The Signs & Symptoms of Nigeria's Medical Brain Drain

Health workers at the Cacovid isolation centre, Mainland, Infectious disease hospital, Yaba, in Lagos, Nigeria. (Photo by: Emmanuel Osodi/Majority World/Universal Images Group via Getty Images)

Only half of the 74,000+ doctors registered in Nigeria actually practice medicine in the country. According to the National Association of Nigerian Nurses and Midwives, Nigeria only has 125,000 nurses and midwives. 

With a population of over 200 million people, Nigeria needs over 730,000 more doctors, nurses and midwives to meet the WHO standard of 4.45 skilled healthcare workers per 1,000 people. 

These harrowing stats are symptomatic of the medical brain drain that has been plaguing the country’s healthcare system. Over the last few years, if not decades, Nigeria’s doctors and nurses have emigrated in drones to the United States, the United Kingdom, Canada and other high-income countries. 

Some sources estimate that approximately 2,000 doctors have left Nigeria over the last few years, and 9 in 10 doctors are currently considering work opportunities outside the country. According to the Organization for Economic Co-operation and Development (OECD), Nigeria is one of the three leading African sources of foreign-born physicians. Almost 8,000 Nigerian-trained doctors practice in the UK and the Association of Nigerian Physicians in the Americas has over 4,000 members in the US.

But why are our doctors and nurses leaving the country? The answer is about more than just higher pay. Nigeria’s doctors and nurses are overworked, underpaid and underfunded.

Overworked

With just over 160,000 doctors, nurses and midwives practicing in Nigeria, there is roughly 1 skilled healthcare worker per 1,000 people. In the US, UK and Canada, the most popular immigration destinations for Nigeria’s healthcare workers, there are 17, 11 and 13 per 1,000, respectively.

The low healthcare worker density leaves Nigeria’s healthcare workers overly stressed and overworked compared to their foreign counterparts, particularly in the public sector. According to a 2017 report from NOIPolls, Nigeria’s polling agency, 92% of doctors indicated low work satisfaction as the major reason for seeking work opportunities abroad, with several doctors expressing frustration with high patient loads and long working hours in qualitative in-depth interviews. A 2021 ICIR Nigeria report indicated that nurses at the National Orthopedic Hospital in Enugu see at least 10 to 12 patients at a time, which is indicative of the typical patient load for nurses at large government hospitals in the country.

As more and more doctors and nurses continue to leave Nigeria, the remaining healthcare workers will be left with even harsher work conditions as they provide care for the millions of patients in the country.

Underpaid

Nigerian healthcare workers are among the lowest paid globally. On average, consultants and specialist doctors with up to 10 years of medical experience earn between N7.8 million ($20,500) and N14.4 million ($39,000) per year in Nigeria, which is approximately ~85% lower than their foreign counterparts in the US, UK and Canada. 

Similarly, a registered nurse in Nigeria is expected to earn N800,000 per year ($2,100), ~98% lower than registered nurses in the US, UK and Canada. As such, it is unsurprising that the 2017 NOIPolls report indicated that 91% of doctors cited poor salaries and emoluments as the major reason for seeking work opportunities abroad. 

However, it is not just low salaries that are pushing Nigeria’s doctors and nurses out of the country. The infrequency with which salaries are paid plays a major role in the medical brain drain, especially in the public sector where healthcare workers could go several months with no pay. At the height of the COVID-19 pandemic in Nigeria in June 2020, 50 doctors and nurses at a COVID-19 response center in the Lagos University Teaching Hospital reportedly had not been paid in 3 months.

Low and infrequent pay have caused incessant healthcare worker strikes in the country. Most recently, on April 01 2021, the National Association of Resident Doctors commenced an indefinite strike to protest poor working conditions and pay, making it the third strike in the last year.

Underfunded

Nigeria continues to fall short of the 2001 African Union commitment to allocate at least 15% of its government budget to healthcare. According to the most recent WorldBank figures, only about ~3.89% of Nigeria’s GDP is spent on healthcare, compared to 16.89%, 10% and 10.79% in the US, UK and Canada, respectively.

A recent report from Knight Frank, a real estate consultancy, indicated that Nigeria would need at least 386,000 additional beds and $82 billion of investment in healthcare real estate to meet the global average of 2.7 beds per 1,000 people. Before the COVID-19 pandemic ensued, Nigeria only had 350 ventilators and 350 ICU beds for its ~200 million population, most of which were in private hospitals - barely enough to handle the healthcare burden of the pandemic.

This low public healthcare expenditure has led to poor infrastructure across Nigeria’s healthcare institutions, leaving doctors and nurses with insufficient resources to provide adequate care for patients. 

Now that the major drivers of Nigeria’s medical brain drain have been diagnosed, it’s imperative to assess the true cost of this phenomenon to the country.

In addition to the shortage of skilled healthcare workers and the negative impact on healthcare service quality, the medical brainn drain has significant economic costs for Nigeria. A 2018 report published by the Mo Ibrahim Foundation estimated that African countries have spent $4.6 billion training doctors who then emigrated to the US, UK, Canada and Australia. The ~40,000 Nigerian doctors practicing outside the country amount to about half of the doctors Nigeria has trained since the 1960s - indicating significant financial losses on Nigeria’s investment in educating and training doctors. These losses are presumably high-income countries’ gain; a 2011 report estimated that, as a result of Africa’s medical brain drain, the US, UK and Canada have gained financial benefits of $846 million, $2.7 billion and $384 million, respectively.

Key Takeaways from TC Health: In order to retain domestically trained doctors and nurses and attract those in the diaspora, the Nigerian government needs to ramp up its public health spending to create a high quality working environment that provides healthcare workers with the tools they need to do their job sustainably and effectively. This will enable government hospitals to pay higher and more frequent salaries to skilled healthcare workers and invest more money in healthcare infrastructure (e.g., renovating and expanding healthcare facilities, investing in educational institutions and research facilities, etc.). Additionally, the high quality training of Nigerian doctors and nurses in the diaspora could be leveraged to provide educational opportunities for domestic healthcare workers, enabling a transfer of skills and technology and converting the brain drain into a wisdom gain.