Enough is Enough
Written by: Chukwuemeka Oluka
‘Mum, it is pronounced “KYOO KUM BUH” and not “KO KOM BA,” our Phonetics teacher, Mr Ogbonna taught us so. It is botanically a fruit, not a vegetable.’
About to throw the first piece of the neatly cut cucumber into a waiting mouth, her jaw slacked, her hand unable to move, and with a fixated gaze, she mumbled,
‘Shay dis pikin wan disgrace me for office today?’’
Making peace quickly with composure, she asked the lad,
‘Oh my daughter, that’s nice. Was that what was taught in school today?’
‘Mama Dele, tell me why you dey laugh now?’
‘You dey ask me why i dey laugh? At least, you don learn new thing today. You should thank God you have a bright daughter, not that Ayodele my son that knows nothing but to consume every food.’
‘Hey Mum, you do not call her “Mama Dele,” but “Nurse Abioye.” You are in hospital — an office.’
Then, Mrs. Abioye drew near, caressed the little girl’s shoulders and said to her, ‘Don’t mind your mummy; one day you’ll become a medical doctor and you’ll travel abroad to join them in speaking their language.’
‘You’d better leave that child alone and go check that catheter. I wonder why her father dropped her off in this hospital. That’s why I don’t fancy his school runs. He would’ve taken her home, rather than bring her to my office.’
Both still engrossed in a heart-to-heart discussion, she walked up to them and said, ‘Nurse, help me take the Vitals of the patient on that bed — her mouth pouted towards a direction — while I prepare the folders for the next shift. I pray Dr Williams arrives on time for the evening call.’
‘Nurse, wait fes… Which person name I hear now?’
‘Dr Williams of course!’
‘You dey whine me? You never hear say Willy don Japa?’
Stepping back a little, her hands covering her mouth, she questioned,
‘Again? You mean another doctor has travelled abroad… Someone I saw which day again?’
‘Stand there dey ask me questions. Willy dey UK already. People are looking for greener pastures. He found luck and he japa. Me sef go japa my own if I jam better luck. I wan follow Willy begin earn money wey carry surname — Pound Sterling! No be dis ona yeye Naira wey don fall yakata like person breast.’
‘Willy is smart… So, this was why he applied to be loaned N1.5 million from the hospital’s Cooperative. Who will then pay the money, now that he has travelled? He must have used the money to process his visa.’
‘That shouldn’t disturb you… I guess the recovery team will fall back to the guarantors he provided. But I’m really happy for him.’
‘This is getting serious… most of the doctors; especially the young ones in this hospital are travelling out in their numbers. Our GOPD alone has seen seven of them relocate abroad in just three months. Willy just made them eight.’
‘Hehehehehe… E shock you? You dey mention GOPD? Visit dermatology department, you’ll find no one there. All of dem don japa!’
****
Yes, you heard the nurses correctly. All of them have ‘japa!’
The truth is that a large number of our medical personnel are leaving the shores of Nigeria in droves for greener pastures. It is no longer news that we lose a significant number of our doctors, nurses, physiotherapists, radiographers and the rest, to brain drain — what we call ‘japa’ in our local parlance.
In a publication by Daily Post on Brain Drain, made in July 2023, the tabloid noted that there were over 11,000 Nigerian-trained doctors in the UK, information made available by the UK General Medical Council, the government body that maintains the official register of medical practitioners. The Council also revealed that after India and Pakistan, Nigeria has the next highest number of foreign doctors working in the UK.
This brain drain in the Nigerian health sector is rising to a crisis level, and it has become challenging for the country to retain its skilled medical workers, and build a functional healthcare delivery system.
In a Punch publication made on December 17, 2023, the President of the Nigerian Association of Resident Doctors (NARD), Dr Dele Abdullahi disclosed that over 900 of its members left for Europe between January and September 2023. He attributed this development to poor working conditions.
It was in a bid to stem the exodus of medical workers, that the administration of former President, Muhammadu Buhari made moves to compel fresh Nigerian-trained Doctors to give some years (5 years) of mandatory service in Nigeria before receiving full registration and license to practice. A bill to that effect would scale through a second reading on the floor of the House of Representatives in April 2023. The bill saw widespread outrage and condemnation from the public, as those affected claimed it violated their right to personal freedom.
Despite this development, some doctors and nurses have defied the odds to continue to japa. Just like in the article, ‘No gree for anybody,’ these medical personnel have decided to take bold steps and not listen to the voices of naysayers.
Fast forward to the present administration, the government of President Bola Tinubu has taken another approach to arrest medical brain drain. Premium Times publication of March 10, 2024, revealed that an Executive Order issued by President Tinubu placed a ban on ‘Leave of Absence’ for health professionals relocating abroad.
However, make no mistake; the Executive Order wasn’t an outright ban on health workers from emigrating abroad, but it means that health workers travelling abroad to seek greener pastures will have to resign from the appointment they ‘enjoy’ before embarking on such journeys.
In a telephone interview with Dr Aliyu Yakubu, the Vice President of the Association of Resident Doctors in the National Orthopaedic Hospital Kano, he said the Government’s response was a knee-jerk reaction to a problem that has been building over time. He noted that the remote response has to do with what has been the issue of the welfare of the Nigerian populace itself before focusing on medical personnel and then, doctors.
