Nigeria’s plan to reverse the country’s brain drain and retain doctors by making it mandatory for all medical graduates to work in understaffed government hospitals for five years has been labelled “obnoxious”.
While the WHO has “red-listed” Nigeria in efforts to dissuade wealthier countries from poaching its health staff – it lost about 5 000 doctors to Britain in 2021 – some analysts say there are benefits to the exodus as relocated Nigerians sent home four times more money than the country made from overseas investment (excluding oil).
The Bill, which could be put to a public hearing in the next few days, passed its second reading in the Nigerian Parliament’s lower house last month, writes Orji Sunday for Bhekisisa.
But the doctors’ union and civil society organisations are fiercely opposing it, describing as a waste of taxpayers’ money.
Calling it “obnoxious and outlandish”, Dr Innocent Orji, president of the Nigerian Association of Resident Doctors, said: “We are going to resist the Bill: it should be withdrawn immediately.”
Yet the government is forging ahead, hoping to reduce the steady stream of medical professionals leaving the country, and set a timeline to recoup investment by the state education system.
Ganiyu Johnson, a lawmaker and leading advocate for the Bill, issued a statement on social and mainstream media addressed to medical students and doctors.
“The government has invested so much money in training,” he said. “If the government subsidised your tuition, the least we expect is … you can give back to society within the period of five years.”
Unstable sector
In the past few years, strikes in the health industry have become more frequent, while doctors’ wages have remained static for more than a decade, despite a government promise to review pay every five years. Job insecurity has also grown.
“I don’t think the government understands this yet,” said Chidiebere Echieh, a consultant cardiothoracic surgeon at the University of Calabar, who graduated from medical school in 2007, and whose salary has remained stagnant, despite further training, since then. For all his experience and skills as a senior surgeon, he is paid the equivalent of about R19 263 a month, far less than medical graduates in most developed countries.
In 2022, Echieh visited the US for a postgraduate programme at the University of Arizona where he saw saw the contrast in health technology between his own country and the US. It is another factor driving Nigerian doctors abroad.
“There are so many healthcare technologies that are not available in Nigeria. No matter how long you practise here, without hands-on experience of these technologies, your mastery will be limited.”
In public health, gaps in technology become death counts. Doctors have reported a rise in trauma and depression, which they claim is caused by too many avoidable deaths across national hospitals.
“It is very depressing to watch people die of easily treatable health conditions due to a lack of basic technology and equipment,” said Orji.
The government and doctors now agree the situation has reached crisis point. Despite a population of 218m, the country has only 24 000 licensed doctors.
The WHO included Nigeria on its recent list to discourage other countries from hunting an already depleted medical workforce. The UK is the biggest recruiter of Nigerian doctors, alongside Canada, the US and Saudi Arabia.
Between 2015 and 2021, the Development Research and Projects Centre, a Nigeria-based not-for-profit, estimates that nearly 5 000 doctors moved to the UK.
Competition for jobs abroad is stiff, with ony the best skilled being taken. Those who fail to make the grade might be forced to stay unwillingly in their home country. This, Adediran said, could lead to low motivation and poor standards of service.
Chima Christian, a Nigeria-based public affairs analyst, takes a different view of the brain drain. “This is a great opportunity (for graduates),” he said.
“There is high demand for Nigeria’s skilled workforce. So much so that we can literally export these people and earn more foreign currencies through remittances. Today, our new oil is human beings.”
More investment was needed in universities, he said, to train more young Nigerians in in-demand fields. The country would then have enough workers to meet its needs back home, without limiting the ambitions of those who want to work abroad.
Christian has a point.
In the past three years, diaspora remittances have emerged as Nigeria’s leading source of foreign earnings excluding the oil industry. In 2021, Nigerians abroad sent home $20bn – at least four times the country’s entire foreign direct investment.
See more from MedicalBrief archives:
Nigeria denies signing agreement with UK to stem brain drain
How to minimise the negative effects of Nigeria’s incessant strikes by doctors
Only Africa’s leaders can staunch Africa’s medical brain drain
Brain drain continues despite conventions on medical poaching