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Ciuci (pronounced see-u-see) Consulting is a strategy and consumer intelligence company with strong technical expertise in strategy formulation, research, and human capital development.

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Health care workers are perhaps the most important category of employees in the world’s labour force. They play a critical role in facilitating and promoting quality health care for the world’s population as well as providing essential services that prevent and treat diseases, sicknesses, injuries, etc. The recent COVID-19 pandemic that ravaged most economies with over 45,428,731 cases and 1,185,721 deaths further gave credence to the unmatched value this sector of the labour force offers humanity.[1]

Unfortunately, in Nigeria and some other parts of the world, the services of health care workers are grossly undervalued. This has led to a significant number of health workers seeking greener pastures and favourable professional opportunities in other countries with better structure. The country’s neglect of its health care workforce is a pointer to its overall attitude to health care delivery, which is abysmal to say the least.

Several data exist to show how Nigeria has failed to appropriately prioritize health care. According to the World Health Organization (WHO), the average life expectancy in the country is 54 years. This is lower than its peers in Africa; with South Africa and Ghana’s average life expectancy at 64 years.[2] Also, there is approximately 1 doctor to 5000 patients in the country,[3] which is a high number in comparison to the WHO’s recommended ratio of 600 patients to 1 doctor. This is alarming because Nigeria has one of the largest human resources for health on the continent. The health sector’s budget which is only four percent of Nigeria’s budget also shows how the government has ignored the importance of this sector.

A trend that has been consistent in the sector is the “Brain Drain”. According to a study carried out in 2010 on the Nigerian migration trend and the issues of brain drain, a total of 637 doctors left Nigeria in 2010 and approximately 227 migrated the following year.[4] A 2017 study by NOI polls in partnership with Nigerian Health Watch revealed that 88 percent of Nigerian doctors, approximately nine out of ten doctors are considering migration abroad for better job opportunities, a number that is projected to keep rising as doctors continue to face systemic challenges.[5]

The recent pandemic has emphasized the need for the country to protect its healthcare workers to ensure a functioning health system for our society. “The COVID-19 pandemic has reminded all of us of the vital role health workers play to relieve suffering and save lives,” said Dr. Tedros Adhanom Ghebreyesus, the WHO Director-General. He added that unless we keep our health workers safe and valued, no country, hospital or clinic can keep its patients safe. This has further accentuated the value of health practitioners globally, with almost every country in the world having a high demand for health care services.  Despite the indispensability of health workers, the government is yet to develop policies to make Nigeria a favourable destination to practice. In light of this, the “Brain Drain” trend is and would continue to be the order of the day.

To understand the mindset of health care workers and students about the prospects of practicing in Nigeria, Ciuci Consulting interviewed a randomly selected sample of 20 students in tertiary institutions, and 30 health care workers.  

[1] (World Health Organization, 2020)

[2] (World Life Expectancy, 2018)

[3] (Abang, 2019)

[4] (Ezeokafor, 2010)

[5] (NOI Polls, 2017)

Analysis of the data collected across the respondents revealed the following insights:

Practicing health care professionals intend to migrate to other countries and students do not want to practice in Nigeria 

95% of the respondents, both students, and doctors, do not intend to practise in Nigeria. All the students confirmed their intentions to migrate to other countries immediately after their education in Nigeria. However, not all health care professionals expressed desires to relocate outside of Nigeria. 5% of the respondents do not intend to relocate. This further validated the previous studies that highlighted that ‘brain drain’ is projected to rise as doctors continue to face challenges.

Across the two categories of respondents, several reasons were highlighted for not wanting to practice in Nigeria. Poor remuneration and incentives, infrastructural decay, and lack of opportunities for growth and advancement were identified as the top three reasons. Students were worried that the infrastructural challenges could negatively impact their ability to deliver quality care to patients and thus, expose patients to further complications and death at their hands. Also, as learning opportunities are pertinent to practicing health care professionals and students alike, concerns were expressed regarding the limited access to practical ways of executing theories taught in schools. The obsolescence of medical equipment in health facilities was cited as one of the reasons limiting learning and growth opportunities.

Other reasons for not wanting to practice in Nigeria included concerns about the abysmally low pay doctors and nurses were entitled to, considering the relatively high cost of education and the effort put in; limited access to consistent power and water supply; and inadequate hospital equipment, particularly in the public hospitals.

For the respondents desirous of practising in Nigeria, their reasons were largely around patriotism and racism. There was a general consensus that health care in Nigeria is plagued with a myriad of problems, however these problems can only be fixed by health care practitioners practising in the country. They highlighted that migrating out of Nigeria would not turnaround the health care sector, instead it would further deteriorate the sector. The prospect of practising in another man’s land was also not appealing to these respondents, particularly because of racism issues.

Preferred country of choice for practice

Canada, United Kingdom, and the United States of America were the most preferred countries for practice. The quality of health care facilities; average remuneration accruable to health care workers; functionality of the economy; and quality of life were factors considered in choosing these countries. Although, some respondents highlighted their scepticism about practicing in the US because of the president’s alleged dislike for African immigrants, and the country’s recent hardened stance on immigration, it was the 3rd most preferred country for practice.

It is apparent that Nigerian health care professionals and students alike have made migrating out of Nigeria a topmost priority and with the demand for health care workers on an increase globally, more “brain” will continue to “drain” in the near future unless drastic positive changes are made in the health sector.

Some of these changes include:

Health care should be better prioritized in Nigeria’s annual budget. Currently, the health care budget is 4%. This is very low when compared with other countries’ health care budgets. At 4%, the resources available to provide infrastructure/equipment, remuneration and incentives of health care workers, and affordable care to patients is inadequate. The general hospitals are an eyesore and majority are struggling to stay afloat. Beyond funding the sector, accountability in the disbursement and use of the sector’s fund is key. Policies should be designed to ensure public office holders are accountable for funds placed in their care. Also, once funding has been pumped into the health sector, the capacity to manage hospitals efficiently must be developed. Public-private initiatives where competency in the private sector could be deployed in the management of hospitals should be explored.

Additionally, government policies should be designed and implemented to encourage investment in the health care sector. Incentives such as tax reliefs should be made available to investors. With a favourable business climate, local and foreign investors would be attracted to the sector. The availability of professionally managed hospitals with profitable models would also be more attractive to health care workers, as job satisfaction, improved remuneration, and growth could be attainable when there are profitable hospitals, adopting best practice models in health care delivery.

To address the learning and development challenges, it is pertinent that schools review their curricula to ensure they are timely and relevant. The theoretical aspects of training should be supplemented with practical sessions. Once the hospitals become well run and funded, students could get access to hands-on experience through horsemanship, internship, etc.

If necessary, steps are not taken to address the brain drain in the health sector, and fix the sector, the situation will get worse. Several people have died over the years because of Nigeria’s crippling health care system and more lives would be lost, unless all hands come on deck – schools, the government and private sector – to resuscitate the failing health care system in Nigeria.

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