Stephen Adewale
While featuring as a guest on the Sunrise Daily of Channels Television on Wednesday, Minister of Labour and Employment, Dr. Chris Ngige said doctors who feel they want to relocate in search of greener pastures are free to do so because the nation has enough medical staff. While his statement was a measured response to a brain drain question, it was loaded with explanatory and justifying rhetoric and peppered with both financial blackmail and Buhari administration’s imperious pronouncement of guiltiness.
His statement, as anticipated, generated a lot of noise, especially from online vuvuzelas and trolls, but as usual, the noise will eventually peter out without any logical resolution. There will be no answers, and we will move on after our psychic energies have been expended. Then, we will move on to another argument, and another up to 2023. Anyone who thinks that the criticism of Ngige’s statement would teach our leaders how to respond to sensitive public issues is either a wild-eyed optimist or pitiful naïve. Ideally, such arguments and counter-arguments are useful for a country that is still in search of development like Nigeria, but that is not what is at stake here.
First, this is not the first time that Nigeria raises questions about the adequacy or otherwise of the country’s medical staff. Whenever those appointed to steer the country’s ship decide to answer these questions, it is most often because there is a need to deny a health crisis. They dredge up logic at such moments to navigate their way out of the situation, never when it really matters to our lives and our destiny as inhabitants of this geographical expression called Nigeria.
Those who fish around this mischief are not doing anything different. In 2015, while delivering a speech at the 38th Annual General Meeting and Scientific Conference of the National Association of Resident Doctors of Nigeria, the country’s Minister of Health, Professor Isaac Folorunso Adewole, argued that the number of physicians in Nigeria was sufficient and that the real health workforce problem was the uneven distribution of physicians. He continued to say that, compared to other African countries, the ratio of one doctor to the over 5,000 population is better!
That this series of arguments comes from federal ministers appointed by the APC whose party promised to increase the medical workforce to 50 doctors per 1,000 people in the first four years in 2015 reinforces the argument that all Nigerian politicians are recycled old wine in new bottles.
In 2015, the party had noted in the document encapsulating its pact with Nigerians, called Commonsense Solutions, that in the past the country’s political manifestos were hardly different from mere platitudes and general statements that could not be held accountable to the drafters. Against this backdrop, APC clearly stated that under its government the situation would be different. Not only had the party failed to fulfill its promises for four years down the line, its ministers had completely forgotten the letters of the manifesto of the party.
The return of democracy had led to the gradual recovery of the hitherto comatose health sector before APC came on board in 2015. Numerous new health policies were promulgated and the task-shifting approach was used to take health services to underserved communities. Life expectancy had improved, Guinea Worm had been eradicated, Ebola contained, and the country was about to eradicate polio. The main challenge at the time was poor health resource management that caused an insurmountable crisis among healthcare professionals. This reached a crescendo in the run-up to the 2015 general election but remained on a plateau bed until now, unfortunately.
Maybe I should recall some of the health-related “change” contract APC has with Nigerians to the ministers of President Buhari. They include: reviewing occupational health laws and immediately starting enforcement of workplace hazard reduction provisions; coordinating the work of numerous federal health agencies more effectively; ensuring that no Nigerian has a reason to leave for medical treatment outside the country; strengthening the workforce to 50 physicians per 1000 people; and, above all, increase life expectancy. APC also promised to enhance federal teaching hospitals’ quality to world-class standards. These were lofty plans, but the 4-year-old administration’s stack negligence and its ministers’ reckless statements on the crisis-laden health sector not only questioned the APC-led government’s willingness to revamp the health sector and meet its goals, but also ensured that those lofty ideas would be constantly confined to the realm of promises.
Resident doctors in 30 tertiary hospitals across the country have severely embarked on a strike over dispute with their hospital management over the past four years. They include UCH Ibadan, UUTH Uyo, ABUTH Zaria, UCTH Calabar, AKTH Kano, Irrua Specialist Teaching Hospital (Edo State), FTH Iddo-Ekiti, JUTH Jos, LUTH Idi-Araba, NAUTH Nnewi, UNTH Enugu, NEC Kaduna, BSUTH Makurdi, KSSH Lokoja, FETHA Abakaliki, UATH Gwagwalada, Federal Neuropsychiatry Hospitals in Abeokuta, Kaduna, Yaba and Enugu, National Orthopaedics Hospitals in Enugu and Kano, as well as the Federal Medical Centres (FMC) in Owerri, Jalingo, Umuahia, Keffi, Asaba, Abeokuta, Birnin Kudu and Lokoja. UITH Ilorin and FMC Yenagoa.
