By Babatunde Ayedoju

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The Nigerian health sector has been bedeviled with a mass exodus of personnel to other countries where they believe that they would get better job offers. The World Health Organisation, WHO, reported that there were 34,923 doctors in Nigeria in 2003. By 2016, it had swollen to 83,565, only to drop to 74,543 in 2018, a loss of about 9,000 doctors.

The mass Exodus of medical personnel from Nigeria actually did not start recently. For more than 40 years, medical doctors trained in Nigerian institutions have been steadily migrating to the USA, Canada, the UK, European Union and the Middle East where they enjoy much better conditions of service, such as higher pay and access to adequate tools and technology.

A 2017 survey by the Nigerian Polling Organisation (NOIPolls), in partnership with Nigeria Health Watch, revealed that about 88 percent of medical doctors in Nigeria were seeking work opportunities abroad at that time.

As of 2020, Nigeria had a doctor-patient ratio of 1:2,753, in sharp contrast to the World Health Organisation (WHO)’s minimum recommended ratio of 1:400 or 600. Further statistics from Nigeria HealthWatch indicate that there were 80,000 doctors registered with the Medical and Dental Council of Nigeria as of June 2021, out of which only about 35,000 were practising in the country. The rest were practising overseas –with about 4,000 in the United States and 5,000 others in the UK– while a few moved to other professions.

According to a 2022 UK immigration report, 13,609 Nigerian healthcare workers (including doctors) were granted working visas within a year, making the country second only to the 42,966 from India.

In October 2022, the Nigeria Medical Association disclosed that only 24,000 licensed medical doctors were available in the country, lamenting that only one doctor was available to treat 30,000 patients in some southern states, while in the north, it was one doctor to 45,000 patients.

In an attempt to address this challenge, the Coordinating Minister of Health and Social Welfare, Professor Ali Pate, few days ago revealed that the Federal Government had made provisions for retired medical providers in non-administrative positions to be re-engaged on a contractual basis. Pate made the disclosure while addressing journalists after a visit to the National Hospital in Abuja.

According to the Health Minister, the Federal Government took this step in order to close the human resource gap currently bedeviling the health sector because of the ‘brain drain’ of clinical manpower in the sector, among other factors.

Talking about a circular earlier released by the Federal Government, Pate said, “The recent circular essentially provided for medical providers who are in non-administrative positions, that is those who are in clinical positions, to be re-engaged in a contract basis on the same terms as they were, so that we do not lose the few that are remaining. What we have seen is that in many facilities, health workers are leaving, some to leave to go abroad, some moving from one facility to the other because of issues of either work overload or some other circumstances.

“Now the replacement of those health workers can be expedited and we will work with other parts of government to ensure that when clinical providers leave their post, the leadership of our hospitals are able to replace them with similarly qualified health providers.

“This is so that the burden does not get more on the remaining ones. In addition, for postgraduate trainees we are going to expedite how they get into internships and the circumstance so that they can have productive experiences and learn to practice in the best way possible,” he said.

Pate, however, pointed out that the issue of replacement of personnel who have gone is not an easy one, given that some institutions previously misused such opportunities by hiring non-health professionals and leaving out clinical professionals such as doctors, nurses, pharmacists and technicians.

Meanwhile, the News Agency of Nigeria reports that a circular from the Office of the Head of the Civil Service of the Federation was addressed to the Permanent Secretary of the Federal Ministry of Health, titled ‘Re: Review of Retirement Age to 65 and 70 years for Health Professionals and Medical/Dental Consultants,’ was signed by Mr Olufemi Oloruntoba, the Permanent Secretary, Service Policies and Strategies Office, on behalf of the HCSF.

It cited the proposed rejection of the increase in retirement age for medical and dental consultants and other health professionals, saying that healthcare professionals are leaving the country because of financial considerations and unfavourable working conditions, not due to their retirement age.

It, however, approved that clinical health workers who have attained the compulsory retirement age or years of service may be offered contract appointments on the same Salary Grade Level that they retired on if desired and deserved.

The circular calls on the government to engage with relevant bodies, such as the Medical and Dental Council of Nigeria and the Nigerian Medical Association, to secure a commitment from medical doctors. It also calls for the establishment of an effective performance management system within the public service to enhance the work ethics of medical officers, consultants, and doctors.

In his comment, Professor Simon Ehiabhi described the Federal Government’s decision to reemploy retired health workers on contract basis as an interventionist policy that will be effective only in the short term, emphasising that fresh hands would still have to be recruited subsequently. While blaming brain drain on the bad state of the economy which has made a lot of health practitioners to see relocation as the most viable alternative, Ehiabhi said that the best solution is better remuneration for health workers.

Similarly, Dr Adedayo  Afe, also from the Adekunle Ajasin University, Akungba-Akoko, questioned the agility and effectiveness of people who have already retired from active service. He said, “The number one question is, how many of them are still very agile? If somebody retired 10 years ago at the age of 60, he is now going to be 70. Is he still going to be agile?”

Afe who noted that there are many young and unemployed graduates of medical sciences who can be recruited to replace the ones who have relocated to other countries said that the only way to arrest brain drain is better remuneration of workers, adding that nobody wants to live in abject poverty.

While warning the Federal Government not to allow the naira become like Zimbabwean dollar, the university don charged the government to address the economic challenges in the country, prominent among which is the deteriorating exchange rate of naira to dollar.

He stressed that if the economy of Nigeria improves, especially the exchange rate of our currency, many workers will no longer see any reason to relocate to other places.

On the other hand, Dr Kunle Akinola from same University said that recruiting retired medical practitioners to replace the ones who have left the country is the best way to go, stating that such retired health workers have adequate experience needed to push the profession forward.

Lamenting about the impact of brain drain on the country so far, Akinola said, “A lot of young people now don’t want to stay. A lot of them don’t even understand what national development is. It’s a pity that despite the investment of the Federal Government in young people by giving them affordable education, such that some of them pay as low as N30,000 to study medicine in federal universities, after graduation they simply desert the country. The impact is already heavy on the educational sector.”