Hindered by poor conditions of Nigeria’s health care, bad remuneration and deteriorating hospital facilities, many medical doctors are abandoning the country for greener pastures abroad.
The PUNCH’s investigations revealed that although the exodus of doctors was not new, it had been on the increase in the last two years with countries such as the United States, the United Kingdom, Canada, Saudi Arabia and Kuwait as their destinations.
It was learnt that the exodus had increased the workload of those who were still in government service, as many states had not been employing doctors.
The Nigerian Medical Association, which expressed concern in an interview with The PUNCH, said in urban centres a doctor attended to 100 patients daily.
50 to 60 doctors leave Lagos hospitals every six months – NMA. In Lagos State, which has the highest number of doctors in the country, the state NMA says no fewer than between 50 and 60 doctors leave the service of the state government every six months.
The Chairman of the state NMA, Dr Saliu Oseni, who disclosed this in an interview with The PUNCH, lamented the failure of the state government to replace doctors, who had left its service for greener pastures abroad.
Oseni said the failure to replace the doctors and employ new ones was affecting the service delivery of the NMA members in the state.
He stated, “It will be difficult to give a total figure of doctors that have left the service of the Lagos State Government since 2017, but to be conservative, no fewer than 50 to 60 doctors left the system every six months. Some of them leave for greener pastures abroad. Some of them take offers from the Federal Government and some retire. Not replacing such doctors is a big challenge to us.”
“The situation is affecting our members as they are being overworked. Although we have a lot of doctors that have left the country, we still have a lot of unemployed doctors. Some of the hospitals have not employed or replaced doctors that have left the system in the last two years,” Oseni said.
“The work that is supposed to be done by junior officers is being done by senior officers and currently in Lagos State hospitals, you see a doctor attending to close to 100 patients per eight-hour work in a clinic which is not good for the doctor and the patients.
“The ideal patient-doctor ratio is supposed to 1:500, but what we have currently in Lagos State-owned hospitals is one doctor to over 5000 patients. You cannot create an ideal environment and you want to judge the environment by the ideal standard. If I am going to see 80 patients in eight hours, there is no way I’ll follow the routine properly.
“By standard, a doctor needs 15 to 30 minutes to attend to a patient very well. This means in eight hours, I would only be able to see 15 patients and in between that time if I need to do some procedures that means I will see less than that. By labour law, we are even entitled to a one-hour break, but most doctors in Lagos State-owned hospitals don’t even have time for a break,” Oseni said.
A medical officer at the General Hospital Ifako-Ijaiye, who spoke on condition of anonymity, said doctors’ workload was too much, adding that it had made many of his colleagues to seek greener pastures.
He stated, “At times when people hear that doctors go abroad for greener pastures, all they think is the money, but I tell you money is not everything. Conditions of our work are overwhelming. That is why suicide and depression are common among those of us that are still in the system.”
In Kaduna State, investigations revealed that doctors were leaving the service of the state government, with hospitals in rural areas mostly affected.
A source at the Gwamna Awwan General Hospital, Kakuri, told one of our correspondents that poor remuneration, insecurity and work progression had forced doctors and other health workers out of the state.
“Who wants to be killed? or who wants to be stunted in terms of career progression?” he asked.
The source noted that in a survey carried out in January 2018, no fewer than 21 doctors left at least one hospital for other countries or greener pastures elsewhere in the country as a result of bad conditions of service.
He added that the situation was similar in all the state-owned hospitals, except the Barau Dikko Specialist Hospital in the state capital.
The state Chairman of the NMA, Dr. Stephen Kache, in an interview with The PUNCH, put the exodus of medical doctors from the state civil service at 60 per cent.
33 medical doctors employed by govt, only eight reported – Kaduna NMA. The NMA chairman noted that no fewer than 33 medical doctors were recently employed in the state, but only eight had reported so far.
The NMA said, “The current exodus of doctors we have is over 60 per cent. They left between six months and one year. Many factors are responsible for the exodus of doctors, but chief among them is poor remuneration and this alone constitutes a significant proportion of reasons doctors leave. Other factors are insecurity and poor work conditions.
“13 out 21 doctors left hospital in eight months”. “In 2018, we did a survey in some hospitals within the state and in one of the hospitals as of January, there were 21 doctors and by August of the same year, there were eight doctors remaining. We went round other hospitals and the picture was similar.
“Recently, the state government tried to replace those that had left and 33 doctors were employed. I am aware that out of the 33 that were employed, only eight of them have reported.”
Better pay, work environment fuelling doctors’ exodus. In Rivers State, findings show that many doctors and other medical workers have left the state.
A medical doctor at the Okomoko General Hospital in the Etche Local Government Area, Dr Young Kale, stated that he was aware of about two doctors who had travelled abroad.
Kale said, “Each year, we hear of several doctors leaving hospitals and travelling abroad to take better offers. I don’t blame them. Doctors here are overworked. If you check the halls, you’ll see hundreds of patients waiting to see a doctor. That alone will show you that doctors are not enough.”
The NMA in Rivers State also decried the situation, attributing it to poor remuneration and hospital facilities.
The Chairman of the NMA in the state, Dr Obelebra Adebiyi, said that the trend, if not checked, would make patients patronise quacks, as doctors would no longer be enough in the hospitals.
