Brain drain, ghost doctors and the misfortune of Nigeria’s healthcare

The World Health Organisation (WHO) prescription states the acceptable ratio of physician to patients is a doctor to a thousand population. However, this ratio remains a far cry from what is obtainable in many parts of the world, especially in the developing world. Nigeria’s healthcare system has been plagued by brain drain which translates into very poor doctor-patients ratio. Recently, it was reported that the UK licensed 91 Nigerian doctors within 15 days, bringing the number of Nigerian-trained physicians to more than 10,200 comprising specialists, associate specialists, general practitioners and doctors in training. This figure is quite alarming considering the fact that Nigeria, with less than 30,000 practicing doctors, currently has far less number of physicians to meet the medical demands of its citizens. 

During the Covid-19 lockdown in 2020, according to the Nigerian Medical Association (NMA), about 5,000 doctors had applied for, and met the requirements to work abroad: they were only waiting for the ease on lockdown in order to leave the country to various parts of the world. Subsequently, officials from the Kingdom of Saudi Arabia were in Nigeria scouting for medical personnel to fill available spaces in their health sector. These are doctors and other medical specialists trained in Nigeria and who were working within the country at the time. 

The continued rise in the number of medical personnel leaving the country, especially doctors, raises concerns and deserves attention. For Nigerian doctors to readily be absorbed into the medical system of other countries implies that the training in Nigeria breeds standard despite the challenges of funding for research and poor infrastructure within the academia. 

Some of the major reasons for the continued brain drain in Nigeria’s healthcare sector are poor welfare of the personnel, inadequate facilities and poor working environment. Again, during the Covid-19 lockdown, it was evident that Nigerian elite could not access medical facilities in countries of their choice and had to cope with what was available within the country. No one ever thought a time would come when Nigerian elite would be deprived of medical attention abroad despite having the means to afford it. 

This should serve as a lesson to the elites that they should prioritise the development of local healthcare system such that anyone leaving to seek medical attention outside the country would be doing so not because it cannot be done in Nigeria but because it is the person’s choice, or for other associated (covert) reasons. In a report by Al Jazeera’s Mercy Abang on 8 April, 2019, she stated that, ‘Even the septuagenarian Nigerian president, Muhammadu Buhari, seeks medical care in London‘. This impugns the person of the president who has built a strong personality based on integrity and discipline, and won the elections with the hope of turning the tide in situations as this. 

In India, for instance, despite the multidimensional challenges associated with high population, the country has been able to develop its health sector such that there is efficient service delivery. The only challenge that most citizens may face is the ability to afford it. This implies that if majority of the citizens can afford the cost of medical care locally, then it would save the government the cost of balancing trade due to medical tourism abroad. India is one of the favoured destinations for Nigerians seeking medical treatment abroad. At the High Commission of India in Abuja, on the one hand, one of the easiest visas to process is of seeking medical care in the country. 

On the other hand, when applying for visa to study a professional course especially in the field of medicine, the process is tedious. This could partly be because, these professionals would return to train other compatriots in the field thereby reducing income to the country in terms of foreign exchange earnings derived from medical tourism by Nigerians. However, they are not to blame because they developed their system and their diplomats are only acting in the manner they deem as in the best national interest of their country: we could develop ours to attain such heights. 

The case of a serious brain drain in Nigeria is not in doubt. Every medical personnel considers working in Europe, United States, or the Middle East unless they lack the opportunity to leave. According to Nigerian Medical Association estimates, the Physician-to-patient ratio in Nigeria is 1:9,083 (that is one doctor to about 10,000 individuals) which is a far cry from the WHO recommendation. Under this circumstance, patients would have to wait for several hours to be attended. The ratio is even worse for dentist with 1:47,079 in every 100,000 population. For nurses the ratio is 1:1,135. This implies that Nigeria needs more medical personnel at a time when they exodus to foreign lands to offer their services after acquiring knowledge in Nigeria. The only way to reduce the mass exodus is by improving welfare and emoluments of the workers within the sector. 

Furthermore, an efficient healthcare system can be a source of foreign exchange earnings as Nigeria would become a medical hub and an easier and more accessible destination to most people in need of medical care especially within West Africa and some parts of Africa as a whole. This is because it would cost less than going to Europe, Asia or the United States to seek medical attention coupled with the factor of considering the purchasing power parity in their native countries compared to Nigeria and other parts of the world like Europe, United States or Asia. 

To some extent, individual attitudes towards national development is part of the problems that hampers growth in the county. In mid-January, there was another alarming report that the Zamfara state government discovered 199 ghost doctors on the state payroll of 280 doctors. The imagination that 199 ghost doctors are on the pay roll of government hospitals is alarming to any well-meaning citizen. To begin with, 280 is an appalling number for physicians in a state with a population above 9 million. How many hospitals are in the state and where are these ghost doctors located? 

It is more disheartening that some individuals defraud the state by including nonexistent physicians on the payroll making the challenge of fewer doctors look less macabre than it actually is from distant observation. This is at a time when Zamfara, a major state affected by banditry, is in dire need of all the possible healthcare attention it could get; a time when all hands should be on deck to ensure that healthcare is prioritized in all ramifications while taking into cognizance factors that facilitate brain drain in the country’s health sector. It is hoped that the government fetch out and mete due punishment to those involved in this crime against the poor people of the state. 

Thus, while battling with the scourge of brain drain in health sector, a group of individuals are busy defrauding Nigerians of any hope at better healthcare delivery. If this is tenable in Zamfara State, then how many more states could be suffering from the same challenge of ghost doctors and medical personnel in the country? Rural communities are usually the ones to bear most of the brunt as they are the places with more chances of having quack medical personnel and location of nonexistent hospitals with dubious staff list. This is devilry at its peak. These are challenges that the various state governments and policy developers must look into in order to have more accurate statistics on the current state of healthcare and how to ameliorate the challenges in the sector. 

Primary healthcare is another area of concern in national health security: ensuring a very functional primary healthcare system shall greatly reduce the rate of maternal and infant mortalities which is very poor in the country. Primary healthcare reaches most of the citizens in the urban and rural areas as the first, and in most cases, the only means of affordable healthcare to many Nigerians. If the primary healthcare system can be optimized towards better service delivery it could save the higher echelons of healthcare the burden and need to handle many health issues of primary concern. And, at the same time, reduce the rate maternal and infant mortalities ravaging the country. 

Consequently, the government at the centre must endeavour to commit all resources towards upgrading the standard of healthcare. This stands as one of the major components of contemporary security. If the government is serious about economic diversification, then luring other African states towards medical tourism in Nigeria should be one key area that will definitely increase foreign exchange. In fact, if only to cut the humongous amount Nigerians spend on medical tourism abroad. Citing how Nigerian leaders flock abroad for medical tourism, how much could Nigeria save if the president and other elected officials get medical care locally? Thus, if the president is going to London it should be strictly on holiday but not with an additional cost for healthcare. 

Having, at least, two medical structures as those frequented by the president constructed and functional within Abuja and similar ones (one) in each geopolitical zone of the country could save Nigeria a lot and earn more for the country in terms of foreign exchange.  If the leaders use it, it would definitely build the confidence of other African leaders to change their preferred destinations for medical tourism abroad. These are structural policy concerns that government, at all levels, must take into consideration with respect to revamping the health sector in Nigeria. 

Ejuailo writes from Lagos via [email protected]