The medical migration menace: Why Nigerian Doctors are voting with their feet, and how to stop the bleeding

Nigeria’s healthcare system is facing a severe crisis due to the mass migration of medical practitioners to developed nations. This phenomenon, known as the “Japa syndrome,” has resulted in a significant shortage of skilled professionals, compromising the quality of patient care.

According to the Nigerian Medical Association (NMA) and the General Medical Council (GMC) UK, between 2021 and 2024, 8,560 Nigerian doctors registered with the GMC UK, representing 39% of all international registrations. Additionally, 2,454 Nigerian doctors migrated to the US, Canada, and Australia during this period.

The Medical and Dental Council of Nigeria reports that this brain drain accounts for approximately 12% of Nigeria’s 80,000 registered medical practitioners. Nearly 1 in 8 Nigerian doctors (12%) have left the country for developed nations since 2021, with the UK being the top destination, accounting for 39% of international registrations.

The health sector in Nigeria is struggling to cope with the shortage of medical practitioners. The doctor-to-patient ratio has worsened, with only 3.8 doctors per 10,000 population – far below the recommended minimum threshold of 23 doctors per 10,000. This shortage means patients often wait for hours or even days to receive medical attention, leading to delayed diagnoses, inadequate treatment, and increased mortality rates.

The brain drain has also affected the quality of healthcare services. Many remaining medical practitioners are overworked, leading to burnout and decreased morale. Hospitals lack specialized professionals, particularly in areas like surgery, anesthesia, and pediatrics. Rural areas are hardest hit, with some communities lacking even a single doctor.

The situation is exacerbated by inadequate infrastructure, outdated equipment, and insufficient resources. As a result, Nigerians are forced to seek medical care abroad, placing a significant financial burden on families and the nation.

Reactions from Medical Practitioners

When asked about the impact of the high migration rate of medical practitioners to developed nations, neurosurgeon Dr. Joseph Obande explained, “The ‘Japa syndrome’ has caused a shortage of personnel, overburdening the remaining workforce and compromising patient care. The loss of specialists has led to poorer health outcomes, underutilization of medical equipment, and inefficiencies in healthcare management.”

Mrs. Elizabeth Nwoyekwe, a nurse and lecturer at one of the Teaching hospitals in North Central Nigeria, highlighted that this migration has severely strained the healthcare system. It has widened the nurse-to-patient ratio, overburdened existing staff, and slowed health services.

Addressing the Reasons for Migration

Dr. Jegede O.C noted that medical practitioners often leave Nigeria because systems abroad are better organized, with better pay and shorter working hours. In contrast, Nigerian healthcare workers face long hours and low compensation.

Emmanuel, a pharmacist practicing in the U.S., shared his perspective on why many healthcare professionals migrate. He stated, “The number one reason is the difference in remuneration. Here, you’re paid well and compensated fairly for your time. In Nigeria, we often worked long hours, but the pay was not encouraging.”

The Differences Between Working in Nigeria and Developed Nations

When asked about the differences between working in Nigeria and developed nations, Dr. Ohioma described his experience as bittersweet. He shared his personal journey to illustrate the contrast.

“In the UK, I was impressed by the orderliness and structure that permeated every aspect of life, including the workplace. Everything that was needed for work was readily available. Public transportation was organized, affordable, and reliable, making commuting to work hassle-free. Constant electricity and water were a given.”

However, Dr. Ohioma also reflected on the challenges of racial bias, both overt and subtle. He recounted an incident with an elderly white patient who requested that he not be present during her consultation.

This constrast on reflection, Emmanuel explains is the differences between the two working environments in Nigeria vs. abroad. He, described them as being worlds apart. He emphasied that in the U.S., the system is well-coordinated, with each personnel clearly understanding their duties and responsibilities unlike in Nigeria.

Access to medical equipment, resources, and supplies ensures that work is more efficient, and patients receive care with the proper tools. There is also mutual respect from colleagues, management, and patients, creating a more professional and supportive atmosphere.

“The difference in the working environment is significant,” he noted, “and unfortunately, the same cannot be said for the opposite direction.”

Solutions to “Medical japa syndrome”

To address the “medical japa syndrome” and retain medical professionals in Nigeria, the government can consider the following strategies:

Short-Term Solutions

1. Improved Remuneration: Offer competitive salaries and benefits to medical professionals, comparable to those in developed countries.
2. Better Working Conditions: Provide modern equipment, adequate facilities, and a safe working environment.
3. Training and Development Opportunities: Offer regular training, workshops, and conferences to enhance skills and knowledge.
4. Loan Forgiveness Programs: Implement loan forgiveness programs or scholarships to incentivize medical professionals to stay in Nigeria.

Long-Term Solutions

1. Healthcare Infrastructure Development: Invest in building modern hospitals, clinics, and healthcare facilities, equipped with state-of-the-art equipment.
2. Medical Education Reform: Reform medical education to ensure it meets international standards, and provide opportunities for specialization and research.
3. National Health Insurance Scheme: Implement a comprehensive national health insurance scheme to ensure universal access to healthcare and reduce the financial burden on medical professionals.
4. Research and Development Funding: Provide funding for research and development in the healthcare sector to encourage innovation and advancement.

Policy and Regulatory Framework

1. National Health Policy: Develop and implement a comprehensive national health policy that addresses the needs of medical professionals and the healthcare system.
2. Regulatory Reforms: Implement regulatory reforms to reduce bureaucracy and make it easier for medical professionals to practice in Nigeria.
3. Diaspora Engagement: Engage with Nigerian medical professionals in the diaspora to encourage them to return and contribute to the development of the healthcare sector.
4. Public-Private Partnerships: Foster public-private partnerships to leverage resources, expertise, and funding to improve the healthcare sector.

Addressing Systemic Issues

1. Corruption: Address corruption in the healthcare sector by implementing transparency and accountability mechanisms.
2. Insecurity: Improve security in the country to ensure the safety of medical professionals and their families.
3. Economic Stability: Implement policies to promote economic stability and growth, reducing the push factors driving medical professionals to leave Nigeria.

By implementing these strategies, the Nigerian government can address the root causes of the “medical japa syndrome” and create an environment that encourages medical professionals to stay and contribute to the development of the healthcare sector.