Nigeria, Africa’s largest country, is in dire need of doctors to meet the health needs of its citizens, official statistics show.

Only one medical doctor is available to cater for every 4,845 Nigerians, the official data sourced by PREMIUM TIMES show.

Nigeria’s population, according to the Nigerian Bureau of Statistics, was estimated at 193.4 million in 2016.

Meanwhile, the Medical and Dental Council of Nigeria (MDCN) in a response to a Freedom of Information request by PREMIUM TIMES showed that as at December 2017, Nigeria had 42,845 registered doctors, dentists and alternative medicine practitioners working in the country. Of these number, 39,912 are medical doctors.

Nigeria’s ratio of doctors to population is about eight times below the World Health Organisation (WHO)’s recommendation of one doctor to 600 patients.

The data provided by the MDCN does not include the number of doctors and dentists who have left Nigeria to work abroad since 2017.

Exodus

PREMIUM TIMES in April last year reported on the mass emigration of doctors and health professionals in search of greener pastures.

The exodus has been a burning issue in the country with officials of the medical association providing contradictory data of their members still practicing in the country and those who have left.

As at the time of that report PREMIUM TIMES’ efforts to get official statistics of medical and dental practitioners practicing in the country and those who have left from MDCN were not successful.

However eight months after the report and a third FOI, the agency was able to provide some of the information required.

MDCN is the agency with the mandate to register and regulate the medical profession in Nigeria.

The agency, as part of its duty, is tasked with the responsibility of registering newly inducted doctors, renewing licences of doctors in the country and also keeping record of those leaving the country.
The agency is also meant to have a record of foreign doctors who come into the country to work.

Response

MDCN in its response signed by the registrar of the agency, Tajudeen Sanusi, said Nigeria has 42,845 doctors in the country.

In a breakdown, the agency stated that as at December 2017, registered doctors still practicing were 39,912, while registered dental practitioners stood at 2,901. It also said there were 32 registered alternative medicine practitioners as at January 9, 2019.

The agency said since its establishment (in 1963), 91,079 Nigerian medical and dental practitioners have been registered so far.

INFO-GRAPH: Nigeria gravely lacks doctors to address citizens’ health needs. [CREDIT: George Kaduna]

Giving a breakdown of the registrations, MDCN said it registered 86,722 medical doctors from 1963 to 2019. A total of 4,357 dentists were regisered from 1963 to 2019 while 32 alternative medicine practitioners were registered from 1992 till 2019, when they came under MDCN regulation.

However, MDCN could not provide the total number of Nigerian doctors and dentists, trained in Nigeria, but working outside the country.

This is unusual as Nigerian trained doctors going abroad to work usually collect a ‘letter of good standing’, which is a form of recommendation from the agency to the medical regulatory board of the country the medical practitioner is moving to.

But the MDCN directed the reporter to the health regulatory agencies in the various countries.

Alarming

With the statistics released by MDCN, it is safe to say the Nigerian health workforce is in dire need of urgent attention.

With the unchecked exodus of medical practitioners out of the country, Nigeria has a very long way to go to meet the WHO recommendation.

A resident doctor at the University College Hospital (UCH) in Ibadan, who pleaded not to be named, said many resident doctors in the institution are planning to leave the country.

University College Hospital Ibadan

Lamenting the work load in the health institution, he said it would have been much easier if the institution had more medical hands.

He said the UCH is the largest health institution with over 10 wards, which are most times manned by resident doctors.

“Some of them (doctors) do not even care for their residency nor intend to complete the programme. What most of them are after is passing the UK or US medical examinations,” he said.

The president, Nigeria Medical Association, Francis Faduyile, in an interview with PREMIUM TIMES last year explained why many are leaving.

Francis Adedayo Faduyile

He listed the reasons as poor remuneration, poor facilities and working condition and lack of job satisfaction.

The associate professor said many of the health professionals are over-worked.

“A doctor is supposed to see a maximum of 20 patients a day but they are seeing about 150 in a day. Certainly by the time he gets to 50, he is already exhausted. Even a nurse that is supposed to see about four patients has to take care of 50 patients in a ward, certainly he/she will get tired,” he said.

Mr Faduyile also said the working environment in Nigeria for many doctors is very hostile.

“Many doctors see patients that they can treat or intervene on their issues die in front of them because the hospitals they are working in do not have the necessary equipment to take care of them.”

He said the remuneration of doctors is very poor compared to other climes. He said what they are paid in Nigeria is just 10 per cent of what they collect in other climes where “they respect doctors”.

“They put you in that right position where you feel very important. We don’t have good funding/maintenance for hospitals in the country. The few doctors that we have are over-worked and are not appreciated; these are some of the reasons why so many of them are leaving unfortunately,” he said.

‘Government Worried’

The Minister of Health, Isaac Adewole in a reaction said the government is worried about the trend in the health sector.

Prof. Isaac Adewole. Minister of Health

But Mr Adewole, as reported by Channels TV during the 38th Annual General Meeting and Scientific conference of the National Association of Resident Doctors of Nigeria (NARD), said according to the data he obtained from MDCN, “there is no serious shortage of doctors in Nigeria.”

Mr Adewole noted that what is perceived as shortage of doctors is actually the uneven distribution of practicing doctors within the country.

This, he said was a result of the emigration of Nigerian trained doctors.

“There is no serious shortage of doctors in Nigeria. People are free to disagree with me but I will tell you what the situation is across Nigeria and many other African countries,” he said.

Global Trend

The increasing international migration of health workers has also been raising concerns globally.

According to WHO, there has been a 60 per cent rise in the number of migrant doctors and nurses working in Organisation for Economic Co-operation and Development (OECD) countries over the last decades.

“Future projections point to a continuing acceleration in international migration of health workers, with escalating mismatch between the supply of and economic demand for health workers,” it said.

Ripple effect

Going by the disturbing trend, Nigeria might find it difficult achieving its Universal Healthcare Coverage goals.

WHO identified critical shortage, inadequate skill mix and uneven geographical distribution of the health workforce as posing major barriers to achieving the health related Millennium Development Goals (now Sustainable Development Goals).

Also, only five of the 49 countries categorised as low-income economies by the World Bank meet the minimum threshold of 23 doctors, nurses and midwives per 10,000 population that was established by WHO as necessary to deliver essential maternal and child health services.

Nigeria though no longer termed low income country drastically falls short of these recommendations.

The availability of medical manpower is also skewed as many health workers do not work in the rural areas where their attentions are needed.

Nigeria has been struggling to provide skilled care at birth to many pregnant women as well as emergency and specialised services for newborns and young children. This has direct consequence on the number of deaths of women and children.

Currently, Nigeria ranks one of the countries with the highest maternal and child mortality rate.

Some pregnancy-related services can be delivered by mid-level health workers, but they do not count for an effective workforce. These should consist of a carefully planned balance of professionals, paraprofessionals and community workers.

The shortage of these impedes access by women and children to lifesaving interventions and services.