From Fred Ezeh, Abuja
Hospitals in Nigeria are currently witnessing reduction in number of qualified manpower, notably, doctors, nurses, pharmacists, and several other healthcare professionals due to the ongoing “japa” wave being witnessed in the health sector.
Many of the migrating healthcare workers said they are tired of poor working conditions, renumeration, failed government promises, and several other factors working against the sector in Nigeria, hence the decision to seek better opportunities elsewhere.
A few days ago, the President of the National Association of Nigerian Nurses and Midwives (NANNM) Comrade Haruna Mamman raised the alarm that Nigeria health sector might experience unprecedented manpower crisis.
He disclosed that records available to the Association as of February, 2025, indicated that, in the last few years, about 15, 495 nurses have left Nigeria for foreign practice.
Coordinating Minister of Health and Social Welfare, Prof. Muhammad Ali Pate had also mentioned at an event in Abuja that about 16, 000 doctors left Nigeria in the last five years in search of better working conditions abroad.
The Minister registered was even more concerned that available records further indicated that more number of doctors, nurses, and other healthcare workers have also indicated interest to leave Nigeria to pursue professional opportunities and experience abroad.
On the other side, the NANNM President, however, told journalists at the end of the National Executive Council (NEC) of NANNM in Abuja, last week, that the situation is becoming alarming, and could soon pose a big manpower threat to timely and quality health care delivery services in Nigeria.
The push factor
In such situations, there are always some push factors that lure the migrating doctors. For the nurses, NANNM President placed the blame for the “japa” being experienced in the health sector on the doorstep of the government.
He said the health sector had witnessed an unprecedented neglect for a long time in terms of infrastructural upgrades, modern equipment, and trained and retrained manpower, among others.
He said that the government has been lackadaisical on issues of nurses’ and midwives’ welfare, as well as the conditions of service. “Just take a look at the Scheme of Service for health workers, particularly the nurses. The document was approved in 2016, but it has not been gazetted about nine years after, and that has affected career growth and renumeration.
“For instance, in some states, nurses of different cadre receive different salary and other entitlements, and that was because of the absence of the scheme of service which would have clearly explained what some is entitled to at what level.”
He also made reference to the issue of industrial court judgment that has not been implemented, as well as the unanswered request for the decentralisation of internship opportunities for those who have graduated from nursing schools, and are seeking an opportunity for an internship.
He said: “We have endured years of unmet promises in this country. We had also refrained from industrial action for years in the hope that our concerns would be addressed. The National Industrial Court of Nigeria (NICN) judgment was delivered in 2016, yet implementation remains elusive. But the association’s patience is already wearing thin.
“Nurses are at their breaking point, and if urgent action is not taken, we may be left with no choice but to escalate our demands through lawful means which that include industrial actions which might affect smooth services at the health facilities.
“The government should expedite action on these nurses’ demands, including the upward review of remuneration and working conditions to stem the tide of migration.
Regarding the doctors, the Minister said the challenge was driven by factors such as economic opportunities, better working conditions, advanced training, and superior research environments abroad.
He said: “I, too, migrated in the early 1990s. In 1993, I started at the MRC Lab in The Gambia and the ECFMG pathway that many here know well. So, I understand the drivers because they haven’t changed. The migration of health professionals from developing countries is not new, but it has accelerated in recent years.
“However, we are taking some realistic measures that would herald a significant reversal in the brain drain challenge.”
Rescue measures
The coordinating Minister of Health and Social Welfare confirmed that steps are being taken to correct some of the identified challenges that are encouraging the growing interest of the Nigerian workforce in foreign practice.
He said: “For instance, we have doubled the quotas for training of health care professionals, notably, medical doctors, pharmacists, nurses, and other health care professionals, because experience shows that when you train more, more might stay, and those who left often return.
“We are also correcting the obvious challenge of maldistribution of medical workforce. We noticed that over 40 per cent of our medical doctors are concentrated in Lagos and Abuja, leaving many parts of Nigeria with inadequate manpower to offer quality and timely medical coverage. It’s true you can’t force doctors to relocate, but you can incentivize them with financial and non-financial rewards.”
Last year, President Bola Ahmed Tinubu signed a policy document titled “National Policy on Health Workforce Migration” designed to discourage the migration of health workers, and possibly bring about a reversal of the brain drain challenge.
Deconstructing the document, the minister of health said the policy will provide clear guideline 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.
It proposes the deployment and application of bilateral and multilateral agreements on recruitment of health professionals, while respecting the freedom of health workers to migrate, and that such agreements should provide a basis to favour in-country migration and facilitate circular or return migration for critical skills.
The Minister said the policy document also 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 document 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.
New concerns
Despite the efforts being made by the government to correct the anomalies and challenges of quality manpower in the health care sector, fresh concerns were raised a few days ago by the leadership of NANNM.
The nurses’ union pointed to the growing proliferation of medical and nursing schools across the country with little or no funding and supervision from the Nursing and Midwifery Council of Nigeria (NMCN).
National Secretary of the Association, Dr. Thomas Shettima, recently led the campaign against the growing proliferation of nursing schools across the country, stressing that such action is not the solution to the “japa” challenge currently being experienced in the health sector, but will rather breed official quacks.
“By the time you have produced these nurses that you can not employ and pay adequately, it becomes a challenge to quality healthcare. These nurses, undoubtedly, have already acquired the knowledge and are unable to go outside but remain in society. If they are in the society and are jobless, but they have the knowledge and are approached for any treatment for their services, they will definitely go and render those services. In rendering the services, some could go outside their ways because they must survive.
“Therefore, if we want to curtail the ‘japa’ syndrome, we must first ask ourselves, why are people going outside the country? If we get the answer, then we will be able to address it.
Simply, people are moving outside Nigeria. In fact, all professionals are moving outside Nigeria, particularly the nurses, because the welfare, their condition of service, and welfare are not good enough.
“For instance, there are some allowances of nurses and midwives that have not been reviewed for over 30 years now. And any call to review that is always met with resistance. For a more durable solution, the government needs to sit with the relevant authorities and unions, particularly in the case of the nurses and midwives, to discuss the way forward.
“So, opening 1,000 schools of nursing in every state will never be a solution to ‘japa’ and quality service delivery. People will still look for a better condition of service. But if we improve our own here, and then train qualified persons to handle our health care, I want to believe it’s the solution to ‘japa’ syndrome.”