Brain drain: Niger’s health system on crutches
Brain drain has impacted negatively on Nigeria’s health system. The loss of highly skilled healthcare professionals to institutions outside the shores of the country has resulted in the shortage of doctors, nurses and other healthcare workers. This has given rise to reduced access to quality healthcare for many Nigerians. This has also contributed to the country’s high maternal and child mortality rates. In this report, JUSTINA ASISHANA examines how this has affected health service delivery in Niger State.
Patients who patronize general hospitals across Niger State face longer waiting hours before they are attended to by doctors. This is because hundreds of physicians, nurses and other health workers have left the country in search of greener pastures. Those who have left the state’s health sector in the past five years have not been replaced by the state.
In most of the hospitals, patients would wait for hours on end without being attended to by medical personnel.
Wasted man-hours are not the only issue experienced by patients. Some of them have suffered the consequences of a lack of doctors, which led to death.
The scarcity of doctors affects everyone, irrespective of their social standing. One such case is the accident involving a former Commissioner and Chief Press Secretary to the former Niger State Governor, Danladi Ndayebo, and a Special Assistant to the Senate President, Mohammed Isa. The two were involved in an accident along Minna-Suleja Road on November 6, 2022, and sustained serious injuries.
Reports have it that the duo died due to what relatives said was medical negligence. Admitted to the hospital at 9.30 p.m., the victims were not attended to until 12 hours later when, at the intervention of a former Secretary to the Niger State Government, Kuta Yahaya, they were taken to the emergency unit.
In a petition dated November 22, 2022, the family of the late Danladi Ndayebo, through their lawyer, Mohammed Maude, said that the members of staff of the hospital left him unattended to for 12 hours after he was admitted to the emergency unit of the hospital, adding that he died without any form of treatment administered on. His colleague who was in the same accident ward with him died a few days later at an Abuja hospital where he had been transferred for medical treatment.
A few of the hospitals boast of modern equipment donated by companies in the oil and gas industry (NNPC, Chevron, IPPG and PETAN) as part of the COVID-19 Intervention in Niger State. But, even where the equipment is available, there are limited or no skilled personnel to operate the equipment. This is what happened to Ndayebo. The hospital he was taken to has x-ray machines and a scanner which would have helped in determining the nature of the injuries he suffered and would have informed the medical intervention required.
However, there was no one to operate these machines and he was left unattended to for hours.
Lack of equipment is a common problem in most hospitals but even where such equipment exists; it might be of no use because there are no trained personnel to man them. This is why patients still have to go to private hospitals and laboratories to access and use such equipment.
Impact of brain drain on health services
There is no recommended World Health Organisation (WHO) doctor-to-patient-ratio, but the Nigeria Medical Association (NMA) said that Nigeria has a doctor-to-patient-ratio of 1:5,000. But in Niger State, the doctor-to-patient-ratio is 1:20,000, according the Executive Medical Director of the Niger State Hospitals Management Boardthe Executive Medical Director of the Niger State Hospitals Management Board, Dr. Ibrahim Abdullahi.
Last year, NMA expressed concern that the doctor-patient ratio is getting worse. The inadequate supply of skilled human resources presented a serious obstacle to the provision of effective health services and created a serious manpower crisis in most health facilities in the country.
The Association, which is the umbrella body for practising doctors, said that the lack of trained personnel had placed undue stress on the existing health workers, exposing them to overwork. The shortage of skilled health workers has worsened the already poor doctor-patient ratio, while the nurse-to-patient ratio in Nigeria is 1:1,660.
The National Association of Nigeria Nurses and Midwives (NANNM) has also stated that between 2017 and 2022, 57,000 nurses migrated from Nigeria for greener pastures abroad. The majority of Nigerian physicians want to emigrate and top among the reasons for leaving the country are poor remuneration, rising insecurity and inadequate diagnostic facilities.
The Hospitals Management Board said that only a few of the doctors who leave resign formally as the majority of them leave without notifying the Board.
The Commissioner of Health, Niger State, Dr Muhammed Makunsidi, said that 3,000 health workers, including medical doctors, pharmacists, nurses, laboratory scientists and midwives have left the state government-owned hospitals to seek employment in other states in Nigeria or outside the country.
Our members collapse at work-NANNM
While patients complain of the poor services being rendered at healthcare centres, nurses and midwives complain of being overburdened with work which has seen several of them collapse while on duty. In order to resolve this issue, hospital administrators have resorted to merging wards for the remaining members of staff to cope.
For example, at the General Hospital Sabon Wuse, the female and paediatric wards have been merged so that the few nurses available can cope with the number of patients.
Due to the shortage, a nurse in Niger State is performing the duty of five nurses, according to the Niger State Chairman of NANNW, Anna Simon.
