Can A New National Policy Stem Nigeria’s Healthcare Brain Drain?

By Theresa Otung*

Nigeria is identified with a substantial capacity for the training of healthcare professionals in Africa. Medical Schools in 78 Nigerian Universities are rated with Africa and Global rankings in EduRank.Org 2024 Rankings, starting from College of Medicine University of Ibadan at number one in Nigeria, 10th in Africa and 659th Globally to Caleb University School of Medicine at 78th, 360th and 6646th respectively. Nigeria equally has 400 Nursing and Midwifery Training Institutions as approved by the Nursing and Midwifery Council of Nigeria (NMCN) in October 2023. Furthermore, there are a plethora of institutions for the training of healthcare professionals at the technical and technologist levels. Despite the high annual turnout of the healthcare workforce from these institutions, healthcare delivery in the country is gravely undermined by the want of professionals. Health Workforce Migration alias Brain Drain is rightly identified as the culprit. Health Workforce Migration defines the outflow of healthcare professionals to attractive opportunities abroad as well as the movement of healthcare workers within States and Federal Government Health facilities due to poor remunerations, poor healthcare facilities/management, job prospects, career opportunities, insecurity, political and economic crises amongst other reasons.

The National Policy on Health Workforce Migration in Nigeria 2023 is a vivid recognition of the threat the unmitigated exodus of skilled healthcare professionals poses to national health systems integrity and the well-being of Nigerians. The policy document contains very laudable objectives, well-informed policy positions and well-thought-out recommendations. The various policy positions adopted reflect an avid resolve to stem the continuous outflow of the healthcare workforce from the country. Improved working conditions, the provision of modern medical facilities and equipment, enhanced safety protocols, increased remunerations, and meaningful incentives for rural areas and underserved communities are mandated by various policy positions in the document. Other policy positions include the Strategic Management of health workforce migration to address the fundamental problems of the shortage of skilled healthcare professionals; Capacity Building and Institutional Development, focused primarily on Expanding and Strengthening local training institutions to provide opportunities for professional development and career advancement as well as stronger training systems for domestic and global markets; provision of a comprehensive framework that carters for the aspirations of our health professionals and the urgent needs of our nation.
The magnitude of Health Workforce Migration in Nigeria is considerable, and the Consequences are far-reaching. Nigeria is increasingly the crucial supplier of healthcare workers abroad, impacting all segments of the healthcare profession, in addition to the significant challenge of the country’s health workforce migration. The following migration data is available from respective regulatory professional bodies for 2022: Medical and Dental professionals 3,000+ Doctors, Nurses and Midwives 4063, Medical Laboratory Scientists 1553, Pharmacists, Optometrists 233, and Physiotherapists 1020. Nigeria was the highest health workforce-exporting country in Africa in 2022, with the UK, US, Canada, Australia, and Saudi Arabia identified as key destinations. There is, however, no comprehensive database on healthcare professionals, so available migration figures reflect only those professionals who requested letters of good standing from their professional bodies. There has also not been any effort on the part of the Nigerian government to document through census Nigerians who are healthcare professionals abroad. Data available from the Medical and Dental Council of Nigeria shows that only 58,000 out of 130,000 Doctors (45%) renewed their practice licenses in 2023. The obvious conclusion is that 55% of registered doctors and dental surgeons have left Nigeria in search of better opportunities abroad.
World Health Organization (WHO) Health Workforce Support and Safeguards ranks Nigeria among the 37 countries with critical health workforce shortages. Nigeria has 0.363 medical doctors per 1,000 people. This is a far cry from WHO’s threshold of 4.45 healthcare workers per 1000 people for adequate health coverage. The World Health Organization predicts a 10 million shortage of health workers by 2030, mainly in low-income countries like Nigeria. Healthcare workforce migration exacerbates the shortage of healthcare professionals, resulting in longer wait times for patients, reduced patient-to-provider ratios, limited access to specialized care, and decreased quality of healthcare services. It undermines the healthcare system’s capacity to respond to public health challenges, perpetuating the cycle of workforce shortages through reduced investment in health education and training.
There is, therefore, a pressing need to holistically address the issue of health workforce shortage in Nigeria, as it poses a significant barrier to achieving the Sustainable Development Goals (SDGs), particularly SDG3, which is to ensure healthy lives and promote well-being for Nigerians of all ages.
In Nigeria, factors that contribute to health workforce migration can be categorized under economic, political, social, and environmental factors which include low and non-suitable salaries, poor working conditions, poorly equipped health facilities, lack of assessable and non-affordable healthcare, limited job prospects and inadequate resources. Dr Oge Nwachukwu, in an interview, said that her desire to migrate was fueled by the difficulty of securing placement for the mandatory House Officer training and the more daunting task of getting employment with living wages afterwards.  Health worker migration is driven by labour market forces, including education, working conditions, remuneration, job satisfaction or the lack thereof and job security.
Strategies to mitigate migration include improving working conditions, providing professional development opportunities, promoting political stability, implementing policies and incentives for underserved areas, and creating robust migration governance structures. Nigeria must have necessary governance structures such as national planning and management, regulatory frameworks, and ethical recruitment practices.
It could be recalled that the House of Representatives, in 2023, proposed a bill that trained medical or dental practitioners compulsorily work in the country for a minimum of 5 years before they are granted full licenses to travel abroad. Freedom of movement of health personnel accords with applicable laws in the Constitution of the Federal Republic of Nigeria 1999 and the WHO Global Code of Practice on International Recruitment of Health Personnel 2010, to migrate to countries that wish to admit and employ them. It is also in consonance with the National Policy on Labour Migration, 2020. Healthcare workforce migration can, therefore, not be stopped or eradicated. It should rather be exploited for specialized and critical manpower development in the health sector. It also offers the prospect of a significant reduction in unemployment of our teaming youths and the capacity to inject billions of revenue in hard currency into Nigeria’s economy. This is pertinent in view of the current state of the Nation. The Nigerian Economic Summit Group (NESG), Unemployment Alert September 2024, shows that Nigeria’s misery index has risen to 36.9 per cent, reportedly one of the highest in the World. Many Nigerians are experiencing a cost of living crisis and weak purchasing power due to rising inflation and/or unemployment. Over 70 per cent of the workforce is exposed to vulnerable employment in non–paid or low–paid jobs and poor working conditions. Urgent steps must, therefore, be taken to ensure that tens of thousands of qualified Nigerians are no longer denied University admission into healthcare courses every year for want of placement and are then compelled to undertake courses with very limited to zero job prospects.
The National Policy on Health Workforce Migration document advances multi-sector and whole-of-government approaches to managed Health workforce migration in Nigeria. This will bring onboard relevant institutions in relevant ministries such as Education (FMoE) and the Federal Ministry of Labour and Employment (FMoLE), amongst others, in ensuring the optimization of the present health workforce and the production of a future health workforce that is responsive to the needs of the country and the world. It further advocates the deployment and application of bilateral and multilateral agreements on recruitment of health professionals, while respecting the freedom of health workers to migrate.