As Nigerian doctors flee their country, the health system is decimated

Fredrick Adesoji is fed up. The resident doctor at Lagos State University Hospital, in Nigeria, tells EL PAÍS that he and his colleagues are still demanding back pay from 2014. Angered by the lack of solutions to this problem – as well as by low salaries and overwork – Dr. Adesoji says he will soon become one of the many doctors leaving Nigeria in search of greener pastures in the United Kingdom.

Six in 10 of the country’s doctors plan to emigrate to a foreign country, according to the Nigerian Association of Resident Doctors. The poor economic situation in the West African country doesn’t help – it has been exacerbated by the end of fuel subsidies, which were stopped in May. “I have completed the travel paperwork and will be leaving soon,” Adesoji sighs. “I’m leaving because the government isn’t treating its health workers well.”

There is no updated data on how many Nigerian doctors have left the country, but some local media outlets estimate that more than 9,000 emigrated between 2016 and 2018. The majority went to work in the United Kingdom, Canada and the United States. In an attempt to stop the departure of healthcare workers like Adesoji, the Nigerian government has taken a radical decision: it intends to amend the Medical and Dental Practitioners Act and force professionals who were trained in Nigeria to practice for a minimum of five years in the country, before granting them a full license to practice. Ganiyu Johnson – one of the legislators promoting the norm – declared this past May: “The government has invested a lot in training these doctors… the least we can expect is that they give something back to society over a period of five years.”

The main complaint of doctors like Adesoji is that medical professionals are poorly paid. In 2019, a doctor who had just started his career – the most common profile of those who leave Nigeria, according to the Association of Resident Doctors – was earning 1.8 million naira (approximately $2,300) per year, according to the National Salary Commission. Since then, the sector hasn’t experienced any salary increase. Still, conditions in the medical sector are better than other professions, such as law – where workers earn an average of 600,000 naira annually – or accounting, with 840,000 naira being the average, according to the National Salary Commission. Other reasons doctors leave the country are the harsh working conditions, Adesoji explains. “We have to work longer hours due to lack of personnel and diagnostic tools, or to supplement our monthly income.”

This lack of doctors was experienced firsthand this past July by Seyi Oladuni, a Nigerian government worker who went to the Badore General Hospital, in Lagos State, to undergo surgery. First, he had to wait in line for more than two hours. He had been diagnosed with appendicitis and was due to have surgery that same month. However, activity at the hospital was at a minimum, due to lack of staff. When he finally had surgery – in August – two of his relatives had to act as nurses to assist the surgeon during the operation. They also had to act as caregivers in the postoperative period. “The doctor in charge asked them to give me medication until I was discharged, because most of the nurses in the hospitals have resigned and are willing to move abroad,” he recalls.

The West African country needs 363,000 doctors to serve its more than 200 million people, according to Uche Rowland, president of the Nigerian Medical Association (NMA). Today, however, Nigeria only has about 24,000 medical graduates annually. This situation translates into a heavy workload for many physicians, especially as more are leaving.

Nigeria currently has one doctor for every 8,300 patients, while the world average is one doctor for every 254 inhabitants, according to data from the World Bank. The country has a universal health coverage index score of less than 55, with 100 being total public health coverage of the population. “We have lost many doctors who go to work in other countries… substitutes aren’t hired. Doctors resign almost every month. Those who stay are overworked and don’t receive care,” complains Alfa Yusuf, the spokesperson for the Association of Resident Doctors.

In a report published in March of 2023, the World Health Organization (WHO) warned that, by 2030, there will be a global shortage of 10 million healthcare workers. The shortage will especially affect low-income countries, such as Nigeria, due to workers going abroad in search of opportunities. In 2021, the WHO publicized a recommendation – which was renewed this year – that rich countries not steal health personnel from 55 vulnerable countries (including Nigeria) which are contending with staff shortages. “Health workers are the backbone of every health system, yet 55 countries with some of the most fragile health systems in the world don’t have enough of them. Many are losing their health workers to international migration,” lamented Tedros Adhanom Ghebreyesus – director-general of the WHO – in a press release in March.

Another patient – Muna Salami – is also saddened by the long wait times at Kubwa General Hospital in Abuja, the Nigerian capital. On August 25, she was in the hospital waiting room for six hours before she was able to see a doctor. “There weren’t enough doctors to care for the sick and that’s why some people prefer to self-medicate, rather than come to the hospital. Even in times of emergency, quick attention is barely achieved,” she criticizes. “There are many things that don’t work in our health system.”

While the public health situation falters, the government and health workers have repeatedly engaged in disputes over issues related to the well-being of workers and the infrastructure deficit in the health sector. In August, doctors across the country went on a three-week strike to demand a pay raise, to help them cope with the rising cost of living in Nigeria.

Alfa Yusuf doesn’t give much importance to the proposed legislative change that would force him and his fellow resident doctors to remain in Nigeria for five years. “Doctors will continue to leave if our well-being isn’t taken care of,” he warns. Members of the Nigerian Medical Students’ Association (NiMSA) argue that the proposed law violates the rights of their newly-graduated colleagues. The group claims that the bill is unpatriotic and untimely, while also in violation of the fundamental human rights of doctors, which are enshrined in the Constitution of Nigeria.

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