The National postgraduate medical college recently alerted the country to a decline in the number of applicants for its post-graduate medical exams, necessitating closing down of some exam centres. This might be the beginning of a cascade of events, which if not promptly addressed, may lead to the collapse of the country's healthcare architecture.
Contrary to the WHO recommendation of 1 doctor to 600 patients, Nigeria has about 30,000 practising medical doctors and a doctor-patient ratio of 1:5,000. This overall figure can be deceptive because states like Zamfara and Kastina have a ratio of 1 doctor to 13,000 patients; which is similar to what obtains in many states in the country.
As such, the onus rests on the government to seek out possible measures to curtail this impending crisis. Worthy of note is the fact that the government over the years has done little to avoid or address some of the factors propelling health worker migration in the country. Some of these issues include; poor working conditions, poor remuneration, incessant industrial disputes, and lack of modern healthcare infrastructure.
What are the possible options on the table?
1. Employment/Training Bond
It is a legal framework to ensure that healthcare personnel work for a certain period before being eligible to 'japa'. Several states especially in northern Nigeria already have this policy in place to boast healthcare personnel shortage in such states. Implementation of this policy nationally is likely to cover personnel seeking appointments in the civil service and post-graduate medical training positions. Applicability to the private sector may not be feasible considering the current employment pattern in the country. Legality and adaptability to the different layers of the country’s healthcare sector are likely roadblocks to implementation
Although, if implemented, this is likely to bring transient stability to the sector, buying the government time to roll out long-term developmental strategies. However, this is not likely to deter the migration of lower cadre staff who currently constitute over 50% of migrating health workers. The government must anticipate rigid opposition from various professional unions in the sector. As such, government sincerity to a long-term healthcare developmental plan, and possible introduction of juicy welfare packages may be needed to sail through this policy.
Implementing this policy can be counter-productive if not well executed. Wrong perception and poor acceptance may trigger panic, further worsening personnel shortage in the sector.
2. Special Incentives
Central to most migration is the need for better welfare conditions. Introduction of health workers support programmes, training packages, and special bonuses will go a long way to reduce health worker migration. While financial incentives are crucial components of employee motivation, results have shown that income alone is not sufficient to deter health workers' migration.
3. Produce more Healthcare Personnel
Nigeria produces about 3,000 doctors and 10,000 nurses yearly. At that rate, it will take the country about 100 years to meet the WHO requirement of 1 doctor to 600 patients. Aside from the migration problem, it is obvious that Nigeria has a production problem.
In the short term, producing more healthcare personnel is not likely to be a viable alternative. However, in the long term, the government needs to boost personnel production through investment in medical education across the country.
4. A Clear Roadmap
The National Strategic Health Development Plan II (2018-2022) was launched by President Muhammadu Buhari in 2018. The document outlined various strategies designed to improve the Nigeria health system and reduce maternal mortality. However, since its launch, Nigeria is yet to achieve 30% of all the critical landmarks outlined in the document. Therefore, there is an urgent need for the government to renew its commitment to healthcare development in the country.
Reducing health worker migration will not happen overnight, and neither will the strictest of policies stop people from migrating. However, the Nigeria government must commit to building a system that will not only train and retain its workers but also attract the best brain internationally.
Dr John Ajefolakemi
email: ajefolakemijohn@gmail.com
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