In December 2016 the Chief of Staff to President Muhammadu Buhari, Alhaji Abba Kyari was hurriedly flown abroad to the United Kingdom after it was reported he started having breathing difficulties resulting in his losing consciousness.
According to reports, Kyari was battling Diabetes and was said to have collapsed and had to be rushed to London for treatment.
On May 7, after spending some few months undergoing extensive health checks early in the year, President Muhammadu Buhari left the country on what was to be an exhaustive healthcare tourism which had him away from the country for 103 days; he was said to undergone several procedures and returned to Nigeria on August 19, 2017.
Few days after the country celebrated its 57th Independence and on the day that teachers all over the country were celebrating World Teachers Day, Nigerians were informed that the Minister of State for Education, Prof. Anthony Anwukah had been flown to the United States for medical treatment; this was despite the government’s alleged stoppage of payment of oversea travel for medical treatment for government officials.
The policy was put in place in order to check the rampant oversea medical travels which had become the norm for senior public office holders. A according to the Minister for Health, Prof Isaac Adewole, the government would certainly not encourage expending Nigerian hard-earned resources on any government official seeking medical care abroad, when such can be handled in Nigeria.
But despite the caveat placed on government officials seeking medical tourism the trend continues unabated. But for the masses the same cannot be said of what they are faced with when they visit public hospitals across the country; for them it is stories of frustration, mismanagement, tears and ultimately death with no reprieve whatsoever.
Somachi Asoluka, a resident of Lagos gave a chilling account of the predicament she and her family faced at the Lagos University Teaching Hospital (LUTH) recently which led to the death of one of her relatives after he was rushed to the hospital.
“My family friend has just died,” she stated on her Facebook page, “He was rushed to LUTH this evening and we were told that there was no bed space, later when a spot was fond there was no consultant was available. How do we translate our rage to change, what is wrong with this sick country? What must happen for things to change?” She asked on social media.
Her story is among the thousands of the reality hitting Nigerians in the rapidly eroding healthcare system in the country.
According to the Nigerian Medical Association, (NMA) the deterioration in the health in the country coupled with the neglect witnessed over an extended period of time evidenced by lack of funding, under supply, inefficiency, decrepit equipment, is having a devastating effect on the workforce who are now seeking greener pastures outside the country.
Mass exodus.
Disclosing the exodus of doctors from hospitals across the country the president of the Lagos State Chapter of the NMA, Dr Olumuyiwa Odusote, said the number of doctors leaving the country is alarming and already the effects are being felt in the hospitals with more than 40,000 of the 75,000 registered doctors in Nigeria plying their trade outside the shores of the country and 70 per cent of those practising within the country already on the process of taking jobs outside the country
“The health crisis in Nigeria is unprecedented as the mass exodus is hitting an alarming proportion. Already, it takes a new patient two to three hours to see a doctor,” he said while addressing news reporters in Lagos recently.
Giving a breakdown on the statistics the NMA has recorded this year on the number of doctors who have yielded to the brain drain, Odutose revealed that over 100 doctors have resigned from the University College Hospital, Ibadan; about 800 doctors resigned from Lagos State hospitals in the last two years with over 50 in November.
“Kebbi State has been unable to employ a single doctor in two years despite multiple adverts for employment; over 200 doctors and nurses have resigned from Ladoke Akintola Teaching Hospital this year. Seventy per cent of Nigerian doctors are making plans to leave for foreign lands and are taking exams to that effect,” he said.
More seeking to leave
A survey carried out in August 2017 by the NOIPolls in partnership with the Nigeria Health Watch, a non-governmental organisation (NGO) found that eight in every ten doctors in Nigeria are considering relocating to another country in search of better working conditions while six in every 10 doctors are already in the process of realizing their dream.
This quest for working abroad cuts across personnel from the junior, middle and senior-levels, both from the private and public hospitals across the country.
The President of the Nigerian Medical Association (NMA), Dr. Mike Ogirima, confirmed that between 10,000 and 15,000 Nigerian doctors are working outside the country and this is after they are trained by the Nigeria government.
“Nigeria has trained these doctors while other countries are making use of them. That is a sad thing. Of course in a country where the working environment is not conducive, what do you expect?” Ogirima said.
While many of the Nigeria trained doctors are leaving elsewhere, the corresponding number of Nigerian doctors trained outside the country returning back is not encouraging.
“I think fewer people are coming in than the number going out every year, so it doesn’t balance out at all,” said Dr Ifeanyi Nsofor, health communications advisor for Nigeria Health Watch which partnered on the survey.
“Based on the National Association of Resident Doctors (NARD) figures that 2,500 are leaving by September this year, I’m not sure we have corresponding numbers coming, so it really doesn’t balance out,” he said.
Doctors trained outside Nigeria are required to sit for the Medical and Dental Consultants’ Association of Nigeria (MDCAN) practice exam each year to enable them practise in Nigeria, but more than half of them failed the test this year.
Desirable countries.
The top countries of desire for most doctors leaving Nigeria are United States, United Kingdom, Canada, South Africa and most recently, Middle East countries; Saudi Arabia has registered a considerable acceptance of Nigerian medical personnel.
