Unease Over Dearth Of Physicians In Nigeria’s Health Sector

There is growing concern in the country’s health sector over shortage of medical professionals particularly trained doctors, with stakeholders putting the blame on poor funding of the sector.

LEADERSHIP investigations revealed that with an estimated 180millon population, Nigeria has about 72,000 medical doctors registered with the Medical and Dental Council of Nigeria (MDCN).

Half of the trained doctors, it was learnt, have left the shores of the country for greener pastures, leaving only about 40,000 to practice in Nigeria.

Our findings revealed that out of the 164 universities in the country, only 41 have been accredited to offer medicine as course, while a few others have partial accreditation.

It was also gathered that contrary to World Health Organisation’s (WHO’s) recommendation of one doctor to 600 patients, Nigerians are left with one doctor to 2,500 patients.

Also, considering Nigeria’s population of about 180,000, some medical experts have averred that the country would need about 303,333 medical doctors and produce at least 10,605 new doctors annually to join the workforce.

The president of Nigeria Medical Association (NMA), Dr Francis Faduyile, told LEADERSHIP in an exclusive chat that the country needs 10 times the number of doctors it currently has to be able to bridge the gap.

Highlighting some of the factors promoting migration of doctors outside the country, the NMA president said so many things are involved.

He said,  “The ones that we have found out is that most doctors are either under-employed or not employed and this has a lot to do with funding for health.  Whereas our people are yearning to have proper health, government, especially the state governments, are not funding health appropriately.

“You will see a lot of general hospitals or state specialist hospitals that you have very few numbers of doctors and they just refuse to employ. So, we have so many doctors who are not employed or are under-employed. Many of them are in the private institutions and their pay is not good. So some of them get frustrated and they leave this country

“Secondly, we have the issue of those who are really working in these government hospitals and are overworked.  The work environment is not conducive and they are not actually appreciated.

“For example, it is a norm that doctors cannot see more than 40 patients per day in a clinic because for a doctor to be able to see a patient, do examination and then start formulating how he wants to treat, he will spend not less than 15 minutes on each patient.

“Let’s even assume that he spends 10 minutes, it means that in one hour, he can only see six patients and from 8am to 6pm, which is our normal official hours, if he takes one hour for break, that is seven hours, which is 42. So, a doctor in the optimal cannot see more than 42 patients in a day.

“But those that are employed are seeing over 150 to 200 and the environment in which they are seeing the patients are terrible. This has caused a lot of frustration on some doctors that are employed and they want to look for somewhere they can practice their training”.

Faduyile also identified remuneration of doctors and other health workers as part of the issue, saying what doctors in Nigeria collect is very poor compared to those in other developing countries or developed countries.

He said, “So, once they can find a place in the outside world where they know that their lifestyle will be better, they will have better pay and better environment where they will be appreciated, many of them tend to go out.

“We expect the federal and state governments to increase funding to health. It is when they increase funding that they can open places and employ more doctors and make them work in their optimal level and not under pressure or under tension”.

On his part, a Consultant Obstetrician and Gynaecologist with the Ahmadu Bello University Teaching Hospital Zaria, Dr Solomon Avidime, said an estimated 2,000 to 3,000 medical doctors are produced from across the medical colleges throughout Nigeria annually.

According to him, taking it from a period of five years, it will amount to about 10,000 to 15, 000 doctors that have been produced, “whereas the total number of doctors working in the country average 35,000 to 45,000”.

Avidime said that the WHO recommendation is 1:600 doctors to community population, but in Nigeria, what is currently obtainable is a ratio of 1:4000.

According to him, the reason why the country has lesser doctors working currently is as a result of the continuous migration of medical doctors to other countries for greener pastures.

He noted that the doctors are leaving in search of greener pasture and to work in an environment that provides for an up-to-date technology, efficient health care system and better welfare.

The Gynaecologist said, “An estimated 2000 doctors migrate annually from Nigeria to the United Kingdom, Saudi Arabia and other developed countries. It is rather unfortunate that Nigeria will use her resources to train medical doctors that will now go and add value and improve doctors’ population ratio of another country.”

LEADERSHIP also gathered that the mass exodus of doctors out of the country, which has resulted in shortage of manpower in Nigeria’s health sector, is taking its toll on the lives of Nigerians.

In Lagos State, our correspondent gathered that as at December 2017, a total of 7500 doctors are currently working in Lagos state.

The acting president, Association of Resident Doctors, Lagos State University Teaching Hospital (ARD- LASUTH), Dr Ibrahim Ogunbi, lamented that doctors’ welfare is very poor in the country.

He said, “For instance, when working in a hospital, you are expected as a doctor to be living very close to that hospital, if not in that hospital. This is very vital because in the case of an emergency, you can quickly attend to the patient.

“In Lagos State, we have doctors that are living at Ikorodu and are working on the Island. Why won’t doctors leave the country? Is the country even a conducive place to live with your family? Is there security; is the transport system okay? What about cost of living? So, these are some of the reasons why doctors are leaving for greener pastures.”

Ogunbi said more than half of Nigerian doctors have moved to Saudi Arabia where he said the government gives doctors a total welfare package.

“Once you get there, there is free accommodation, tax is free, your place of work is very close to where you leave and you have free transportation also. The government caters for the children of the doctors that are working in the country”, he stated.

In Ebonyi State, the situation is not different. The chairman of NMA, Ebonyi State branch, Dr John Egede, decried the mass exodus of doctors from the Federal Teaching Hospital Abakaliki (FETHA) to European countries in search of greener pastures.

Egede told our reporter that currently, the FETHA has about 763 medical doctors, while those working in the state-owned hospitals are about 27.

