POORLY-equipped and generally underfunded, Nigeria’s dysfunctional health system is taking a further hit from a mass exodus of medical doctors. This has led to a considerable loss of confidence in the sector. In fact, if there was any hope of improvement in the immediate future, that hope is now looking increasingly forlorn as those who should fix the ailing health system are taking the lead in seeking medical help abroad, draining the country of its scarce foreign reserves.
There is no doubt that the government has always been lukewarm in its response to issues affecting the general welfare of Nigerians, especially health issues. The corollary has been the frequent disruption in health care delivery, compounded by strikes and unnecessary loss of lives. The present times call for a different approach; the situation in the health sector is almost at a tipping point, where something urgent has to be done to save it from a total collapse.
It is little wonder that the country’s life expectancy has remained rooted at 54.5 years over the years. Currently, Nigeria is said to have the third lowest life expectancy in the world, just marginally better off than countries such as Sierra Leone, Chad and Central African Republic, with Sierra Leone standing at 53 years, and the other two at joint 54 years. Even countries like Somalia and Afghanistan that seem to be perpetually enmeshed in war, at 58 and 65 years respectively, fare better than Nigeria in this respect.
In a lamentation that cannot be offhandedly dismissed, the Chairman of the Nigerian Medical Association, Lagos State Chapter, Saliu Oseni, said that between 50 and 60 doctors were leaving the state service every six months. While most are seeking employment abroad, others are retiring, having put in the statutory number of years of service. Yet, they are not being replaced. In a twist of irony, while there are lots of vacancies, many graduate doctors are also roaming the street in search of jobs.
Oseni’s counterpart in Kaduna State, Stephen Kache, put the exodus of doctors from the state civil service at over 60 per cent. “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,” Kache said. He painted a picture of how the government’s efforts at replacing fleeing doctors ended in a complete fiasco. According to him, 33 doctors were recently offered employment by the government, only eight eventually took up the offer.
The situation is not different across the country as doctors are either moving from states to take up appointment with the federal service, where their lot would be a little bit better, or they are fleeing the country outright. This has placed Nigeria in a situation where one doctor has to cater for the health needs of between 4,000 and 5,000 patients, according to experts. By the World Health Organisation standards, the ratio of doctor to patients should be 1:600.
With doctors leaving and not being replaced, there is no doubt that the remaining ones are overworked and are, therefore, not expected to be at their best all the time. In a place like Lagos, where the bulk of doctors in Nigeria practise, the state NMA branch says a doctor sees as many as 100 patients a day, instead of about 15 patients in eight hours. It should come as no surprise when people who are not supposed to die end up losing their lives because they did not get the best of treatment. It is also the reason why, sometimes, terrifying reports come out of doctors forgetting scalpels or other foreign objects inside patients after surgery.
All over the country, the complaint has been of doctors seeking greener pastures abroad because of the lack of job satisfaction at home. The preferred countries have been the United Kingdom, the United States, Canada and, recently, Saudi Arabia and Kuwait. A report has it that, in March, hundreds of Nigerian doctors took a recruitment test conducted simultaneously in Lagos and Abuja by Saudi Arabian health ministry officials. Weeks earlier, the Professional Linguistic Assessment Board exams were conducted by the British Council for the same purpose.
It is a tragedy that the country spends its scarce resources to subsidise the training of doctors only for such doctors to end up serving societies that have more than enough doctors, just because the Nigerian system cannot look after its doctors. NOIPolls, a public opinion polling and research organisation, said, “Nine in every 10 doctors are considering work opportunities outside Nigeria.”
The inevitable consequences of the situation include the phenomenal increase in cases of quackery and the resort to traditional medical practitioners, whose practices cannot be scientifically measured or assessed. The time to start putting things right is now, and it has to start with a functional primary health care system. If Nigeria can improve the funding of the health sector for doctors to be able to practise their trade with self-fulfilment and job satisfaction, it should not be surprising that many of the fleeing doctors would return and enrich the country with the knowledge they have acquired abroad.
The government should also ensure the banning of top public servants from using public funds to seek medical treatment abroad. If, for instance, President Muhammadu Buhari knows that he will have to seek treatment in Nigeria – not the UK – he would understand the need to fund the health sector, which, last year, got less than four per cent of the budget, instead of the 15 per cent decreed by the Abuja Declaration of 2001. All the doctors need are just a comfortable salary and an environment under which they can give their best. With some commitment from the government and security, the country should be able to reverse the medical tourism that takes rich Nigerians to India for medical treatment and stem the tide of doctors fleeing abroad.
The Punch Newspaper Editorial Board