Reactions have continued to trail comments by the Minister of Labour and Employment, Chris Ngige, that he is not bothered about medical doctors leaving Nigeria because the country has surplus.
Medical associations and experts in the health sector have since countered the minister, saying Nigeria has inadequate number of doctors and is experiencing hardships as a result of the situation.
Ngige, himself a trained medical doctor, spoke yesterday as guest on Channels TV progaramme, Sunrise Daily.
“I’m not worried, we have surplus (Doctors), if we have a surplus, we export. I was taught Biology and Chemistry by Indian teachers in my secondary school days.
“They are surplus in their country. We have a surplus in the medical profession in our country. I can tell you this. It is my area, we have excess. We have enough, more than enough, quote me,” he had said in the programme which airs daily from 7am-9am.
He added that “There is nothing wrong [with Nigerian doctors practicing overseas], they go out to sharpen their skills, earn money and send them back home here. Yes, we have foreign exchange earnings from them, not from oil.”
While insisting that the move does not amount to brain drain, Ngige said “Those guys go there, they are better trained because of the facilities they have there. Eventually, I know a couple of them who practise abroad but set up medical centres back home. They have CAT scan, MRI scan which even the government hospitals cannot maintain. So, I don’t see any loss.
“Brain drain will only be inimical when for instance neurosurgeons travel and we don’t have neurosurgeons here.”
Nigeria has inadequate doctors – NMA
However, reacting to the minister’s statement, the Nigerian Medical Association (NMA), which is the umbrella body of medical doctors in the country, said Nigeria is suffering from inadequate number of doctors.
President of the NMA, Dr Francis Adedayo Faduyile, said it is an unfortunate comment from the minister because “it is not true.”
Dr Faduyile said there are many indices that are used to assess whether a country has adequate number of doctors or not. He said one of them is to compare the country’s doctor to patient ratio to that of the World Health Organization (WHO), which recommends one doctor to 600 patients.
The NMA boss said for Nigeria, however, the ratio is one doctor to 5,000 people or one doctor to 6,000 people, adding that in some areas it could be worse with one doctor to 10, 000 patients.
He said: “So it shows that for every 1000 people or patients we are short by about 10 doctors. So we are grossly in shortage of doctors. Again some of the countries that he (Dr Ngige) is saying that doctors are free to go to like the United Kingdom have an average of 2.8 doctors per 1000.
“Meanwhile, Nigeria has about 0.2 per 1000. You can see the disparity yet you are saying that we can actually go to places where they have more than enough.”
He said it also showed that those countries where the doctors are leaving for place more premium on health than Nigeria does.
“It is a big issue that we don’t have enough personnel on ground because it has caused a lot of hardships to health management in this country. That is why we have very poor health statistics. The maternal mortality rate of Nigeria is one of the worst in the world; same for the infant mortality and the perinatal mortality.
“So the health indices in Nigeria are terribly bad and if we must improve, the government must do more; we must have more personnel in place,” he said.
He added that government should improve funding for the health sector in line with the 2001 Abuja Declaration which stipulates the allocation of 15% of the budget to the health sector.
‘Doctors leaving for greener pastures’
A medical doctor and public health expert, Dr Olajide Adebola, said a situation where the country has one doctor attending to over 6000 patients could not be called surplus.
He said: “Nigeria is nowhere near the WHO standard for numbers of medical practitioners. The minister should get information before speaking. We lack medical doctors and it is not healthy for the nation. Many are travelling to Europe and some are no longer in practice.”
A Gynaecologist at Rapha Medical Centre, Abuja, Dr Samuel Ojah also disagrees with the minister.
“To the best of my knowledge in over 50 percent of our local government areas across the country, you cannot find a single qualified medical doctor practising there. Even the ratio of a doctor to about 6000 population is a far cry from the recommended doctor/600 population.”
He said it is unfortunate that the minister thinks that doctors are leaving because we have surplus, while they are actually migrating for greener pastures which doctors cannot get here in Nigeria.
“A trip of 50 km or more from a city center will give you the sorry state of our health care delivery system. It is the lack of qualified medical doctors and poor medical infrastructure that account for the very poor health statistics in the country. But the admission of the minister that government cannot maintain good equipment is most regrettable,” he said.
Dr Uchenna Ewelike, a public health physician and health economist, said “we are one of the greatest exporters of doctors in the whole of Africa and unfortunately, Nigeria does not have enough doctors required to strengthen its own health system.
He said the Nigeria ratio of one doctor to 6,000 people is big burden to the health system, adding that it meant it is very difficult for the number of doctor in Nigeria to satisfy the needs of the Nigerian population.
Registrar of the Medical and Dental Council (MDCN), Dr Tajudeen Sanusi, did not respond to calls and text message on the issue up to press time.
Western countries gain, Africa loses
A poll citing the MDCN indicated that there are about 72, 000 nationally-registered Nigerian doctors, with only about half practicing in-country today.
A recent report by the Mo Ibrahim Foundation found that the impact of brain drain is particularly pervasive when it comes to public service delivery in the health sector. In too many African countries, there are more locally born physicians residing outside their country than in it. This puts an enormous strain on public health delivery on the continent, especially considering that there are not enough physicians to attend to citizens in most African countries.
According to WHO, the African average (calculated using the latest data year in the period 2012-2016 for 26 countries for which data is available at time of collection) is 0.45 physicians per 1,000 people.
On average, it cost each African country between $21,000 and $59,000 to train a medical doctor. Nine countries – Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe – have lost more than $2.0 billion since 2010 from training doctors who then migrated. Annually, it is estimated that Africa loses around $2.0 billion through brain drain in the health sector alone.
Currently, only three African countries have at least one physician per 1,000 people: Libya, Mauritius and Tunisia, with a physician-to-population of 2.09, 2.00 and 1.29, respectively.