The brain drain of healthcare professionals in Nigeria: The buck stops with government
Nigeria's health sector faces an exodus of skilled workers. Adebisi Adenipekun makes recommendations to address the push and pull factors leading Nigerian healthcare professionals to emigrate abroad.
While reading this article, chances are high that at least one healthcare professional is planning to exit Nigeria. They could be at the early stages of this process, such as discussing the possibility with colleagues abroad, or at an advanced stage, such as booking accommodation upon arriving abroad.
There are many narratives concerning the emigration of healthcare professionals from developing countries like Nigeria to more developed countries. The views cut across a broad spectrum from outright condemnation of health professionals for leaving their country to loud ovation for every health worker that has been able to leave, and of course, several views in between the two extremes. This article will explore healthcare professionals’ motivations for leaving the country and what measures could be taken to retain healthcare professionals.
The motivation of healthcare professionals to leave developing countries for developed countries has been widely reported in the literature from as early as the 1960s when as many as 27,000 professionals from Africa travelled to western countries. The World Bank in 2007 reported that over 44 percent of African citizens who completed their study programmes abroad, especially PhDs, between 1986 and 1996 did not return to Africa. Regardless of the data set used, the recent statistics on the emigration of healthcare professionals from Nigeria to developed countries are worrisome. For instance, the UK immigration report in 2022 put the number of Nigerian healthcare professionals granted working visas in the UK in 2021 at 13,609. Also, between December 2021 and May 2022, a total of 727 Nigerian-trained medical doctors relocated to the UK. While the UK is one of the top destinations, Nigerian-trained healthcare professionals emigrate to Canada, the US, Saudi Arabia, Australia, and other developed countries.
The reasons for this mass exodus of highly skilled healthcare professionals have been broadly classified into pull and push factors. The pull factors are the incentives and positive structures available in developed countries that provide the promise of a better life and opportunities for healthcare professionals in their countries. These include, but are not limited to, the prestige of foreign education, higher prospects for career development, better remuneration packages and working conditions, and improved quality of life.
The push factors are negative conditions and systems in developing countries, including Nigeria, that tend to “force” healthcare professionals to seek opportunities outside of the country. The deplorable working condition of healthcare professionals in Nigeria is a source of concern to both healthcare service providers and their patients. The high level of economic inequity in the country plays a part in these conditions. The rich will often seek solace in their ability to travel abroad for healthcare services or get healthcare in well-equipped private hospitals. This leaves more than 40 per cent of Nigerians living below the poverty line to overwhelm the understaffed and ill-equipped government hospitals.
However, at the risk of stating the obvious, the push factor in Nigeria transcends the challenges with the healthcare system. Escalating security challenges and harsh economic conditions have been a recurrent theme for the emigration of healthcare providers in recent years. Healthcare professionals and their families are not immune to the impact of inflation, increasing rates of banditry and kidnapping experienced in the country. What is worse is the lack of a sense of clarity and hope of when and how the government will resolve these challenges. On this premise, one can argue that healthcare professionals being poached by developed countries needed to prioritise their survival and the well-being of their families as opposed to being considered selfish.
A critical question, therefore, is “what is the government of Nigeria doing to retain the best brains in the country?”. It is expected that politicians and their aids will articulate excuses to justify the gap as opposed to taking responsibility and innovatively tackling the root causes of the challenges. Healthcare professionals cannot be guilt-tripped to stay in the country. The government must demonstrate commitment to improving the quality of work and life for healthcare professionals in order to retain them. Briefly highlighted below are five recommendations on how to tackle the brain drain in Nigeria.
Increase human resources for health (HRH) training capacity: The demand for healthcare professionals in the country currently outweighs our production capacity (without factoring in those who are emigrating). A plan to close the HRH gap in Nigeria requires clarity of the gaps and clear projections on how to close the gaps. We can either import HRH (like the developed countries) or train them locally. I argue for the latter because it is more organic and can potentially be a source of revenue (through remittances) for Nigeria. If there is a shortage of HRH in developed countries, why can’t we invest in training healthcare professionals for the global market?
Invest in health technology and telemedicine: Many public hospitals are overwhelmed with patients (and their caregivers) because we are yet to fully explore the potentials of telemedicine and health technology. We need to urgently fix basic healthcare service issues such as interoperable electronic medical records in Nigeria.
Improve healthcare financing mechanisms: It is not sustainable for both government and individual citizens to bear the cost of healthcare. Health insurance works and there are several models Nigeria can learn from. The need to ramp up health insurance coverage for the informal sector in Nigeria will be a game changer in financing the cost of healthcare and remunerating healthcare professionals appropriately.
Fix infrastructure: Healthcare professionals have families and form an integral part of society. Their decisions to stay or leave the country will be influenced by the quality of life available to the people they care about. The decision to stay will remain tough if the power supply remains unreliable, there is no access to broadband internet, and the potholes on the road mean a threat to life, among others. These might take some years to fix but the government must show leadership and commitment for citizens to decide to make the sacrifice.
Tackle insecurity: This is tricky but very important. If the government is helpless in the face of security threats, citizens have no choice but to escape for safety reasons. This is simply intrinsic to human nature.
In conclusion, both the pull and push factors behind the brain drain of healthcare professionals from Nigeria can be tackled by deliberate planning and actions by the government of Nigeria. This will, however, require an as-of-yet-unseen political will to address both the immediate issues around capacity and financing in the healthcare sector, along with the societal issues that make choosing to stay in Nigeria more difficult.
Adebisi Adenipekun is a current MPP student and trained pharmacist from Nigeria.