A few days ago, the United States Mission in Nigeria tweeted an image of an exceptional Nigerian doctor, Dr. Onyema Ogbuagbu who has helped Pfizer in developing a COVID-19 vaccine at Yale University. The tweet stated that ‘Nigerians contribute to the world in so many ways’. This is exceptional news, and something that we should all be proud of as a nation.
The infographic also states that this remarkable doctor, who is now an Associate Professor of Medicine and Infectious Disease Specialist at Yale, graduated with a degree in Medicine from the University of Calabar in 2003. Dr. Ogbuagbu is one of more than 4000 Nigerian physicians, dentists and allied health professionals who are living and practising in the U.S., Canada and the Caribbean, according to the Association of Nigerian Physicians in The Americas (ANPA). Recent figures also estimate that there are approximately 7875 Nigerian doctors who are practising in the U.K.
Nigeria is currently experiencing a mass exodus of healthcare professionals. The brain drain of the medical talent from Nigeria is well documented and reported, but the figures are staggering. So let’s remind ourselves of what the current situation is through a few key points.
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There are currently approximately 4.0 physicians per 10,000 population in Nigeria; that is 1 physician to 2500 people. We are clearly lagging behind the World Health Organisation’s recommended doctor-to-patient ratio of 1 physician to 1000 people. For further context, that is 0.4 physicians to 1000 people. This is in comparison to approximately 8 per 1000 in Cuba, 4 per 1000 in countries such as Sweden, Austria and Georgia; 3 per 1000 in the United States and United Kingdom; 1.7 per 1000 in China and Turkey. Nigeria sits comfortably on the long list of developing countries in the ‘less than 1 physician per 1000 population’ category.
The feedback from most Nigerian doctors working in primary care and tertiary hospitals around the country, with regards to medical training, working conditions, payscales, infrastructure etc., is satirical, and somewhat symbolic of the ‘0.4 to 1000’ density of physicians, as the remaining 0.6 which would make up a whole individual is allocated to fighting against deeply rooted systemic issues in the healthcare sector. A survey report by NOIPolls and Nigerian Health Watch on the ‘Emigration of Nigerian Medical Doctors’ highlights several contributory factors to the lingering brain drain, with the most common being high taxes & deductions from salary, low work satisfaction, poor salaries, huge knowledge gap, and poor quality of practice.
The current global average of annual health expenditure is approximately 9.8% of GDP. Nigeria currently spends less than 5% of it’s annual federal budget on healthcare. As you can imagine, with a population of approximately 206 million people, the allocated funds spread thin. In 2019, this amounted to 1,191 billion Nigerian Naira, while private spending on health is projected to add up to 4,284 billion Naira by 2021. All that money definitely doesn’t go into paying doctors, as recent reports have found that Nigerian doctors are amongst the least paid globally, and in Africa. There are 45 other countries in Africa who pay their doctors better.
The issues surrounding the economics of how and why Nigerian doctors are not remunerated fairly are multifaceted, however they are reflected in the comments made by the Minister of Labour and Employment, Chris Ngige in April 2019. During a Channels Television’s breakfast show, Sunrise Daily, the minister, who is also a medical doctor, stated he was not worried about the brain drain of doctors. “We have surplus. If we have a surplus, we export. I was taught Biology and Chemistry by Indian teachers in my secondary school days. They are surplus in their country. We have a surplus in the medical profession in our country. I can tell you this. It is my area, we have excess. We have enough, more than enough.”
We definitely do not have enough doctors in Nigeria to sustain the healthcare needs of the population, and there are currently no active policies or initiatives by the government to mitigate our depreciating health statistics, through the public and private health sectors. The failure to recognise that a complete overhaul of the system is imminent. It is no wonder that our doctors are fleeing to greener pastures for better training, better pay and a sense of fulfillment.
So yes, ‘Nigerians contribute to the world in so many ways’, but clearly, many Nigerian doctors would rather do so elsewhere.
Dr. Helen Zidon is the Deputy Head of Medical Information at Aspen Pharma Group, where she oversees the medical information functions of Aspen territories globally for multiple widely used pharmaceutical products. She is a public speaker and advocate for Global and Public Health, accessible and streamlined medical care, and the incorporation of Medical Technology in medical academia and medical practice.
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