With years of little or no improvement in health care services at primary health centers and general hospitals, teaching hospitals fail to meet many Nigerians’ clinical health needs, especially those who are unable to afford private hospitals. As the health crisis continues, thousands of people who voted for change die of preventable and curable health conditions; health commodities such as drugs and reagents are expiring, the remaining little trust in our health sector continues to erode, while senior officials like Professor Adewole and Chris Ngige continued to live in denial.
However, the critical point is the adequacy of doctors in Nigeria. It is true that Nigeria has one of the highest population ratios in Africa, according to the World Health Organisation (WHO), but the question is by whose standards should a country like Nigeria benchmark its doctors’ sufficiency? Ours is not just an African country. With an area of 923,768 square kilometers of land and an estimated population of 183,028,970, Nigeria remains the most populous country in Africa and the seventh most populous country in the world with an annual growth rate of 2.67% and a daily increase of 13,111. Global standards should be our benchmark instead of the African standard.
A doctor to 600 population is the current global recommendation. A poll citing Nigeria’s Medical and Dental Council reported that there are about 72,000 Nigerian doctors registered at the national level, with only 35,000 in the country. Factoring this figure with national population estimates, there is a deficit of more than 260,000 physicians in Nigeria and at least 10,605 new physicians need to be recruited annually to meet global targets! This gap is especially critical for a country like Nigeria that has some of the world’s poorest indices of health outcome, including the fourth highest maternal mortality ratio and the eight highest infant mortality ratios.
Northeast alone has the highest maternal mortality rate compared to other regions of the country, with 1,549 deaths per 100,000 live births, according to the statistics recently published by the WHO. While in many parts of the world the risk of a child dying before the age of five is decreasing, WHO submitted that the maternal mortality rate in Nigeria remains very high. Dr. Ngige is mistaken. Doctors in Nigeria are not enough!
Which doctors are moving abroad is equally important? For senior doctors (consultants), leaving the country at such an established point in their career is not the norm nor the easiest of choices for them. While young medical graduates are not particularly surprised these days to meet their senior consultant colleagues in examination halls writing the same exams that doctors need to practice abroad. On the flip side, newly qualified junior doctors have no choice yet to move as they have to stay for at least one year for their compulsory year of residential care and another year of national service. Well, some don’t consider the latter year of service compulsory! That’s another column’s conversation reserves.
There are more than 3,000 temporary and 2,000 full licenses to practice issued annually, representing a proxy-number of newly registered doctors, according to the MDCN database. A far cry from the more than 10,000 physicians required each year! The interpretation of this statistics is that those in the middle are the doctors free to move abroad. They are the ones who should receive specialist training to fill the gap when the current specialist crop retires or becomes weary, but who cannot find such training opportunities in the country at the moment. Those are the ones that leave.
According to the NOI survey, 89% of these mid-level physicians are considering job opportunities abroad and/or have taken exams that allow them to “port” or “cut out” as they say. Of the subsequent junior doctors, 91 percent are already considering their options abroad. Anecdotal evidence also suggests that the numbers of those registered to take qualifying examinations for national residency training are dwindling, with the examination bodies routine postponement of application deadlines to accommodate more applications.
So, if this trend continues, the number of doctors remaining in Nigeria will be so limited a few years from now that it will be a huge problem for the country. The number of Nigerian doctors settling in the UK doubled in 2018 compared to 2008, with more than 6,000 Nigerian doctors registered for practice in the UK, according to the UK General Medical Council database. The other African countries with relatively higher doctor-to-population ratios like South Africa have declining numbers of nationals registered in the UK and only 20 doctors have emigrated from Mauritius to the UK in the past decade.
A stitch in time saves nine, as the old adage says. Some sincere demonstration by the government officials that these highly skilled workers, who have benefitted from national resources to be trained as doctors, are valued and needed in their country will be a great start.
It is very sad to see those appointed to chair the country’s affairs display on a daily basis their myopic understanding of the country. Dr. Ngige’s endgame of ego-stroking is to cover up the APC-led government’s palpable failure in the health sector. Rather than maintain a clear-headedness about their second missionary journey to Abuja, they are turning every public appearance into political opportunism. Well, as they shall see, their games will not win them medals, only the embarrassment of being told they are not smart enough to preside over the country’s affairs.
Stephen Adewale is a fellow of the American Council of Learned Society and currently serves as the Director of Africa Dialogue Mission, Abuja, Nigeria.
THE VIEWS OF THE ABOVE ARTICLE ARE THOSE OF THE AUTHOR AND DO NOT NECESSARILY REFLECT THE VIEWS OF THE KAFTAN POST EDITORIAL TEAM
