The sensational report, the other day, of a job fair organized by Saudi Arabia to recruit Nigerian medical doctors to go ply their trade in the Arab Kingdom, is certainly no complimentary news. Far from being a public image boost to Nigeria’s tragic international reputation, the fact that the Saudis were audacious enough to organize the job fair at the Sheraton Towers in the nation’s capital, Abuja presents yet another embarrassing score-card for a nation enmeshed in the thralldom of deficient healthcare delivery. In a nation bedeviled by a dilapidating healthcare delivery system and an incredulous sense of value, this provocative, pugnacious, nose-thumping and eye-poking assault at a time when resident doctors under the aegis of the Nigerian Association of Resident Doctors (NARD) are currently on strike; exposes the pathetic contradiction and asymmetry inherent in Nigeria’s human resources equation. The conditions under which doctors work in Nigeria are as terrifying as they are demeaning. Medical doctors are poorly paid considering the resources it takes to produce one. Certainly, Nigeria needs a visionary leader who will make capacity-building and human resource development an emergency.
Quite predictably, the federal government feigned ignorance as the Abuja-based recruiting agency, Meed Consultants, proceeded with the recruitment exercise of Nigerian doctors for Saudi Arabia. The overzealous and eccentric Labor and Employment Minister, Chris Ngige, denied knowledge of the recruitment exercise despite the wide publicity the event received on both social and conventional media. Ngige, who had issued an ultimatum to the striking doctors to return to work or be sacked passed the buck to Health Ministers Osagie Ehanire, saying the Health minister was in charge of doctors. “I am not aware of that. You can please contact the Minister of Health. His ministry is in charge of doctors,” Ngige insisted. Ehanire, however, was not available for comment. However, in his reaction, NARD President, Uyilawa Okhuaihesuyi, said doctors were at liberty to do whatever they wanted since the government had failed to fulfill its promises. He said there was no benefit for any doctor still practicing in Nigeria, saying those who were staying back were only being patriotic. “Everybody is free to do whatever he/she wants. The government has not fulfilled its promises to the health sector. Those who stay behind are only doing so because of patriotism, not as if there is any benefit or something.”
According to the recruitment invitation, the areas of practice for which Saudi Arabia is recruiting the Nigerian doctors include: anesthesia, ICU, pediatrics surgery, family medicine (consultants only), obstetrics and gynecology, ENT, Emergency medicine, all sub-specialties (surgery), all sub-specialties (internal medicine), orthopedic surgery, Ophthalmology, Radiology as well as Hematology and Histopathology. Interestingly, this was not the first time the said firm was conducting a recruitment of Nigerian doctors to go work in Saudi Arabia. The said firm is said to have conducted a similar exercise in 2019 in Lagos and Abuja to recruit Nigeria’s best medical brains. Hundreds of Nigerian doctors gathered in Abuja and Lagos, to take a test conducted by the Saudi Arabian health ministry. In a symbol of the Nigerian medical brain drain, those yet to migrate must complete foreign exams in order to get work placements abroad. Weeks before the effort by Saudi Arabia to lure Nigeria’s greatest medical talents, dozens had sat the regular Professional Linguistic Assessments Board (PLAB) exams at the British Council. Once they pass, it will enable them to work in the UK. It is an open secret that British, American, South African, Emirati and Saudi Arabian agencies operate in Nigeria to recruit the best doctors.
Medical schools and residencies are subsidized by government funds, an investment that is now benefiting other countries. Approximately 36,000 Nigerian medical doctors are currently working outside the country. A recent survey found about eight out of 10 doctors who remained in Nigeria were looking for jobs overseas, with the US and UK as leading destinations. According to a factsheet on the number of registered doctors in 2020, Nigerians make the top-list of foreign doctors practicing in England with 3,936 doctors, coming fifth after India with 25,336; Pakistan 8,998; South Africa 5, 695; and Ireland 4, 010. This figure is almost a seventh of the about 27,000 medical doctors currently practicing in Nigeria. Considering the expertise and exposure of these doctors, and the overwhelming health problems befalling many Nigerians, it is a shameful depletion of human resources that Nigeria must reverse if it considers health development a priority.
