Enforcing national health policy towards tackling brain drain, by Theresa Otung

Patients in hospitals, medical professionals, civil society organisations, and Nigerians in the Diaspora are concerned that although the Federal Government approved a comprehensive new health policy on Aug. 12, 2024, which aims to strengthen the healthcare system and retain skilled medical professionals, little or nothing has been done to achieve its objectives.

The National Policy on Health Workforce Migration in Nigeria has as its major objectives improved working conditions which mandates the provision of modern medical equipment, better facilities and enhanced safety protocols; increased salaries and benefits; incentives for rural service which include financial and non-financial incentives to encourage health workers to serve in rural areas.

Many have pointed out that the continued migration of healthcare workers, including doctors, nurses and laboratory scientists, poses significant challenges for addressing health issues in Nigeria.

While health workers often move abroad on grounds of furthering their studies and ensuring job security, there has been little effort to encourage them to return to help tackle fundamental problems that have resulted in a shortage of skilled healthcare professionals in Nigeria, particularly in rural and underserved areas.

The severe shortage of manpower resulting from longstanding issues in producing skilled professionals and difficulties in deploying existing ones has exacerbated the brain drain in Nigeria’s health sector.

Others underscored the need for government at all levels to prioritise healthcare and invest adequately in the healthcare sector to reverse the trend of brain drain, protect lives and property, provide access to social amenities and advance opportunities for medical doctors to practice professionally in Nigeria.

They also urged the government to ensure effective implementation of the National Healthcare Policy to fully realise its objective of providing healthcare services to the citizenry.

Why this has become important, analysts believe that nearly every health worker in Nigeria seeks opportunities to relocate to Europe, Asia or America and that the loss of skilled personnel compromises patient care and overwhelms the remaining medical workforce.

They described health workers as the backbone of Nigeria’s robust healthcare system and that their dedication and expertise play a fundamental role in advancing the health agenda of the country. However, their migration to foreign shores, attractive opportunities and improved living standards have led to an eroding health workforce causing a brain drain.

More than that, they reiterated that as many healthcare professionals continue to leave, the healthcare system risks plunging into an even worse state with cases of chronic fatigue, burnout and strained family relationships for the remaining health professionals.

This, among other things further increased the number of skilled professionals seeking opportunities abroad and consequently, positioned Nigeria among the 55 countries with severe shortage of health workers on the World Health Organisation (WHO) Health Workforce Support and Safeguard List 2023.

According to the WHO, the health sector in Nigeria has one doctor to about 10,000 patients as opposed to the organisation’s recommendation of one doctor to 600 people. The WHO also predicted a 10 million shortage of health workers by 2030, mainly in low-income countries like Nigeria, stating that Nigeria has a skilled health worker density of 1.83 per 1000, far below the WHO recommendation and the factors that contribute to such include low production of health workers, poor management, and political and economic crises.

Equivocally, Nigeria ranks among the 37 countries with critical health workforce shortages, with 0.363 medical doctors per 1,000 people, far below the WHO’s threshold of 4.45 healthcare workers per 1000 people for adequate health coverage. There is a pressing need to holistically address the issue of health workforce shortage in Nigeria, as it poses a significant barrier to achieving the SDGs, especially SDG3: “to ensure healthy lives and promote well-being for all at all ages.”

Against this backdrop, Nigeria has increasingly been a crucial supplier of healthcare workers abroad as an estimated highest workforce-exporting country in Africa, with the UK, US, Canada, Australia, and Saudi Arabia as key destinations between 2021 and 2022, second to India, which has 42,966 healthcare workers, while the Philippines is third with 11,021 healthcare workers.

Contrarily, unlike India and the Philippines, Nigeria does not have a managed migration system and a robust system to train healthcare workers for domestic and global labour markets. The WHO Global Code of Practice on the International Recruitment of Health Personnel was adopted by the World Health Assembly in 2010 to improve international health worker migration and minimise its negative consequences.

In line with this, the Joint Health Sector Union, (JOHESU), the Nigerian Association of Resident Doctors (NARD) and the Nigerian Medical Association (NMA) have at several fora equally lamented inadequate funding and poor remuneration of healthcare personnel, in their bid to improve the nation’s health sector. More so, the lack of adequate funding and fiscal allocation toward advancing capacity building and the development of programmes to boost healthcare providers’ manpower within the nation’s health sector also contributes to the brain drain crisis.

More than that, it is unequivocal to state that Nigeria’s healthcare system will continue to grapple with a significant brain drain if the trend of health workers leaving the country in search of better living standards, higher salaries and access to advanced technology does not return to contribute meaningfully to provide a sustainable solution to myriads of health challenges in the country.

A patient who pleaded anonymity expressed worry over poor attention at the hospital over treatment of her ailment, saying “Only one doctor seemed to be attending to all of us in this hospital”. According to her, they referred her from the Nsukka Healthcare Centre to Nsukka General Hospital, yet there is no improvement in the ailment.

“I have been referred to several hospitals for my medical condition by health officers and I am growing increasingly frustrated with the poor healthcare services and poor attendants by healthcare providers,” she said.

For his part, Dr Kingsley Oke, Consultant Psychiatrist and Medical Director 445 Nigerian Air Force Military Hospital Ikeja, Lagos, said the brain drain of health workers has led to a shortage of skilled manpower and patients in most hospitals do not receive enough quality healthcare.

Oke said, “There is also a long wait time due to a shortage of manpower as patients wait for the only available doctor to attend to them.

“Government should improve the services of the healthcare sector and increase the remuneration of Nigeria doctors, who are least paid in the world.”

In its Communique during the 63rd Annual General Conference and Delegates Meeting from April 30 to May 7, 2023, the NMA president, Dr Uche Ojinmah and Secretary-General, Dr Jide Onyekwelu, urged the government to prioritise healthcare to find lasting solutions to brain drain, which has led to the mass exodus of doctors and other health workers for greener pastures.

“Government should show better political commitment to healthcare financing, pay better and competitive salaries, provide a better work environment, readjust the security architecture to protect lives and property.

“It should provide access to social amenities and increased opportunities for doctors in Nigeria,” they stated.

Analysts believe that addressing the brain drain in Nigeria’s healthcare sector requires a collaborative approach involving stakeholders across sectors and disciplines, to channel the flow of health workers migration towards mutually beneficial outcomes while safeguarding the stability of Nigeria’s health system. They agreed that doing so will help to tackle a critical concern that impacts the nation’s healthcare system, as well as the fundamental problems of the shortage of skilled healthcare professionals in Nigeria, particularly in rural and underserved areas.