Those seeking for recruitment in the United States write the United States Medical Licensing Examination, (USMLE) while those eyeing employment opportunities in the United Kingdom undergo the Professional and Linguistic Assessments Board (PLAB) examination. For those interested in migrating to Canada, they need to meet the requirements in evaluation for the Medical Council of Canada (MCC) Evaluating Exam (MCC EE), while South Africa requires an examination set by the Health Professions Council of South Africa (HPCSA).
Ogirima said that in 2012, more than 1,000 doctors had written exams for the Professional and Linguistic Assessment Board Examination (PLAB) to practise in the UK and the number has been increasing arithmetically to the extent that doctors who just finished their housemanship are now joining in the trend after their training.
“Annually, the number of Nigerian doctors departing the country to work abroad ranges between 500 to 700,” an NMA official said and the number is increasing because the doctors who have migrated are now helping in recruiting their colleagues as well, a practise that has inspired so many doctors to consider taking their services outside the country.
Among the factors that dissuade doctors to sign off from Nigeria are high taxes and deductions from their salary, low work satisfaction, and poor salaries and emoluments.
Poor Remuneration
The remuneration for doctors working in Nigeria is nothing to be compared to what their colleagues next door make. For example doctors in the United States earn an estimated $75,000 (N26.2m) on an 8-hour workload daily five times a week while in Germany the annual pay is $68,000 (N23.8m) annually on a 10 hour-daily shift.
The estimated annual income for a General practitioner (GP) in Canada is $64,000 (N22.4m) on a 10 hour per day, 6 days a week schedule while the doctors in Australia rake in $62,000 (N21.7m) annually for work done for five hours, five days a week.
South Africa, Japan and Sweden pay $37,000 (N12.9m), $66,000 (N23.1m) and $60,000 (N21m) annually respectively for working approximately seven hours. In Ghana you earn $20,000 (N7m) annually for nine hours daily five days a week; the minimum annual pay for a doctor in Kenya is $38,000 (N13.3m) while doctors in Rwanda earn $21,000 (N7.3m)
But in Nigeria doctors earn $18,000 (N6.3m) annually and work for 9-10 hours daily, 6 days a week with their salaries irregular.
Doctors in some of the Federal Tertiary Health Institutions (FTHI) are being owed salaries and allowances dating back to 2014.
According to a member of the Association of Resident Doctors (ARD) at the University Of Benin Teaching Hospital (UBTH) many of the doctors are still being owed despite several protests and industrial actions the doctors have embarked on.
“The Doctors of UBTH have not been paid percentage of their salaries since January 2014; this is not the case in most federal government hospitals in the country. One wonders why doctors in UBTH should earn less than those in OAUTH, Ife, UCH, Ibadan, National Hospital, Abuja, UCTH, Calabar etc. The only reason that comes to mind is that the management in these institutions is more competent,” the source said.
The imbroglio witnessed in some hospitals regarding salaries has led to the doctors taking to protests and at times storming the accounts departments of their respective hospitals to enforce their payment.
“If I have to now carry placard and protest on the street, call media briefing and wear black ward coat before I am paid for services being rendered tell me why I will not move out of this country when an opportunity comes to me,” a resident doctor in one of the government hospitals said.
Poor infrastructure, decaying equipment, mismanagement.
Another issue giving rise to the massive abandonment of duties by doctors is the frustration they encounter in infrastructures, equipment and materials.
Doctors are made to work in the harshest of conditions with equipment malfunctioning or not functioning at all. Alternate power delivery in hospitals across the country is minimized leading to some patient relatives being asked to come to hospitals with generators some doctors lamented.
In one of the hospitals in the South-South region which received accolades for its stem cell centre and hitherto regarded as the citadel of health care, training and research, became a shadow of itself with the Ultrasound machine at the hospital not working and the Stem cell transplant centre in the hospital, which was established with the intention of bringing smiles to the families with sickle cell, has dilapidated to rots and rust.
“The situation is not different in the department of Radiotherapy as the radiotherapy machine which the government of Nigeria spent fortune to alleviate the conditions of many patients from several states no longer functions leading to patients to referred far and wide for such care,” a doctor complained.
Accident and Emergency department of most hospitals operates below a standard, primary health care centre hardly have what to work with, Some public hospitals don’t have necessary tools like glucometers to check sugar level or instruments to measure blood pressure while the hospital pharmacy lacks drugs and intravenous fluids.
This non availability of materials are borne by the patients as their relatives are made to go source for the materials and are usually billed for items they purchased that was not offered by the hospital
“I had one of the worst day of my practising lives as a paediatrician when I saw a child that was having a fit and I needed adrenaline. I was trying to revive the child, who was two years of age and when I looked back and shouted at my assistants where the adrenaline was, they told me tearfully that there was none,” a doctor recounted, “I lost that child for something that should be available in the hospital. I felt miserable that day because that child ought not to die.”
The most notable indication to the level of decay in the health institutions across the country came recently when the wife of the President, Hajia Aisha Buhari, lamented the non-functionality of the X-Ray machine at the State House Clinic. This followed her daughter calling out at the management of the Aso Clinic inability to provide Paracetamol (pain relief) tablets to the clinic despite a budget of N3billion for the provision of drugs.