She noted, “I don’t know how many doctors have travelled abroad and how many are remaining in Rivers State because we have not done a study to get the statistics, but a lot of doctors are leaving the country and a lot more are still planning to leave for myriad reasons. Most of them (doctors) are going out for better training and exposure now that the world is a global village.”
Adebiyi, however, stated that once health facilities and wages were improved in the state, doctors and other health workers who were still considering leaving the country would have a rethink and stay back.
The Oyo State Commissioner for Health, Dr Bashir Bello, who assumed office about two weeks ago, said the ministry was compiling a list of doctors who had left the service of the state for greener pastures abroad.
Bello, in a chat with one of our correspondents, admitted that a sizeable number of doctors had left the state, but believed that health sector repositioning was one of the cardinal programmes of Governor Seyi Makinde.
In Enugu State, the NMA said the brain drain known as human capital flight had reached an alarming level.
The state Chairman of the NMA, Dr Ike Okwesili, told The PUNCH that the reasons behind brain drain were usually bad remuneration, the poor quality of life in the country and poor job satisfaction arising from ill- equipped public hospitals.
Okwesili said Enugu like other states did not implement the Consolidated Medical Scale or the Consolidated Health Salary Scale. This, he said, caused the migration of workers from state to federal jobs, which he described as “internal brain drain.”
Doctors leaving Enugu on a daily basis – State NMA
Okwesili, who said that it would be difficult to give an accurate number of doctors that left the state for other countries or move from the state- owned hospitals to federal hospitals, explained that doctors were leaving the state on a daily basis.
He said that the problem could be resolved by identifying the magnitude of the problem. “This has to come by way of full implementation of the National Health Act. The National Council on Health in Section 41of the Act has the responsibility of identifying the human resource requirements of the health sector across all levels of care.
“Doing this will give a quantitative assessment of the cumulative loss. Section 46 of the Act prohibits sponsorship of public servants with public funds for medical checkups, investigations and treatment abroad, except in special cases where there should be authorisation by the health minister or the commissioner for health as the case may be.
“The enforcement of these will help all of us improve the budgetary allocations to health in line with the Abuja declaration.”
A medical doctor in Huntsville, Alabama in the United States, Mrs Olaoluwa Odofin, lamented the high level of infrastructural decay in Nigeria’s health sector.
Speaking with The PUNCH, in Huntsville, on Sunday, Odofin urged government at all levels to ensure a quick rehabilitation of the health sector, saying “health is wealth.”
Odofin said poor health infrastructure and inadequate welfare for practitioners in Nigeria were responsible for the exodus of doctors.
The internist said all her classmates, who graduated with her from the University of Ilorin over a decade ago, had left Nigeria for greener pastures abroad.
She said, “You can’t compare the level of medical infrastructure here in the US with what obtains back home in Nigeria.
“It’s like comparing day and night. I came to the US for my residency between 2009 and 2012, and I began practising in 2012.
“Our government’s back home should do the right thing by fixing the health sector so that nobody would need to travel here for medical treatment.
“Nigeria has the medical personnel needed to put smiles on the faces of the masses. It’s up to the government to live up to their electoral promises.”
In the same vein, another medical doctor in Houston, Texas, Samuel Adesoba, said poor remuneration and inadequate facilities were some of the reasons why Nigerian medical doctors travelled abroad for greener pastures.
Adesoba, who graduated from the Obafemi Awolowo University, Ile-Ife, in 1987, is an internal medicine specialist, family doctor and general practitioner.
He explained that poor welfare package and shoddy infrastructure were a hindrance to self- actualization by Nigerian medical doctors.
This, he said, should compel government to invest in infrastructure across the country.
He said, “Nigeria has competent professionals across various medical fields. So, personnel aren’t the problem. The problem is the structure. The structure affects so many things such as equipment, drugs and insurance.”
Commenting on the development, the NMA through its First Vice-President, Dr Mingeh Tijo, listed countries such as the US and the UK as the destinations of Nigerian doctors.
He added, “What is even worrisome is the fact that the Arabian countries such as Saudi Arabia and Kuwait have now opened up their spaces for Nigerian doctors. These countries are becoming new destinations for our doctors.
“In the last three years, the trend is increasing, nothing is really happening in the health care space in the country. There is no recruitment and the infrastructure is still the same.”
“On the average, studies have shown that about 700 doctors leave the country every year. During the recruitment Saudi Arabia did recently, thousands of our doctors were struggling to leave the country.”
“The effects are so enormous that some of our doctors are now committing suicide because of the pressure of work. Poor service delivery is imminent because we are overworked, and then the patents are the ones suffering for this.
He stated, “Patient-doctor ratio is approximately 1:5000. The number of patients a doctor sees per day depends on the locality the doctor is operating from. Some see 70 patients in a day; some 100, but in some tertiary institutions, the ratio may not be as high as that. Again, it depends on whether the doctor is practising in a rural or urban area.”
“About 50 per cent of the doctors are in the South-West; even at that, about 40 per cent of the doctors in the South-West are in Lagos. The remaining 50 per cent are spread in the six geopolitical zones. Some states in the Northern Nigeria have less than 30 doctors in their service.”
According to him, the number of graduate doctors per year is less than 3000, adding “the new ones are the ones that want to run out of the country.
“The government must prioritise health care in the country, policies should be implemented, infrastructure should be improved upon, and recruitment must be done to fill the void among the health workers.”