By Fred Ezeh, Abuja
Last week, the Federal Government took a drastic step that it believed could solve the problem of massive brain drain being experienced in the Nigeria health sector.
In the last five years, the health sector in Nigeria has witnessed unprecedented shortage of manpower as a result of the decision of some health care workers in Nigeria to seek professional opportunities and experiences abroad.
In response to the growing public concern, the President signed a policy document titled “National Policy on Health Workforce Migration” designed by the Federal Ministry of Health and expected, with inputs from various stakeholders to discourage the migration of health workers.
Evidently, the emigration was not limited to doctors alone, as Nurses, Optometrists, Laboratory Scientists, Physiotherapists, Pharmacists, and several other professionals in the health care delivery system did not only indicated interest, but left the shores of Nigeria for foreign practice.
Data obtained from the Federal Ministry of Health indicated that year 2022 represented the peak of the migration of medical doctors. Over 3, 000 doctors requested for Letter of Good Standing from the Medical and Dental Council of Nigeria (MDCN).
It noted that the figure does not represent the total migration of medical and dental professionals, but only those that informed MDCN about their migration.
The United Kingdom was the choice destination for 68 per cent of migrated doctors. Other choice countries of destinations were Canada (10 per cent), USA (7 per cent), UAE (5 per cent), Australia (3 per cent), Ireland (3 per cent), Saudi Arabia (1 per cent) and Maldives (1 per cent).
As regards the Nurses and Midwives, the data also noted a huge jump in the number of Nurses that requested for verification from the Nursing and Midwifery Council of Nigeria (NMCN) to migrate for foreign practice.
It said that 52 per cent of the Nurses and Midwives who requested for the Letter of Good Standing chose the United Kingdom as their new country of practice, while 36 per cent chose the US. 17 other countries accounted for 12 per cent of the total migration number.
2021 and 2022 accounted for 89 per cent of the total migration of Medical Laboratory Professionals through Medical and Laboratory Science Council of Nigeria (MLSCN).
Also, Canada was the destination for 72 per cent of Pharmacists who left Nigeria through Pharmacy Council of Nigeria (PCN) in 2022. But the number of Pharmacists who migrated through PCN has not changed significantly compared to other cadres of health workers between 2018 and 2022.
The data further indicated a steady rise in the number of Optometrists that have migrated from Nigeria from 2021. This is more concerning when compared the numbers who migrated in 2021 and 2022 to the total number of graduates (it means the manpower that left the country is higher than what was produced within the period).
Similarly, in 2022, 1,020 Physiotherapists requested for Letters of Good Standing from the Medical Rehabilitation Therapists (Registration) Board of Nigeria (MRTBN) to process their traveling for foreign practice.
This number of Physiotherapy emigrants is obviously more than the total number of Physiotherapy emigrants through MRTBN platform in the previous four years (from the year 2018 to 2021). Expectedly, the UK was the home destination for 91 per cent of Physiotherapists who left the country as indicated by records the MRTBN.
Expectedly, these massive migrations of health workforce brought about significant drop in quality of services in health care sector, as well as prolonged stay by patients to obtain the needed services in the hospitals.
Deconstructing the policy
Coordinating Minister of Health and Social Welfare, Prof. Muhammad Ali Pate, is optimistic that the National Policy on Health Workforce Migration in Nigeria will address a critical concern that impacts the healthcare system of Nigeria.
He said the policy would provide guidelines to strategically manage health workforce migration that, expectedly, would address the fundamental problems of the shortage of skilled healthcare professionals in Nigeria, particularly in rural and underserved areas.
Nigeria, undoubtedly, suffer from severe shortage of health workers, stemming from long-lasting challenges on the production of skilled professionals, and on the difficulty to deploy existing professionals in rural and underserved areas. In this context, the migration of healthcare workers has made these problems more salient.
The policy thus outlined a comprehensive framework to address these fundamental challenges through a managed migration of the healthcare workers that focuses on improving quality and quantity of training, recruitment, and international cooperation.
The document, according to the Federal Ministry of Health is a forward-looking strategy that seeks to strike a balance between the needs of the healthcare system and the aspirations of healthcare professionals.
“By implementing a holistic set of interventions to develop regular and managed migration systems, the policy aims to strengthen Nigeria’s healthcare delivery, improve health outcomes, and secure the future of the nation’s healthcare workforce,” the Ministry explained.
Key highlight of the policy
The policy document recognized importance and aligned with the objectives of Universal Health Coverage (UHC) by advocating the institutionalization of an effective well-managed migration of health workers linked to the UHC aspirations of the government.
It proposed the deployment and application of bilateral and multilateral agreements on recruitment of health professionals, while respecting the freedom of health workers to migrate. Such agreements are expected to provide a basis to favour in-country migration and facilitate circular or return migration for critical skills.
The Policy recommended a good working package/incentives for health workers who choose to remain in the country especially those who choose to serve in rural and deprived parts of the country; those in training programmes in the country, and providing necessary equipment and commodities to deliver quality care.
The Policy further advocated the development and strengthening of a human resources for health registry to support the use of evidence-based policies and provide data for improvement in the availability and international comparability of migration statistics for health personnel in Nigeria.
