Merriam-Webster dictionary defines brain drain as the departure of educated or professional people from one country, economic sector, or field for another usually for better pay or living conditions. So, brain drain cuts across all professions including Nigerian doctors who are now migrating not only to developed countries but also to the developing or even underdeveloped countries so far there is better pay or living conditions.
The increasing international migration of health workers has also been raising concerns globally. According to World Health Organization (WHO), there has been a 60 percent rise in the number of migrant doctors and nurses working in Organization for Economic Co-operation and Development (OECD) countries over the last decades. There are about 42,000 medical doctors currently in Nigeria out of the 75,000 medical doctors registered by the MDCN, 33000 have migrated to other countries in search of greener pastures.
2 Every day, at least one doctor or health worker leaves the shores of the country for greener pastures, yet the migrants struggle to complete foreign exams to get work placements abroad.
3 Going by the disturbing trend, Nigeria might find it difficult achieving its Universal Healthcare Coverage goals. Nigerian health system is on d verge of collapse if some drastic measures are not put in place. Pathetic!
This brain drain has negatively affected the health care delivery system of Nigeria. With an estimated population of over 200million, one doctor in Nigeria attends to 10,000 patients, which is in sharp contrast with WHO recommendation of one doctor per 600 patients. It is even worse in remote parts of the country where it is like 1:22,000 patients.
4 This has significantly affected the quality of health care delivery in Nigeria. 8 out of 10 Nigerians are presently receiving substandard or no medical care at all.
5 This is why we have very poor health statistics. The few doctors that are left in the country are over-worked and not appreciated which can also affect their psycho-social interactions with patients, other health workers and even with their family members.
Recent figures show that Nigerian doctors are still emigrating in droves to the West especially the United Kingdom as they employ at least 12 new doctors a week.6 Sadly, the most skilled individuals are leaving their country of origin to contribute their expertise to the economy of another country. This has made Nigerian medical schools as farms for d harvesting of skilled surgeons for western markets.
Ironically, it is a perverse subsidy that poor nations like ours are now subsidizing treatment in the rich nations7 due to high cost of training doctors, especially resident doctors. On average, it cost each African country between $21,000 and $59,000 to train a medical doctor. Nine countries – Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe – have lost more than $2.0 billion since 2010 from training doctors who then migrated. Annually, it is estimated that Africa loses around $2.0 billion through brain drain in the health sector alone. We are now getting remittance at the expense of death of our brothers and sisters as a low doctor to patient ratio worsens medical outcomes leading to unnecessary fatalities, avoidable deaths, longer wait times, more frequent medical errors and a general deterioration in the health of Nigeria’s population. Currently, Nigeria ranks one of the countries with the highest maternal and child mortality rate.
How can we stem this tide?
Creating an enabling environment is one of the ways this brain drain can be curbed. This involves provision of health infrastructure, better working condition and equipment for the improvement of quality of life. There is nothing more agonizing than seeing doctors watching helplessly with patient dying in their presence due to lack of necessary equipment to work with.
Enabling environment also entails establishing a cordial relationship among health workers in order to prevent inter-professional disharmony. This can only be achieved if patient is seen as a centre point in hospital environment.
To meet up with the WHO recommended doctor to patient ratio, Nigerian Government must show more commitment and prioritization of health care system.
Only about 4% of Nigeria budget is allocated to health.5 Findings reveal while the annual health care threshold per person in the US is $10,000, in Nigeria it is just $6.3,5 FG of Nigeria can do better by improving funding for the health sector in line with 2001 Abuja declaration which stipulates the allocation of 15% of the budget to the health sector. This will empower training institutions with needed equipment and personnel.
One of the reasons why there is a mass exodus of Nigerian doctors is career progression, a desire to gain further training and skills. If FG could help in this aspect, this would go a long way in delivering a world class services in teaching, research and health care through proper planning, implementation, mentoring and evaluation of appropriate postgraduate programmes of training. Regular review of the training curricular of all faculties of the college that is aimed at raising the standards of training content and methods of delivery in conjunction with more scientific and rigorous examination methods in line with international best practices .
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One of the responsibilities of a government is protection of lives and properties of her citizens. Insecurity is another factor that must be strongly addressed in order to prevent doctors from fleeing the country. This will also help our Primary healthcare system (PHC) to have access to medical doctors since the availability of medical manpower is already skewed as many health workers do not work in the rural areas where their attentions are needed.
Nigeria government can also help in bringing home Nigerian doctors who volunteered to work in our hospital during their leave time to share their cutting edge skills and knowledge with home based colleagues.
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Financial inducement 8and better pay will prevent a lot of doctors from migrating to other countries. People always forget that doctors are human too who also have dreams, desires and long for basic needs of life. They have families to take of, exams for career progression nagging their peace and plaguing their souls coupled with highly demanding and nerve-racking workload for service delivery.
I strongly believe if all these solutions are put in place, d 8 out of every 10 doctors (88%) that are considering work opportunities abroad according to NOI polls9 will change their minds.
DOCTORS PERCENTAGE
Home 48%
Abroad 52%
Seeking job abroad 88%
Source: Nigerian Medical Association & www.eureka.com.ng
It has also been found out that if Nigeria is producing 3,000 medical doctors annually; it will take us 25yrs to be able to produce the total number of doctors that will adequately take care of the population.2,10 Unfortunately, there is no end in sight as future projections point to a continuing acceleration in international migration of health workers, with escalating mismatch between the supply of and economic demand for health workers.
DEBAYO OLANREWAJU SHEFIU
DEPARTMENT OF OBSTETRICS & GYNAECOLOGY (REGISTRAR)
FMC BIDA, NIGER STATE.