Nigerian doctors abroad

THE sensational report, the other day, that Nigeria has about 3,936 medical doctors working in the United Kingdom is certainly no complimentary information. Far from being a public image boost to Nigeria's tragic international reputation, this report presents yet another embarrassing score-card for a nation enmeshed in the thraldom of deficient healthcare delivery. In a nation bedeviled by a dilapidating healthcare delivery system and an incredulous sense of value, this startling revelation of medical brain-drain exposes the contradiction and asymmetry inherent in the nation's human resources equation.

According to a factsheet on the number of registered doctors in 2012, Nigerians make the top-list of foreign doctors practising in the United Kingdom with 3,936 doctors, coming fifth after India with 25,336; Pakistan 8,998; South Africa 5, 695; and Ireland 4, 010. This figure is almost a seventh of the about 27,000 medical doctors currently practising in Nigeria.
Considering the expertise and exposure of these doctors, and the overwhelming health problems befalling many Nigerians, it is a shameful depletion of human resources that Nigeria must reverse if it considers health development a priority.
Yet, this is a daunting task for a nation, which the World Health Organisation (WHO) in the year under consideration reported as being in a worsening state of health. From being the country with the highest number of children infected with the human immunodeficiency virus (HIV) globally, to an alert, on both the prevalence of diabetes and the rising cases of chronic kidney diseases in the nation's children, Nigeria, has in recent times, been challenged by health crises. To address these crises facing an estimated 167 million people, one doctor would have to cater for 6,187 people.
Candidly, this manpower deficit rudely highlights the gaping paradox, whereby the Nigerian health sector suffers a lack of confidence from its people and apathy from its political leaders, while its nationals develop the healthcare system of other countries. But who is to be blamed for a social order that has lured Nigerian-trained doctors from these shores by the simple assurance of basic necessities, compliance with international best practice and respectable professionalism?
The conditions under which doctors work in Nigeria are as terrifying as they are demeaning. Medical doctors are poorly paid considering the resources it takes to produce one. Remuneration is so poor that graduands from medical school often do not secure places for housemanship. In dire circumstances, many are made to lobby or give inducement to get placements in hospitals, even as some endure unending casualisation as face-saving measures. In some secondary and tertiary healthcare centres, where there is a preponderance of experts, the integrity of many is being compromised by the absence of enabling environment and equipment to diagnose and treat simple medical conditions. Moreover, in the face of this damning situation, the medical association is being dragged into messy, needless and unprofitable politicking that cheapens its professionalism.
This systemic decay and jaundiced value system is further exacerbated by low morale that has made the medical profession a desecrated terrain for misfits and a haven for quackery. Many years ago, medical doctors, by their calling and professional standing, enjoyed the respect and patronage of the society. However, a value disorientation that reveres undeserving title-holders and vainglorious social esteem has caused reverse. An infestation by quacks and other illegal claimants to the medical field, unbeknownst to the public, has also undervalued the importance of the medical doctor to adequate and sustainable healthcare.
According to the President of the Nigerian Medical Association (NMA), Dr. Osahon Enabulele, these are the suffocating challenges in the healthcare system that promote brain drain in the medical profession. "Until governments at the local, state and federal levels are able to effectively handle the various factors that promote the daily emigration of medical doctors/dentists to other countries," he charged, "Nigeria may continue to serve as a manufacturing plant for the production of medical doctors/dentists for the healthcare system of developed countries..."
What is more? The gloomy picture painted by this scenario is made worse by the phenomenal increase in medical tourism and its attendant injury to the Nigerian economy. A recent NMA projection states that before the end of the year, no fewer than 5,000 Nigerians will journey out of the country seeking medical attention from countries with developed medical services. It further stated that annually Nigeria loses $800 million or about N125 billion to capital flight emanating from patients' treatment cost.
Yet, this has not always been the case. It is a testimony to the hardwork, commitment and foresight of the founding fathers of Nigeria that, once upon a time in a postcolonial Nigeria, the University College Hospital (UCH) Ibadan ranked as one of the best teaching hospitals in all Commonwealth countries. In this same Nigeria, medical doctors won laurels for ground-breaking medical researches conducted from the nation's university teaching hospitals. If within a generation the tables were upturned, the question to ask is: how did Nigeria come to such a sorry pass?
Better still: How does the nation overcome this? Certainly, Nigeria needs a visionary leadership that would make capacity-building and human resource development an emergency. The incessant patronage of foreign healthcare services with its attendant capital flight is indicative of apathy and nonchalance towards the development of a homegrown healthcare delivery service. In this regard, leaders should show example by patronising Nigerian hospitals, rather than travelling abroad for medical check-ups, if they are sincere and truly committed to the state of healthcare in the country for which they budgeted so much. It is a denigration of all leadership signifies, as well as a telling advertisement of perfidy and unreliability, if Nigerian leaders claim to be genuine leaders of their people and refuse to patronize the healthcare facilities of their domains, run-down on their watch as those facilities may be.
To this end, there is dire need for the provision of a national regulatory framework for the management of the sector, as canvassed by the NMA. One of the things such regulation should do is to prescribe sanctions for public officials who indiscriminately seek medical attention abroad. This would dissuade frivolous spending of tax-payers' money and compel adequate investment in the nation's healthcare system.
As feelers from the industry suggest, many highly skilled Nigerian doctors abroad are willing to come back to lend support to the crippling healthcare management, but they are hamstrung by the inauspicious working conditions of poor infrastructure and social ills befalling the nation. Therefore, the government should strive to upgrade the nation's healthcare facilities and provide incentives for private sector participation in standardizing the healthcare sector.
Moreover, in collaboration with the NMA, the Medical and Dental Council of Nigeria, government should facilitate proper and expeditious steps to address the plight of medical doctors and their conditions of service. This is to boost morale, imbue confidence in the public and avert incessant industrial actions, which have become embarrassing to both the nation and the profession.