Reacting to the ban in a phone chat with Matron Angela Nnwolisa, a registered nurse and midwife with almost two (2) decades of professional experience, she said the ban wasn’t the best approach. She feels the Government would’ve looked into the root causes driving the Japa syndrome and tackle it. She said some take a Leave of Absence with the intention of coming back. They travel out and undergo one or two professional courses to add to their qualifications. This they do, to improve their remuneration upon return. According to her, the implication of the ban will see a sharp rise in medical brain drain in the long run.
In addition, a Nigerian-trained neurosurgeon, Dr Cyril Okpata, who worked for fifteen (15) years in Nigeria before relocating to the UK, shared similar sentiments in a phone chat with the writer. He reckoned that banning Leave of Absence won’t stop the japa syndrome. In his words, ‘You don’t treat symptoms; you go to the root cause of diseases and treat it.’ He questioned why Leave of Absence would be banned, but the President and other politicians would fly abroad with taxpayers’ money to get medical attention, — something he described as health tourism.
In identifying the reasons for medical brain drain, there are ‘pull’ and ‘push’ factors. ‘Push’ factors border on the ineptitude of the government to effectively respond to unending complaints of poor salaries, and welfare packages as well as the deplorable working conditions of healthcare professionals and doctors in Nigeria.
There are also escalating security challenges. A situation where more than ten (10) doctors were victims of kidnapping and other violent crimes in less than two (2) months is alarming. This happened in Enugu state, according to the Premium Times report of November 17 2023.
With these issues identified, it is safe to say that medical professionals, who are yet to emigrate, render their services under extreme conditions. It can be truly frustrating. Nevertheless, some have learnt to adapt to the suffering and smiling mentality in Nigeria until the opportunity to japa comes calling.
On the other hand, the ‘pull’ factors see Nigeria’s medical talents leave in their numbers to countries luring them with bumper pay structures, better working conditions and improved quality of life, just so they come in and fill their depleted workforce.
Following the 2020 COVID-19 pandemic, these destination countries actively seek to attract our medical brains to address the sharp shortage of medical personnel caused by the pandemic.
Sadly, Nigeria is also among the countries struggling with a serious shortage of health workers occasioned by the ‘pull’ and ‘push’ factors. The negative effect will have to be a very low physician-to-patient ratio, low enough not to reach the recommendation by World Health Organization (WHO). This shortage impedes drastically on care delivery, especially in rural areas where access to healthcare services is limited.
President Tinubu at an event to mark Universal Health Coverage Day observed annually on December 12, appealed to Nigerian health workers practising abroad to return home and render their service. He said his administration was prioritising and improving the health sector through massive investments and increased budgetary allocation in the proposed 2024 budget.
However, the 2024 budget that was presented by the President, in which less than five per cent (<5%) of the N27.5 trillion expenditure plan was earmarked for the health sector is shameful. Also, this figure is nowhere near the 2001 Abuja Declaration, where African Union countries set a target of allocating at least 15% of their budget each year to the health sector. One then wonders if the 2024 budgetary allocation to the health sector is enough to match promises made on the global stage with actions.
As contained in the WHO website, and based on the WHO-established minimum threshold, a country needs a mix of 23 doctors, nurses and midwives per 10,000 population to deliver essential maternal and child health services. The medical brain drain syndrome explains why maternal and child mortality rates are on the rise in Nigeria.
As a matter of urgency, the Government at all levels must know that the situation in the health sector has reached a crisis level. To this end, a State of Emergency should be declared in the sector to get back to the glory days when Nigeria’s healthcare delivery was one of the topmost in the world. To achieve this, the Federal Government must have to significantly raise allocations in the national budget to the health sector.
The Federal Government should also find ways to stabilize the economy. When the value of the Naira improves, the spending power of people improves, and that will go across the board. The undisputed truth is that economic realities are outpacing the efforts the Government has put in place to improve the health sector.
Also, the salaries and welfare packages of our healthcare professionals and doctors have to be raised to such a bar, so that there will be no need for them to want to japa. There have been many promises in this regard. Therefore, the Federal Government should be able to keep to their promise and not renege on it.
For instance, the agreement it signed with the Nigerian Medical Association (NMA) on the upward review of the Consolidated Medical Salary Structure (CONMESS) and allowances should be implemented without them begging for it. The agreement should also be in line with the current purchasing power of the Naira. The government must learn to be proactive and begin to match words with action on the issues of brain drain.
Doctors in Nigeria watch helplessly as patients die because of poor and lack of needed medical facilities. Someone specializes up to the level to be able to perform heart surgeries, and in the whole of the country, one can count on one hand, the places heart-lung machines can be found. This adds to the frustration. Call it depression! So, the Government should make available, the basic medical equipment and essential drugs. Modern diagnostic procedures like Computed Tomography scans and Magnetic Resonance Imaging remain a luxury in Nigeria.
For the security of health workers, there should be the presence of strong security formations in most public hospitals. Armed patrol teams should be notched up across the states. Adequate funding of security by state governments and the deployment of modern technologies to fight crimes will also go a long way to reducing the brain drain in the health sector. In addition, all health institutions in the 36 — states should be mandated to set up security committee meetings.
We have to make Nigeria’s pastures greener so that other countries’ pastures won’t lure our healthcare professionals.
Enough is enough!
