Being a medical professional in Nigeria is an uphill task, literally and practically. There is a strange air of external conflict between what hopes the professional has for himself versus what is expected of him. Even though the profession seems built to insulate him in a cult of personality and significance, it also attempts to reduce him to an object of servility at all times.
In different climes, the motivations that drive one to seek to become a medical doctor are very much dependent on the socioeconomic factors of the particular geographic area. This near-dichotomy yields basically two extremes on the doctor scale.
- Doctors who see the profession as a vital and essential role to play, hence value patient care more than personal development and actualization.
- Doctors who see the profession as a well-paying job and the perfect environment to practice is one which everyone should aspire to and never settle for less.
Like all spectra, there are many shades of grey in between, but the divide is pretty much definite.
A quick glance at both sides of the divide will show that doctors in the first class are usually in good socioeconomic environments, hence the decision to become a doctor wasn’t necessarily a financial one. Whereas a doctor who his entire household made sacrifices to foot his education sees the job as a route to comfort, stability and being uplifted from his humble beginnings.
It has long been an ethical debate as to whether a doctor’s responsibilities to the healthcare of the society supersedes his probable need for a luxurious lifestyle. The dilemma bares itself in the question that goes, “If they are mutually exclusive, should medical doctors choose their fulfilment or the delivery of healthcare to a society that increasingly desperately needs it?”
A part of the Hippocratic Oath, which all medical doctors swear by, says “I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body, as well as the infirm.” Also, the WHO Global Code of Practice on the International Recruitment of Health Personnel has its principles laid on the bedrock of increasing fairness in international recruitment and mitigating the effects of workforce loss in source countries. Though still completely voluntary at this stage, it does stop slightly short of begging the question if doctors should be allowed to seek greener pastures considering the vitality of their presence in these low-income countries that are mainly the source countries.
It is without doubt that there are merits in the arguments of those who believe the profession is a calling and those who are truly ‘called’ will be more people-driven, more compassionate to the needs of the helpless who stand to suffer more as they are the true harsh recipients of this exodus. On the other hand, though very essential, doctors are human beings too and deservedly have a right to the best life they can attain to.
This essay seeks to briefly explore the scope of the Nigerian problem and prognosticate as to its effects in the foreseeable future.
The term, brain drain, was introduced in the 1960s to capture the largely increasing number of trained professionals, medical and otherwise, seeking greater economic and social opportunities in developed nations. The brain drain of healthcare workers is defined as “the movement of health personnel in search of a better standard of living and life quality, higher salaries, access to advanced technology and more stable political conditions in different places worldwide”. Although brain drain is usually used in the context of cross-border and international migration from developing country to developed country, it can also occur internally from rural areas to urban areas.
It’s important to note that brain drain of healthcare workers was not always in the direction of emigration from developing to developed countries. Earlier on, it was a problem of developed countries who lost a good number of doctors who went on missions/outreaches to third world countries – who hitherto had very few doctors or none – on a near-permanent basis. However, with increases in the healthcare workforce of those countries, the need for these immigrant doctors grew more insignificant.
To hone in on the Nigerian problem with brain drain in the healthcare sector, there are largely two groups of factors: the push factors and the pull factors.
The Push Factors
These are internal factors that contribute to ‘pushing’ medical personnel away from Nigeria. In a nutshell, a medical doctor who has just begun his practice in Nigeria is faced with few employment opportunities in a country where patient:doctor ratio is exponentially higher than the recommended (shortage of doctors and heavy workload). When he does get a job, the hospital is hardly up to standard (poor medical facilities and lack of equipment) and his wages aren’t comparable to what his peers earn outside the country (poor remuneration). Despite that, the other members of society think he is selfish and too demanding; politicians are prioritized in the distribution of N-95 masks in an outbreak while doctors make the available surgical masks desirable (treatment of medical doctors). When it is possible, the elite in society seek medical help outside the country in such a public fashion, that it erodes the public confidence in the ability of the available doctors (medical tourism). All these culminate in increased doctor burnout and work-related stress, worsens job dissatisfaction and ultimately leads to the mass emigration of doctors we see today.
These push factors may therefore be summarized as
- Job related factors – heavy workload, substandard facilities
- Economic factors – poor remuneration, unemployment
- Psychological factors – doctor burnout, public perception and treatment of doctors
The Pull Factors
These are the external factors in developed countries that synergistically add to their deletion of the numerous push factors of developing countries.
- Financial Security
- Better Work Environment
- Job Satisfaction/Fulfilment
It is without a doubt that the haemorrhage of doctors from Nigeria to better climes will not resolve without a gargantuan shift in the politics involved and the attention it receives. It is known that a critical part of any health system is its workforce. Healthcare personnel are the wheels that run the healthcare system and provide necessary healthcare services to the populace, which is an important prerequisite for sustainable socio-economic development. Currently, in Nigeria, that workforce is worryingly dwindling and the younger doctors and doctors-to-be, who have the wherewithal, do not consider long-term practice in Nigeria an option.
There are also a few factors why the brain drain may last a while longer at least. Firstly, the gap between the developing and developed countries seem to keep increasing each year and with the situation as it is, it worsens the severity of the push factors on those that are left behind. Hence, those who may have chosen to remain behind feel their regrets more acutely and may renege on former commitments to stay behind, and the chain continues. Also, it hardly seems like there is enough political will, if at all there is any, to change to a more favourable course or a national response of some sort.
While it is true that in the hierarchy of doctors, the likeliness to leave increases as one goes down the cadre. However, the workforce is built as a triangular prism, with much more people in the lower ranks. This exodus, hence does not simply limit healthcare delivery in the present, but also has far reaching effects into the future as the erasure of the ‘middlemen’ in medical practice remains a continual process.
In summary, an eventual collapse of the healthcare sector in Nigeria approaches inevitability with each day, each bad policy, and as push factors pile up. This is a scenario that deserves critical attention, swift decision to steer the country in the right direction and an abundance of hope that we haven’t passed critical point yet. However, it is indeed unlikely that anyone is willing to wait behind to find out.
Heavy: Lift with Caution 