Simon stated that from 2015 to 2023, more than 400 nurses had left Niger State. Some left for abroad or other states in Nigeria, while others have either died or retired.
She said that in 2016, there were about 1,000 nurses. But currently, there are less than 600 nurses working in the state government-owned hospitals, even as she added that no efforts are being made to fill the vacant positions.
Push and pull factor
Simon and the Niger State Chairman of NMA, Yusuf Muhammad, conceded that the main reasons their members were going abroad or other states to work were pay, insecurity, and lack of equipment and infrastructure.
Muhammad said that the N5, 000 paid to health workers for hazard allowance was a pittance compared to the work they do. The last salary review was in 2010 when health workers were given a 180 per cent salary increment to boost their standard of living.
Announcing the increase at the time, the then state’s Commissioner for Health, Mohammed Sani Adamu, said the money was to be paid out in instalments with 70 per cent of the money being paid out immediately, while the rest was to be paid out in phases. Since then, there have been no salary increments and health workers who have received promotions do not get pay increments.
In 2016, then Governor Alhaji Abubakar Sani Bello declared a state of emergency in the health sector, lifted a ban on employment and approved a 100 per cent increase in pay for all health workers. But this has not stemmed the tide of skilled personnel leaving the state.
On average, entry-level salaries for doctors vary depending on the state. Medical doctors earn between N150, 000 and N200, 000. Registrars earn between N220, 000 and N300, 000; Senior Registrars, between N260, 000 and N470, 000, and Consultants, between N450, 000 and 800,000.
Under the current Consolidated Medical Salary Structure (CONMESS) agreement, which took effect in April 2019, the least salary a medical staff working in the Federal Public Service can earn under the new minimum wage is N1,667,601. This salary scale applies to the members of the medical staff at Level 1 Step 1.
On the other hand, the highest-paid member of the medical staff will earn N8,517,892. This applies to the very senior and experienced medical staff at Level 7 Step 9.
Niger State is one of five states in the country where doctors and other health workers are being paid at the same level as those working for the Federal Government.
Despite this and other measures aimed at encouraging doctors to remain in the state, the exodus of its trained medical personnel continues.
While doctors in Niger State have incomes that match those employed by the Federal Government, their salaries still compare poorly against what doctors in the countries many of them emigrate to earn.
Demands for better salaries and working conditions have led to frequent industrial actions which regularly disrupt health services.
On May 17, doctors began a strike to demand the immediate payment of the 2023 Medical Residency Training Fund (MRTF), tangible steps on the “upward review” of the CONMESS and payment of all salary arrears owed its members since 2015.
They also want the immediate massive recruitment of members of clinical staff in the hospitals and the abolishment of the bureaucratic limitations to the immediate replacement of doctors and nurses who had left the system.
Besides salary, insecurity is another reason for the mass exodus of health workers from Niger State to other states in Nigeria or abroad. Doctors, nurses, and pharmacists have been killed or abducted and held for ransom by bandits who have taken over 12 local government areas in the state, leading to thousands of people being displaced and hundreds dead.
‘We are working hard to address the trend’
Coincidentally, at the time the UK imposed the ban on the recruitment of health personnel, the Nigeria House of Representatives passed the Medical and Dental Practitioners Act (Amendment) Bill, that, if enacted into law, will compel medical and dental graduates trained in Nigeria to offer five years of compulsory service in Nigeria before being granted a licence to practise. They can then move abroad if they wish.
The bill has been rejected by the doctors who have gone to court to challenge it, saying it contravenes their fundamental human rights of movement and association.
The doctors claimed that the bill would not stem the brain drain unless the government addresses the challenges such as poor working conditions, lack of medical equipment and facilities, and insecurity. The revocation of the Bill is among the demands they made during the recent strike action.
The Executive Medical Director, Niger State Hospitals Management Board, Dr Ibrahim Abdullahi, said while the state could not stop skilled health workers from leaving the state’s health system, it was committed to improving their working conditions and welfare.
“We are currently paying salaries on the same level as the Federal Government,” he said.
The state is also committed to recruiting more specialists to increase the current 33 specialist doctors. Other plans include having the state university accredited to establish a medical course and a teaching hospital and the hiring of 400 additional health workers and 450 midwives.
On when this will take effect, Abdullahi was non-committal about when the medical personnel would be hired as these were just proposals.
Efforts by the government to upgrade health facilities and improve access by residents will amount to nothing if doctors and other skilled health personnel continue to exit for better opportunities in Nigeria and abroad. Until the state stops this trend, it will not be able to meet its goal of providing adequate resources for effective and efficient healthcare delivery.
- This article was produced as part of the Aftershocks Data Fellowship (22-23) with support from the Africa Women’s Journalism Project (AWJP) in partnership with The ONE Campaign and the International Centre for Journalists (ICFJ).