It also advances multi-sector and whole-of-government approaches to managed migration in Nigeria, by ensuring that institutions in relevant ministries such as, Federal Ministries of Education, Labour and Employment, amongst others are involved in ensuring the optimization of the present health workforce and the production of a future health workforce that is responsive to the needs of the country and the world.
It also recognized the role of the private sector as a source of innovation and health as a service. The private sector should be involved in the flow and production of skilled health workers and the use of “digital in health” as a way of delivering quality and effective health services.
The policy noted that as a basis for health systems strengthening, recognition and effective managed migration can play a key role in building capacity of health systems in Nigeria and skill/ knowledge transfer from the diaspora.
Addressing the challenge
In addressing health workforce migration, there is need to align with the WHO Global
Code of Practice on the International Recruitment of Health Personnel, and this could be achieved through deep collaboration.
The increased capacity of health instiutions is necessary to address the shortage of health workforce in Nigeria. Nigeria’s health workforce needs to be well-trained to acquire the skills needed to render quality services in Nigeria as well as in the global labour market.
Similarly, expanding and strengthening the health workforce training, whether they migrate or stay in Nigeria, is crucial to increase the number of and quality of health workers that will eventually serve in Nigeria.
Research and innovation could also provide framework for evidence-based management of health workforce migration. This will provide information for decision-making and continuous development of strategies using modern innovation for implementation.
Meanwhile, in the cause for formulating the policy, some stakeholders, notably, Directors of Hospital, Nursing, PPP/Diaspora, Federal Ministry of Health; Director, Wages and Employment, Federal Ministry of Labour and Employment; Representative of Permanent Secretary, Federal Ministry of Finance; Permanent Secretary, Office of the Head of Service of the Federation; Head of Health Services, Nigeria Immigration Service; Director, Federal Ministry of Education.
Others such as Registrars, MDCN, NMCN; President National Association of Nigeria Nurses and Midwives; Chairman, Nigeria in Diaspora Commission; President, Association of Private Medical Practitioners; Representative of CMD, National Hospital Abuja; Secretary, National Association of Nurse Practitioners (America); PR Secretary, Association of Intensive Care Nurses (UK); Director, Institute of Biomedical Research and Innovations, University of Uyo; World Bank Team; Executive Secretary, National Human Rights Commission; Civil Society Network; made submissions.
They felt that health workforce migration is a huge challenge to the Nigerian health care sector in Nigeria, and worsens the shortage of healthcare professionals, thus leading to longer waiting times, reduced patient-to-provider ratios, limited access to specialized care, and decreased quality of healthcare services.
“This also weakens the healthcare system’s ability to respond to public health challenges and perpetuates the cycle of workforce shortages by reducing investment in health education and training
Eighty per cent of them felt that the most important driver is economic, and 20 per cent felt that the most important factor was professional growth. However, factors that contribute to health workforce migration was categorized under economic, political, social, and environmental factors which include low and non-suitable salaries, poor working conditions, poorly equipped health facilities, lack of assessable and non-affordable healthcare, limited job prospects and inadequate resources.
Shortcomings and suggestions
Shortly after the launch of the policy document, some stakeholders began to speak on the policy vis-a-vis the possibility of the policy to yield the desired result.
Some of them also of picked out several things that could have been included in the policy so it can achieve it-desired objective.
President, Medical and Dental Consultants’ Association of Nigeria (MDCAN), Prof. Muhammad Aminu Muhammad, told Daily Sun that the Association is okay with the National Health Workforce Migration policy document even though they were not consulted to make an input in the final document.
He said: “We are okay with the document for two reasons. The Government has recognized, for the first time, that health workforce migration otherwise known, as “japa” is a problem that needs urgent solutions.
“Secondly, the policy document has set a basis for a discussion with stakeholders that will, perhaps, herald some solutions or something close to that to the issue of health workforce migration.
“But the problem is that the input of MDCAN should have been sought before approval of the document to make it more acceptable and practical. All we heard was the approval of the policy document by the federal government.
“Nevertheless, we are optimistic that sincere approach to the implementation of the content of the document will result in some changes to the challenge being experienced.
“It can reduce the magnitude if stakeholders are involved in designing practical ways of implementation of the policy, and government has the political will to implement it.
NMA President, Dr. Bala Audu, also said the Association was neither consulted nor their input sought for in the formulation of the policy.
“Though, I am relatively new in office as NMA President, but I don’t know what transpired with my predecessor as regards the Policy. I don’t know if he was invited to send a representation to the policy formulation meeting. But as for me, I neither participated nor sent a representative to the meeting.
“However, we are okay with the policy even though we have some observations to me. From all indications, the policy was built to fix the issue of training, security and incentives for the health workforce. Sadly, there was no clear implementation strategy for the policy. This is one of the lapses that we identified, and we will soon open conversation with the government on that.
“It’s important we know that aside gaining advanced professional experience, incentive is the most driving force behind the mass exodus of medical workforce from Nigeria.
“Evidently, the receiving countries provide better renumeration, training, working tools and conditions, motivations, as well as other things that enhances the capacity of the health workers.
“If these things, particularly the issue of incentives are corrected, Nigerian doctors abroad would not hesitate to return, but might lure their colleagues from other countries to practice in Nigeria.”