The Looming Disaster In Nigeria’s Healthcare Delivery – Dr. Mamudu Dako

 

“The WHO Global Health Workforce statistics estimated the Physicians to 1000 people ratio for Nigeria as 0.4 (2018). Ratio for some other countries are:- Cuba 8.4 (2018), Ghana 0.1 (2017), Israel 4.6 (2018), Norway 2.9 (2018), Saudi Arabia 2.6 (2018), Sweden 4.0 (2016), Togo 0.1 (2018), USA 2.6 (2017), UK 2.8 (2018), UAE 2.5 (2018) and Australia 3.7 (2017)”

PEGASUS REPORTERS |AUGUST 17, 2021

Health is defined by the WHO as a state of complete well-being physically, mentally, and socially and not mere absence of infirmity. Health is a fundamental human right universally and in Nigeria, the provision of health is in the concurrent list in our constitution.

In Nigeria, just like most countries of the world, healthcare facilities and services are provided by Federal, States and Local governments as well as organizations such as religious bodies, and individuals or groups of individuals.

The pinnacle of healthcare organizations globally is the World Health Organisation (WHO), an organ of the United Nations (UN), created in 1948 to coordinate health issues within the countries of the United Nation system.

Again in Nigeria just like most countries of the world Public Health (Global Health) is essentially almost exclusively the responsibility of the government. Provision of Primary, Secondary and Tertiary health are all comers businesses as federal, state and local governments as well as private and some organizations are involved in one way or the other.

Certain parameters or indices are usually used to access the level or quality of health care in a community or country. These include life expectancy at birth, maternal mortality ratio, infants, and under 5 mortalities. Usually, there is a direct correlation between the above indices and the quantity and quality of the manpower, availability of healthcare infrastructure as well the quality of management of the resources.

In Nigeria, all the indices mentioned above are amongst the worst in the world! For example, according to the data based on the latest United Nations Population Division estimates the life expectancy of the world population, expectancy in Nigeria at birth in 2019 is 56.75, Ghana 66.13, Benin Republic 64.45, Algeria 78.76, Togo 63.08, UAE 79.80, China 79.73 and the USA 81.65.

The figures are in years and females are higher than males in all countries reported. Nigeria infant and under-5 mortality are also amongst the worst in the world. According to the same reports, 2019 infant mortality in Nigeria is 74. For the same period, figures for some countries are- USA 6, UK 4, Benin Republic 59, Ghana 34, Togo 46, Norway 2, UAE 3, and China 7. We also score low in the Maternal Mortality Ratio. This is the number of women that died out of every 100,000 live births. Our figure for the same period is 917. Figures for some other countries are- UK 7, UAE 3, USA 19, Ghana 308, Togo 396, Benin Republic 397, and Saudi Arabia 17.

The WHO Global Health Workforce statistics estimated the Physicians to 1000 people ratio for Nigeria as 0.4 (2018). Ratio for some other countries are:- Cuba 8.4 (2018), Ghana 0.1 (2017), Israel 4.6 (2018), Norway 2.9 (2018), Saudi Arabia 2.6 (2018), Sweden 4.0 (2016), Togo 0.1 (2018), USA 2.6 (2017), UK 2.8 (2018), UAE 2.5 (2018) and Australia 3.7 (2017)

It should be noted from above that the far Eastern countries and the Scandinavian countries have the best health statistics in the world while West African countries have the worst. The quantity and quality of health infrastructure in Nigeria are far below acceptable standards! Investment in health is also very low.

The above poor health statistics in Nigeria notwithstanding, the Nigerian government still watches and allows the mass exodus of its available scanty healthcare personnel to America, Europe Australia, and the Asian countries that have better statistics. This is unacceptable.
Factors driving this retrograde movement can be classified as ATTRACTIVE and REPULSIVE. While the repulsive factors are in Nigeria, the attractive factors are in the foreign host countries.

ATTRACTIVE:
These are factors available in the foreign countries that make them attractive to work in. The most attractive is monetary rewards. For an average medical officer who earned N200,000.00 monthly in Nigeria, $2000.00 monthly in a Gulf country is a big bonanza even though his/her peer from the Western countries employed to do the same job in the same facility earns much more. This dollar salary is tax-free and the cost of living is minimal. He has a monthly surplus of over N800,000.00! This salary comes promptly and regularly compared with what is obtained in Nigeria. Another attractive factor is the work environment. Modern working tools are available and medications are usually readily available. The work environment is safe and to some extent friendly.

REPULSIVE:
These are adverse conditions in Nigeria that mitigate against work practice. The most repulsive factor is (in)security. Doctors have become endangered species in Nigeria especially in rural and semi-urban communities where they are perceived as rich by the people they serve. Many doctors have lost their lives and many more ran away and abandoned their homes and practices as a result of attacks or fear of attacks in their areas of operations. This is real and unacceptable. The high cost of living in Nigeria, the government’s unstable and unfriendly policies, and the absence of appropriate tools to work with are also repulsive. Poor remuneration and government failed promises resulting in incessant industrial strikes are also negating factors. The absence of a strong government political will to develop the health sector is also a major negative factor.

CONSEQUENCES:
Healthcare personnel training is universal. Consequently, personnel trained even in developing countries can work in any developed country with initial minimal orientation.
Globalization and easy access to global information highway also play major roles in the global labour market and the frustrated Nigerian personnel is a beneficiary.
No country in the world is self-sufficient with medical health personnel; doctors, nurses, laboratory scientists, etc are in high demand globally!

Consequently, the frustrated Nigerian health care providers readily find solace in the Gulf countries, Europe Australia and Canada, where the repulsive factors are absent and the attractive factors are present.

For the past five years, this mass exodus of healthcare manpower has assumed an alarming proportion. This has depleted the workforce in the already fractured health system. Most of the newly graduated doctors rarely think of internships and those that border to do internships leave to the attractive countries almost immediately after their house-manship. Consultants, registrars, and senior registrars in the teaching hospitals, government, and private hospitals are not left out in this exodus for greener pastures.

The impacts of this movement in our health facilities, both government and private can not be overemphasized. They are fast depleting the essential workforce. It is not unusual nowadays to place an advert for a medical officer or staff nurse and for three months there is no single applicant. The same goes for laboratory scientists, pharmacists, etc. This spells doom for the future of healthcare delivery in Nigeria and we need a miracle to avert this pending doom. Something positive has to be done and as quickly as possible.

Only God and “good governance” can save Nigeria from this pending doom.

Dr. Dako Mamudu is the CEO of Dako Foundation For Rural Healthcare And Education and sents this piece from the Las Vegas in the7USA

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