The best time to plant a tree is 20 years ago.
The second-best time is today.
Chinese proverb
Nowadays, news of emigration of Nigerian Doctors, especially newly qualified doctors to Europe, North America, Middle East and elsewhere – to seek specialist training or earn a living – is common. Consequently, one question arises.
Do Nigerian medical schools exist to train doctors for export?
A huge problem
The short answer is No! Our Medical Schools exist to train doctors to work in Nigerian hospitals. If that is agreed, then it should also follow that it is uneconomic for Nigeria to lose elite, trained and highly skilled doctors to other, mostly richer countries (UK, USA, Saudi Arabia)! Doctors are usually the brightest in their cohort and what Economists call “merit goods”.
So, a situation where the poor is apparently subsidizing the rich, suggests that there is no value placed on the investment in doctors. Many would agree that this is not sensible nor give value for money.
And another one
Secondly, the reduced number of medical doctors and of course, other specialists is interfering with the delivery of quality of care in Nigeria. Hence, fuelling medical tourism. Lack of doctors in numbers and lack of well-trained specialists in particular, impacts on care and promotes poor outcomes. Even forgetting the huge amounts lost yearly to medical tourism, we are losing the crème de la crème of our society.
So, we do not have enough doctors in Nigeria. We are also losing the ones we have managed to produce and train, to other countries, to the detriment of our healthcare system. Our patients including government officials, and their families, are leaving the country for medical tourism because our healthcare system is in distress. Some patients are even travelling abroad to see Nigerian doctors who had left the country.
Does the government realise the scale of the problems? Does it actually care?
What can be done?
We believe and recommend that urgent action by the Government to retain the majority of our doctors within Nigeria is required in order to promote the health of every one of us in the society.
The strategy
New and blue-sky thinking is required. First, we believe that skilled Nigerian Doctors with specialist training and personal experience of the push and pull dynamics of doctor emigration should be contracted to help develop solutions to reverse the trend. There is also a large pool of Nigerian healthcare specialists, all over the World, who can be incentivised to return home.
Some have returned or are returning on their own accord and building capacity within the private health care sector. They are scattered across small centres of healthcare excellence mainly in the private sector in few cities and offering services to even fewer teaching hospitals. These are Nigerians who are committed to the motherland and wish to improve healthcare delivery in the country. A formal platform of engagement should be developed.
At the heart of all these is the nexus between medical education, societal well-being and progress. As such, we believe it is long overdue for Nigeria to develop robust nationalistic policies and programmes that promote the common good. The common good is for many of our doctors to remain in Nigeria to service its healthcare needs. The common good is for easy accessibility and affordability of good quality healthcare in Nigeria. The common good is for creating a healthcare system that delivers good outcomes such that no one needs to travel out. The health of the nation should be paramount to the government and the general citizenry.
Right now, many young doctors are frustrated and disillusioned. Medicine has failed to deliver or meet their expectations. Poor job prospects, poor salaries, poor conditions of work and service, poor remunerations and poor training facilities are all they have. We need to stop destroying our young doctors and pull them out from under the bus.
The future of healthcare in Nigeria is in the private sector. Hence, we must encourage entrepreneurship that delivers more hospitals in more corners of the country. This can be through single digit loans and removal of heavy handed bureaucracy. We also need to create a soft landing for medical doctors in the diaspora. We must encourage them to return through collaborations with the teaching hospitals and public/private partnerships.
Ultimately, the real solutions may be found in the courage for government intervention and legislative actions to develop a package of measures beginning with maximum opportunities for local training for all medical graduates under satisfactory, attractive terms and conditions of service that may dissuade emigration. We must keep our best doctors for Nigeria.
Conclusion
If a strategy can be developed to achieve and implement the outputs of such blue sky thinking, we believe that Nigeria may be able to have a good chance to leap frog to a position where the changes its young doctors and medical tourists are looking for overseas can be mostly found in Nigeria; with huge savings for individuals and the economy.
We believe the best time to take action and achieve the desired results is now.
Signed
Dr. Samuel Osaghae, FMCS (Nig), FWACS, FRCS, FEBU, Consultant Urological Surgeon, University of Benin School of Medicine and Teaching Hospital
Dr. Biodun Ogungbo, MBBS, FRCS, FRCSEd, MSc. Consultant Neurological Surgeon, Brain and Spine Surgery Consortium Abuja
