Nigeria's medical brain drain

ABUJA, Nigeria — Each week, at least 12 Nigerian doctors are employed in the United Kingdom. More than 4,000 are already practicing in the United States, while Canada continues to attract medical professionals from Africa’s most populous nation.

But there are no full-time specialists at most Nigerian public hospitals. They are largely staffed by retired nurses, community health officers, and new doctors with little clinical experience. More than half of the doctors remaining in Nigeria work in a handful of major cities.

Doctors are leaving Nigeria — and the government seems to be making little effort to convince them to stay. In a recent viral video widely ridiculed on social media, health minister Isaac Adewole suggested that doctors who couldn’t find work should turn to alternative careers.

“It might sound selfish, but we can't all be specialists,” Adewole said. “Some [doctors] will be specialists, some will be GPs [general practitioners], and some will be farmers.”

A similar approach was taken by President Muhammadu Buhari last month. “You don’t have to be in [a doctor’s] uniform to be loyal,” he said. “Others who feel they have another country [to go to] may choose to go. We will stay here and salvage it together.” Online, citizens drily pointed to the president’s habit of going abroad for medical treatment.

But while officials play down the impact of Nigeria’s medical brain drain, advocates are increasingly concerned about the crisis, which they say has both human and economic costs.

Aside from leading to a severe shortage of medical staff in Nigeria and disrupting health care services, a report released in August by the Mo Ibrahim Foundation estimated that African countries have footed a bill of $4.6 billion in training doctors who were then recruited by the U.K., U.S., Canada, and Australia.

Following Adewole’s video, Nigerians took to social media to decry the minister’s claims. They blamed the government for the poor structuring of the medical residency program in Nigeria, which has left many doctors without placements, and for a difficult working environment that has recently seen the health sector plagued by incessant strikes.

It is not known exactly how many doctors have left the country. In 2017, a Nigerian Medical Association official, Olumuyiwa Odusote, told local media that 40,000 Nigerian doctors were practicing outside the country — around half of all doctors Nigeria has trained since the 1960s.

NMA President Dr. Mike Ogirima has put the number much lower, at about 15,000. Neither the NMA nor the Medical and Dental Council of Nigeria could provide Devex with an official figure.

However, the Association of Nigerian Physicians in the Americas has more than 4,000 members; data from the U.K. shows that more than 5,000 Nigerian doctors are working there; and the Canadian Medical Association Masterfile has recorded a quadrupling of Nigerian doctors practicing in the country over a decade, from 176 in 2008 to 568 in 2018. Other top destinations include Saudi Arabia, Kuwait, and the United Arab Emirates.

And there is no end in sight. A 2017 poll showed that 9 out of 10 doctors in Nigeria wanted to leave the country due to poor working conditions and low remuneration. Another survey showed that high numbers have registered to take foreign medical exams allowing them to practice abroad.

Organizing online

In WhatsApp and Telegram groups, Nigerian health care professionals are sharing information on how to migrate to higher income countries. Bimpe Folarin, a 32-year old nurse, moderates one such group. Bimpe works as a wedding makeup artist on the weekends for additional income, and says she has not received any salary from the government for three months. Most of her colleagues have at least one “side hustle” ranging from small-scale trading to photography, she told Devex.

“Those that don’t have a second job either have rich spouses or are cheating the system. It is a depressing mood at work and I just want to leave,” she said.

Bimpe wanted to move to the U.S. but, fearing recent stigma around her Muslim faith, the mother of two is now thinking of Canada. She is saving 40 percent of her monthly salary for the trip, and believes she can reach her target of 2 million Nigerian nairas ($5,500) whenever the government pays her outstanding salary. “I should be in Canada by early 2019,” she said.

In the group she moderates, hopeful emigrants refer to the paucity of job opportunities, low pay, insecurity, a bleak future for their children, and poor social infrastructure as reasons for wanting to leave Nigeria.

Hospitals owned by Nigeria’s central government, which are more competitive for placements, pay young doctors up to 200,000 nairas ($550) monthly. Some state hospitals and private facilities pay just a quarter of that. If they go to the U.S., doctors earn an average of $25,000 monthly.

“My husband used to be a die-hard, never-leave-the-country guy,” another medical doctor, Dr. Damilola Odewole, shared on social media. “But we couldn't pay our rent and our daughters need to school and eat, plus they weren't giving us residency [placements at a hospital],” she said. They even increased the price for the medical exams, she added. The family is now looking to leave Nigeria.

Uneven distribution

In spite of the surge in doctors travelling abroad, the health minister argued the country has a better doctor-patient ratio — 1 to every 4,088 residents — than many countries in the region.

Instead, what Nigeria is struggling with is an uneven distribution of health care professionals, he suggested, explaining that about 50 percent of doctors work in the metropolitan hubs of Lagos and Abuja, while many facilities in the north and in rural areas are left without doctors.

A health ministry official also admitted that better salaries would discourage health workers from travelling abroad, but said the Nigerian government simply cannot match what the U.K., U.S., Canada, and Saudi Arabia are paying.

For doctors who spoke to Devex, however, the decision to leave is about more than just pay, including poor working conditions, delays in salary payments, and lack of employment.

And as hospitals across Nigeria lose their doctors, patient care is limited and health professionals who are left behind are overworked. Health indices show that Nigeria continues to be a major concern for global efforts to control diseases including HIV, tuberculosis, and malaria. Only a third of births are handled by skilled health personnel, while the country has one of the highest maternal mortality rates in the world.

At Adeoyo Hospital in Ibadan, southwest Nigeria, all surgeries had to be cancelled or rescheduled when the hospital’s only anesthesiologist left in June. That situation is not unique.

“There was a time that all the resident doctors in our O&G [obstetrics and gynecology] unit moved to U.K. and Canada within two months,” said Folarin. “The house officers had to be the ones on call performing cesarean sections until the hospital could employ another resident doctor, who also left after a month because of the workload and a better job offer in London.”

Update, Nov. 22: This story was updated to clarify that comments from Dr. Damilola Odewole were shared on social media.