Yet, this is a daunting task for a nation, which the WHO reported as being in a worsening state of health. From being the country with the highest number of children infected with the human immunodeficiency virus (HIV) globally, to an alert, on both the prevalence of diabetes and the rising cases of chronic kidney diseases in the nation’s children, Nigeria, has in recent times, been challenged by health crises. To address these crises facing an estimated 200 million people, one doctor would have to cater for 6,187 people, as against WHO recommendation of one doctor per 600 people. Doctors have blamed the mass exit on poor working conditions – only four percent of Nigeria’s budget is allocated to health. While the annual healthcare threshold per person in the US is $10,000, in Nigeria it is just $6.
Candidly, this manpower deficit rudely highlights the gaping paradox, whereby the Nigerian health sector suffers a lack of confidence from its people and apathy from its political leaders, while its nationals develop the healthcare system of other countries. But who is to be blamed for a social order that has lured Nigerian-trained doctors from these shores by the simple assurance of basic necessities, compliance with international best practice and respectable professionalism? Remuneration is so poor that graduates from medical school often do not secure places for housemanship. In dire circumstances, many are made to lobby or give inducement to get placements in hospitals, even as some endure unending casualization as face-saving measures. In some secondary and tertiary healthcare centers, where there is a preponderance of experts, the integrity of many is being compromised by the absence of enabling environment and equipment to diagnose and treat simple medical conditions. Moreover, in the face of this damning situation, the medical association is being dragged into messy, needless and unprofitable politicking that cheapens its professionalism.
This systemic decay and jaundiced value system is further exacerbated by low morale that has made the medical profession a desecrated terrain for misfits and a haven for quackery. Many years ago, medical doctors, by their calling and professional standing, enjoyed the respect and patronage of the society. However, a value disorientation that reveres undeserving title-holders and vainglorious social esteem has caused reverse. An infestation by quacks and other illegal claimants to the medical field, unbeknownst to the public, has also undervalued the importance of the medical doctor to adequate and sustainable healthcare.
These are the suffocating challenges in the healthcare system that promote brain drain in the medical profession. Until governments at the local, state and federal levels are able to effectively handle the various factors that promote the daily emigration of medical doctors/dentists to other countries, Nigeria will continue to serve as a manufacturing plant for the production of medical doctors/dentists for the healthcare system of developed countries. What is more? The gloomy picture painted is made worse by the phenomenal increase in medical tourism and its attendant injury to the Nigerian economy. A recent NMA projection states that before the end of the year, no fewer than 5,000 Nigerians will journey out of the country seeking medical attention from countries with developed medical services. It further stated that annually Nigeria loses $800 million or about N125 billion to capital flight emanating from patients’ treatment cost.
Yet, this has not always been the case. It is a testimony to the hardwork, commitment and foresight of the founding fathers of Nigeria that, once upon a time in a postcolonial Nigeria, the University College Hospital (UCH) Ibadan ranked as one of the best teaching hospitals in all Commonwealth countries. In this same Nigeria, medical doctors won laurels for ground-breaking medical research conducted from the nation’s university teaching hospitals. If within a generation the tables were upturned, the question to ask is: how did Nigeria come to such a sorry pass?
Better still: How does the nation overcome this? The incessant patronage of foreign healthcare services with its attendant capital flight is indicative of apathy and nonchalance towards the development of a homegrown healthcare delivery service. In this regard, leaders should show example by patronizing Nigerian hospitals, rather than travelling abroad for medical check-ups, if they are sincere and truly committed to the state of healthcare in the country for which they budgeted so much. It is a denigration of all leadership signifies, as well as a telling advertisement of perfidy and unreliability, if Nigerian leaders claim to be genuine leaders of their people and refuse to patronize the healthcare facilities of their domains, run-down on their watch as those facilities may be.
To this end, there is dire need for the provision of a national regulatory framework for the management of the sector, as canvassed by the NMA. One of the things such regulation should do is to prescribe sanctions for public officials who indiscriminately seek medical attention abroad. This would dissuade frivolous spending of tax-payers’ money and compel adequate investment in the nation’s healthcare system. As feelers from the industry suggest, many highly skilled Nigerian doctors abroad are willing to come back to lend support to the crippling healthcare management, but they are hamstrung by the inauspicious working conditions of poor infrastructure and social ills befalling the nation. Therefore, the government should strive to upgrade the nation’s healthcare facilities and provide incentives for private sector participation in standardizing the healthcare sector.
Moreover, in collaboration with the NMA, the Medical and Dental Council of Nigeria, government should facilitate proper and expeditious steps to address the plight of medical doctors and their conditions of service. This is to boost morale, imbue confidence in the public and avert incessant industrial actions, which have become embarrassing to both the nation and the profession