The newly elected NMA state chairman pegged the figure of those working with private hospitals at about 10 doctors, adding that most of the private hospitals in the state are owned by medical doctors working in the teaching hospitals, except for the few who are attached to some mission hospitals in the state.

In Osun State, the chairman of the state chapter of NMA, Prof Edward Komolafe, told our correspondent that no fewer than 2,500 doctors fled Nigeria for overseas countries in 2017 alone.

Komolafe who refused to disclose the numbers of doctors in the service of the state government said it would amount to injustice if he should give any figure because no number can be said to be accurate at any point in time because doctors are living the service of Osun State government on a daily bases due to the carefree attitude of the state government towards their welfare.

The chairman said Osun state has the record of being the most affected in terms of the mass exodus of doctors, especially since government introduced the modulated salary structure.

According to him, the half salary Osun government is claiming to be paying for the past 36 months is grossly below half when compared with salary structure of doctors in neighbouring states

Komolafe said that the mass exodus of doctors has put more pressure on the few doctors left in service, adding that the few ones in service are being persuaded to stay behind; yet the situation does not bother government.

A source in the Ministry of Health who pleaded anonymity disclosed that there are 126 resident doctors and 12 consultants in the service of the state.

He however declined information on doctors in federal institutions.

The story is also not different in Edo State where government efforts to provide quality and affordable health care delivery in the state saw the previous government of former governor, Adams Oshiomhole, building a gigantic five star emergency ward equipped with a state-of-the-art amenities.

However, the imposing edifice has not record a single patient due to lack of personnel to manage the equipment provided by the state government.

When contacted on the number of medical doctors working under the state and federal governments health centres, chairman of Nigeria Medical Association, Edo state chapter, Dr Valentine Omoifo, said some of the doctors are not members of the association and therefore the association cannot give accurate statistics.

He however referred our correspondent to the management of the state owned central hospital.

The Chief Medical director at the state-owned central hospital and former Edo State chairman of NMA disclosed that there are 190 medical doctors who are on the employ of  the state government across the state. The figure, it was gathered, is grossly inadequate.

On why some of his colleagues seek greener pastures outside the country, Omoifor stated: “The answers are very simple. I am sure that if journalists have the opportunity to go to other countries they will live to practice in another clime.

“The doctors in Nigeria are not happy with what is obtainable here.  Doctors are not happy with the working environment; they are overworked and paid very little. No amenities to work, no job satisfaction. 

“There is also no security; doctors are kidnapped almost on a daily basis. The government knows what to do in order to change the narrative; people are leaving in droves. Every doctor that is here is just managing”.

Also speaking, Dr Philip Ugbodaga, who corroborated Omoifo’s position lamented that Nigeria health indices are among the worst in the world.

He added that what is required is the political will by government to change the healthcare situation.

He said, “It is quite unfortunate that close to 60 years after independence, Nigeria is still unable to have a robust healthcare system that is efficient and responsive to the medical needs of its citizens. Our health indices are among the worst in the world.

“Those Nigerians trained as doctors leaving the country complain of poor working environment, inadequate remuneration and poor facilities, amongst other issues.

“The solution is simple but requires political will, interest and a deliberate policy to energise the healthcare sector. Any nation that wishes to develop must invest heavily in health and education. These are the two pillars of development, which we cannot afford to run away from.

“I am greatly enthused that many states are beginning to understand the nexus between healthcare, education and development so much that a state like Edo is laying a very solid foundation for the healthcare system with a rejuvenated Primary Health Care model and other policies that lay specific emphasis on infrastructure, technology, remuneration and skilled manpower”.

Giving an insight into the number of medical practitioners that have left the country, Ugbodaga said, “ It is difficult to ascertain the exact number but it is estimated that between 800 to 1,000 Doctors leave Nigeria yearly.

“In UK for example, about two per cent of the medical workforce is contributed by Nigerian doctors and this may even be more in the United States of America and elsewhere. It is also estimated that about 40,000 out of the 75,000 registered Nigerian medical doctors are practicing outside the country.

“By the World Health Organization standards, Nigeria needs over 300,000 Doctors to adequately care for its estimated 180 million populations. The tragedy however is that the majority of our highly trained medical workforce are currently practicing outside the country.

“The expertise of these doctors is required here. Our people, especially at the grassroots, need their skills but they are outside our shores. So, whereas in America you have one medical doctor caring for 300 patients, we have one medical doctor caring for over 4,000 patients here in Nigeria. This is against the World Health Organization’s recommendation of a 1/600 doctor/patient ratio”.

He further identified harsh economic situation, coupled with poor infrastructure, unenviable remuneration and decayed facilities as major challenges militating against the sector

In Rivers State, LEADERSHIP findings revealed that there are a total of 1792 medical doctors practicing in both public and private health facilities.

According to a document obtained from the Rivers State Ministry of Health, 800 medical doctors work in the University of Port Harcourt Teaching Hospital (UPTH) while 233 work in the Rivers State Hospital Management Board (RSHMB).

The document revealed that 80 medical doctors work at the headquarters of the State Ministry of Health, Port Harcourt, while 245 others are attached to the Rivers State Primary Health Care Management Board (RSPHCMB).

The private health facilities in the state have a total of 399 medical doctors working in them, while 35 work in private-public-partnership (PPP) health facilities in the state.

Also in Kogi state, there are about 210 doctors, out of which 110 are on the nominal role of the state government, with the remaining ones being engaged in either private practice or working at federal government owned health centres in the state.

The NMA and other stakeholders in the health sector have therefore called for increased funding for health both at states and federal level.

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