Speaking at a function in October, Mrs. Buhari said she took ill and was advised to travel to London for treatment, which is the tradition for high level persons in Nigeria, but she refused and called the Aso clinic.
“I called the Aso Clinic to find out if they have an X-Ray machine; they said it’s not working. In the end I had to go to a hospital owned and operated by foreigners 100 per cent. There is a budget for the Hospital and if you go there now, you will see a number of constructions going on but they don’t have a single syringe there. What is the purpose of the buildings if there are no equipment there to work with? You can imagine what happens across the states to governors wives if this will happen to me in Abuja,” she said.
Inconsistent government policies.
While her concern might be to what happens to wives of state governors, the masses are at the receiving end as there is no succour for them and with the latest government ban for medical doctors working in public hospitals to engage in private, more damage awaits them.
This policy of the Federal Government, according to Dr. Emmanuel Obayi, who is the President, National Association of Resident Doctors (NARD) Federal Medical Centre Abuja has the potential of leaving public health institutions in disarray owing to the fact that most doctors operating in the public sector are poorly remunerated and are forced to work in harsh conditions.
““The federal government is joking. We don’t think they are serious with the ban slammed on doctors in public sector from engaging in private practice. Compare the welfare package of doctors in the public sector in some other countries with what we have in Nigeria. You will find out that we receive peanuts from government here. If government pays its doctors very well, there will be no need for them to engage in private practice of any kind. Even if they do, it will be just to help humanity,” he said adding that the ban could increase the exodus of practitioners in public health institutions.
More worrisome is the fact that the government do not put any machinery in place to cushion the effect of its policies. This was also the very manner in which the administration of then President Goodluck Jonathan sacked 16,000 resident doctors while Prof Onyebuchi Chukwu was the Minister for Health in 2014. The high rate of brain drain witnessed in the health sector analysts believe is as a direct consequence of that singular policy of the government.
“After Jonathan reinstated the sacked doctors the residency program was broken into two parts: Junior residency and senior residency. That means you are given three years for junior residency and after you pass (residency examinations) you have to reapply for senior residency. The Chief Medical Directors (CMD) wanted to use it to break NARD but now the NARD members are running away with their back before they break it. Furthermore it is easier to get a placement for job in UK than to get a spot for residency in Nigeria,” a senior residency officer explained, “that singular act of the FG sacking that amount of doctors sent shock waves throughout the residency program so many knew instantly that there is no job security here.”
Another complaint the doctors are making is the high tax and deductions from their salaries with a doctor complaining of deductions amounting to N80, 000 from his salary as a Senior Registrar.
“I just feel that the deductions from my salary is paying someone else salary but if you look at how many hours we put in you start asking yourself if this sacrifice is worth it,” a doctor said.
Widening doctor-patient ratio
With the dwindling numbers being recorded in Nigeria hospitals there is the fear that the doctor patient ratio in Nigeria will further increase and have an adverse effect on doctors who are already overstretched with demand for their services. With the situation in the health sector, the doctor patio ratios is a far cry from the recommendations of the World Health Organisation ( WHO) of one doctor to 600 patients.
It is estimated in Nigeria that the doctor patient ratio in Nigeria stands at between 1: 400 to 1: 6000 which places Nigeria on 187th out of 191 nations on the WHO performance rating. This reality affects the quality of healthcare delivery in the country.
Nigeria needs 303,333 doctors to cater to its present population, and will require 10,605 new doctors each year to maintain coverage.
“Only at this level can we expect good quality care that is not compromised by errors occasioned by fatigued and overworked doctors,” said Dr Bell Ihua, chief executive officer of NOIPolls.
Millenium Declaration still a mirage
One way of achieving the consolidation of healthcare delivery in Nigeria is by increasing funding and financing of the healthcare sector as pledged by African leaders 16 years ago to adopt the Millennium Declaration designed to improve social and economic conditions in the world’s poorest countries by 2015.
In April 2001, heads of state of African Union countries met in Abuja and pledged to set a target of allocating at least 15 per cent of their annual budget to improve the health sector, a declaration that was applauded by WHO and the United Nations but since then till today, the best we have achieved is six percent.
In the 2017 national budget, the allocation to health is 4.1 per cent while in 2016 it was 4.4 per cent which shows the mirage of achieving the minimum of 15 per cent to achieve basic medical care that a citizen needs. Partnership for Advocacy in Child and Family Health (PACFaH), a health policy advocacy project led by Nigerian NGOs in its report on the State of the Nigeria Health – 2017 decried the low budget allocation to health.
The advocacy group which holds government to account to fulfil health policy and funding commitments, said “the 2017 proposed health budget is at 4.17 percent, a whopping 73 percent gap from the 15 percent benchmark, urging the Federal Government to allocate 7.5 per cent of the 2018 Budget to health sector with a view to attaining 15 per cent by 2026.
If these suggestions are not taken heed, the forecast for the health sector in Nigeria in five years looks disastrous.
By Ahaoma Kanu
