and also improve the quality of life for all Nigerians.
“The brain drain will continue as long as the environment in which medical practitioners are subjected to in Nigeria is hostile even to the extent that a practitioner who just qualified, has to struggle to get a place for the mandatory housemanship even from most of the medical schools that trained them.” The president, Nigeria Medial Association (NMA), Dr. Francis Faduyile said the disparity in doctor-patient ration in Nigeria has remained low simply because the country is not retaining up to 60 percent of its products. In his words, doctors in the country have poor remuneration, the working environment is not good, unstable government funding, and lack of adequate equipment.
“Again we have states that are not even putting any attention to health. They owe their workforce six to seven months. We have states that are paying less than half of what their counterparts are receiving in the federal government. Such doctors will not stay there, they will be looking out. “We have doctors and other health practitioners being overworked. Where you are supposed to have ten doctors to see some number of patients, we have one doctor to all patients day in day out. “For a doctor to see a patient it is not elastic, it is inelastic, for you to see a patient adequately and be able to treat properly, you need about 10 to 15 minutes,” he stated.
According to Faduyile, maximally, a doctor should see 42 patients a day. He regretted that a doctor sees 150 to 200 patients in a day. “There is no way they can cope. These are the major reasons,” he stated, adding that those are the reasons a lot of medical personnel leave the country in their numbers. For, Dr. Olalere Olajide, a public health specialist working in a US-funded HIV programme in Nigeria, the major reason is the search for greener pastures, where they would get better salaries that would be sufficient to take care of their families and needs.
“The situation in the country is not always encouraging. People are not being well paid. Imagine a doctor working in Osun State, the last time they collected a full salary was about 38 months ago. It is not only in Osun State, there are so many states where doctors earn less than N100,000 in a month.
“Even those working in federal government establishments collect around N300,000, but now someone comes from Dubai offering N1million to 2 million in a month, why will such doctor not go? And working environment is also better in the advanced countries,” he explained. According to Olajide, to train a medical doctor in most of the advanced countries is very costly so it is cheaper in Nigeria and citizens of those countries are not as interested in the profession.
So, those countries would be ready to recruit from Nigeria to meet their medical needs, he said. For policy makers faced with managing the challenges of international migration, a detailed understanding of its forms, patterns, and causes is critical. A growing literature explores “push” and “pull” factors shaping emigration, highlighting the failure of African countries to create economic opportunities for their citizens but also arguing for the importance of social and political factors.
Migration has continued to be a major influence on the society, politically, economically and socially. Increase in the number of people migrating is significant for many developing countries because they most times lose their better-educated nationals to richer countries. Medical practitioners and nurses represent a proportion of the highly skilled workers who migrate, but the loss of human resources in the health sector for developing countries means that the capacity of the health system to deliver health care equitably is significantly compromised.
In the year 2000, approximately 2.9 percent of the world’s population was living outside their country of birth and of these 37 percent are economically active. The reserve of migrant population has more than doubled since 1965.The migration of health-care workers has closely followed general trends in international migration. The migration to health workers is not new: nurses and physicians have sought employment abroad for many reasons, including high unemployment in the health-care labour market in their home country. However, there are certain key features of the health-care.
Although the choice to migrate is basically a personal one, however, the overall social and economic circumstances have important impact on the decision to migrate. The source country is actually the first culprit as the basic reason for emigration is the accomplishment of the hierarchy of needs i.e. physiological, safety, belonging, esteem, and self-actualization. State involvements also promote migration as for instance favourable conditions for visa and work permits and active recruitment of workers from countries with an oversupply of health professionals. High rate of unemployment also provides a ground for migration.
Professional development, higher education for postgraduate professional qualification are important reasons resulting in emigration and some of the reasons for not returning after training are lack of research culture, funding opportunities, limited career growth, underprivileged facilities, scholarly motivation and law and order situation in the country. Lack of education for children in their home country especially with high competition for university admission and unethical ways and means to acquire seats all result in dissatisfaction.
Although the plus side of migration is acquiring of expensive skills, which are not available within the country of origin, the negative aspect is that these skills and knowledge never migrate back.Nigerian professionals in diverse fields, especially in health and education sectors are regularly leaving the shores of the country for Europe, America and Canada among other developed countries in the world in search of greener pasture. The economic cost of these emigrations can be seen largely as loss of investment capital.
In African countries, the health professionals are among the relatively well-paid persons, and thus they contribute to accumulation of national savings. Those savings are eventually loaned to entrepreneurs for investment. Thus, emigration may lead to the loss of such savings, except where persons who emigrate remit their savings to their home countries for investment. The health practitioners, by virtue of their education and earnings, quite often set up health-related (e.g. private clinics, hospitals, pharmacies) and non-health related businesses (e.g. retail and wholesale shops). Thus, emigration reduces the growth of entrepreneurship in affected countries and prospects for economic growth.
Doctors and nurses usually provide job opportunities for housekeepers, gardeners and security guards within their places of residence. Thus, emigration of practising health professionals usually results in loss of employment opportunities and income for those poor workers and their families. Given that the health professionals are among the relatively well-paid persons in African countries, they are also major contributors to the income tax. Since the incomes of emigrants are not amenable to tax administration systems of African countries, emigration leads to a net loss in tax revenues. Some other effects of emigration include the loss of health services, supervisors and public health researchers.
Developed countries continue to deprive African countries of billions of dollars’ worth of invaluable investments embodied in their human resources. If the current trend of poaching of scarce human resources in the health sector from African countries is not curtailed, the chances of achieving the Millennium Development Goals would remain dismal. Such continued plunder of investments embodied in human resources contributes to further underdevelopment of Africa and to keeping the majority of her people in the vicious circle of poverty. Therefore, both developed and developing countries need to urgently develop and implement strategies for addressing this issue.