Nigerian healthcare workers, especially doctors, are migrating to other parts of the world to find better working conditions.
This year alone, over 5,000 Nigeria doctors registered with the United Kingdom's General Medical Council (GMC). Canada and Saudi Arabia have also experienced a substantial increase in the number of Nigerians in their health sector. In fact, 40,000 of the 75,000 registered doctors in Nigeria practice abroad.
One of them, Dr Olufunmilayo Harvey, who moved from a government hospital in Osogbo, Osun State to Leeds, England, in 2016 tells me that working conditions are so poor that many doctors become pressed to leave Nigeria right after medical school.
We explored why.
Too many practitioners, not enough jobs
As a newly qualified doctor, your first foray into the labour force is the housemanship, a compulsory one-year internship where you practice under supervision in hospitals across the country.
But like with a lot of things in Nigeria, securing a house job is difficult. Many doctors spend months or years at home looking for a placement. And in many cases, they are left frustrated.
Dr. Funmilayo Harvey opines that candidates without a strong network are unlikely to secure house jobs. “For a lot of people, the only way to get one is through connections. You finish medical school and can’t find space for the internship because you don’t know anyone in those hospitals. This is where the system starts to fail you,” he says.
And if you manage to secure and finish your housemanship, you face the same challenge when you apply for your residency, the program that will allow you to qualify as a specialist. Applying for a housemanship is like applying for a job; you write exams with the National Postgraduate Medical College of Nigeria or the West African College of Physicians and then apply to hospitals that offer residency programmes and wait for interviews. If you are successful, you get a residency.
Like with housemanships, doctors struggle to find residency placements. However, the challenge here is the difficulty of the exams, according to Dr. Hassan Adeyemi* a general practitioner in Oyo State.
A 2018 study found that the pass rate for the primary exam to specialise in surgery is less than 40% in the country, compared to a 98% pass rate for a similar exam with the United States Medical Licensing exam.
“It's almost as if there's a deliberate plot to keep doctors out of residency programmes in Nigeria,” Dr. Hassan murmurs. The 28-year-old, who is also planning to leave Nigeria in a few months, says that sometimes doctors write the exams many times before they pass.
Unfavourable work environment
Those who manage to scale the hurdles of securing housemanships or residency programmes then have to navigate Nigeria’s health sector, with the miserable working conditions and ethical quandaries that come with it.
More than 100 million Nigerians cannot afford to pay bills for treatment in public health facilities. Nigeria currently has no viable system for affordable health care, so low-income families—more than half of the population—don’t have access to formal health care.
These health challenges are well-known and Nigeria has drawn global attention for its failing health care system. Although doctors would not want to distract anyone from the plight of patients and citizens, they also suffer because of the malaise. For example, because patients cannot afford the type of services they need, doctors and nurses often have to go against standard procedure to help them.
Dr. Olufunmilayo confesses that rather than prescribing a particular drug for a patient, doctors sometimes have to authorise cheaper medication because the patient does not have money to pay for the appropriate treatment.
“Even when it is not the right medicine, you have to prescribe the closest because you want to help. You’re in a fix; the system has failed you as a professional, but you can’t just abandon your patient,” he states.
The deplorable state of facilities in health institutions across the country also forces doctors to work under difficult conditions, without the needed equipment or infrastructure.
“Imagine an emergency where a bleeding patient walks in, and you have to tell them that the generator does not have petrol. Or that you need money to buy cotton wool,” Dr. Olufunmilayo queries.
It’s not fiction. At the moment, some doctors in Edo State have resorted to performing surgeries with torches and candles.
“It’s a frustrating system. Over time, you become disillusioned, then start asking yourself hard questions about working in Nigeria,” Dr. Olufunmilayo muses.
Nigerian doctors are severely overworked, according to a 2017 survey. Doctors are supposed to see a maximum of 20 patients a day but sometimes have to see up to 150. Why is this? Well, the World Health Organisation recommends that a country has one doctor for every 600 patients; Nigeria has one doctor to 4,000 patients.
But if health institutions don’t have enough doctors, how come doctors still struggle to get jobs?
If public health institutions, especially state-owned hospitals, employed more healthcare workers, they would not be able to pay them. After all, there have been too many cases of doctors being owed salaries for months.
The sector is a mess, and despite repeated calls for a more enabling environment and better facilities for workers, the situation has stayed the same.
It’s no wonder medical doctors are leaving in droves.
What about the government?
In terms of addressing the poor welfare of Nigerian doctors, there have been conversations around implementing the Basic Healthcare provision Fund (BHCPF) that is supposed to cater to the primary health needs of Nigerians, but no further updates have been provided outside the discussions.
Recently, the Minister of Health, Isaac Adewole, suggested that doctors become ‘farmers’ or ‘tailors’ instead of getting residency placements. That laxity explains why so many doctors are willing to move abroad, regardless of how expensive it can be.
“The cost of everything from the exam till the time you move is about ₦2 million,” Dr. Olufunmilayo offers.
Moving to the United Kingdom requires a pass from the Professional and Linguistic Assessment Board (PLAB). PLAB tests come up twice a year, and in March 2018 alone, 1000 Nigerian doctors passed the examination qualifying them to register for work in the United Kingdom.
With PLAB, Nigerian trained doctors can get provisional or full registration with a licence to practice in the UK. Evidence of English language capability and fitness to practice are also application requirements.
Dr. Funmilayo explains that he was even willing to take a loan to leave the country—that’s how sure he was that he would fare better in the UK. “Here, they never owe salaries,” he laughs. Unsurprisingly, there is always power in the hospital, and he has never felt compelled to pay a patient’s bill.
It's easy to see that the real loser here is Nigeria. While developed countries like Canada and the United Kingdom get more doctors, Nigeria is losing the few doctors it has.
Those who have doctors receive many more; and to those who have few, even the few we have are fleeing the country.
Name changed to protect his identity*