Does Nigeria Have Too Many Doctors To Worry About A 'Brain Drain'?

Nigeria has too many doctors and is not suffering from a "brain drain", the country's minister of labour has said.

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But Chris Ngige's comments, made on a local TV station on Wednesday, have stirred controversy in Africa's most-populous country, which is estimated to have spent more than $2bn (£1.5bn) since 2010 after training doctors who subsequently emigrated.

John Afam-Osemene, who graduated as a doctor in 2016, hopes to be one of them - planning to move to the UK to work.

He says this was not his intention but poor pay and working conditions at home prompted his decision.

"Graduation is a beautiful experience; it's all smiles, but shortly after the real world hits you," he told the BBC.

Dr Chioma Nwakanma, who worked in a public hospital in the south of the country, explains that she and her colleagues have often lacked even the basics.

"I mean as basic as oxygen tanks. Protective equipment like gloves, we have to borrow from patients," she told the BBC.

She came to prominence during a Lassa fever outbreak last year, when she spoke out about a lack of protective equipment after a colleague contracted the virus and later died.

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"It hit home. We knew her husband, her friends, she was a mother. It was very personal to me because we were like goats [being led] to the slaughter," said Dr Nwakanma, who has now moved into private practice.

'Chronic underfunding'

Poor infrastructure and low pay are the reasons behind frequent strikes by doctors in public hospitals - including one that started last week in Imo state where medics say they are owed salary arrears.

Dr Francis Adedayo Faduyile, president of the Nigerian Medical Association (NMA), blames "chronic underfunding" for the state of the healthcare system and says this is leading to the "mass migration" of doctors.

The labour minister argues it is normal for a country with a surplus of goods and services to export them.

But for Dr Faduyile, the more doctors leaving will put a further strain on a system that is already stretched thin.

"If we have any crisis, the health system is weak and will not be able to cope. Unless the government does something significantly different, I think the situation will continue," he told the BBC.

The NMA says there are only 40,000 doctors in an estimated population of 196 million.

The latest data from the World Health Organization (WHO) reveals that Nigeria's physician-to-patient ratio is four doctors per 10,000 patients and patients often wait hours to be seen. In the US the ratio is 26 doctors per 10,000 people and 28 in the UK.

Nigeria repeatedly falls short on its 2001 commitment to spend at least 15% of its budget on health. Last year just 3.9% was allocated.

'Everybody I know is leaving'

Brain drain is not a new phenomenon in Nigeria, but the concerns are that doctors are now leaving much earlier in their careers.

"From internship days everyone is thinking PLAB [Professional and Linguistics Assessments Board], that's the exam for the UK," Dr Nwakanma says.

"Everyone is thinking USMLE [United States Medical Licensing Exam] for the US. It's part of the system. When you graduate people ask, 'Where are you doing your residency? The UK or the US?'"

And even President Muhammadu Buhari himself goes abroad for his treatment. He spent many months in the UK during his first term in office.

There are currently more than 5,000 Nigeria-trained doctors registered in the UK.

Other popular destinations include the US, Canada and Saudi Arabia, but the UK Home Office's decision to relax immigration rules for non-EU doctors in the wake of Brexit, could lead to more doctors choosing the UK.

"Everybody I know is leaving," Dr Nwakanma said.

"We're all in this WhatsApp group. Everyone started with a Nigerian number, one year later, you see a British number or an American number. Numbers are changing because people are leaving."

"If I have 10 friends, nine of them are leaving."

Dr Afam-Osemene has one more exam to go before he is able to qualify to practise medicine abroad.

He would like to come home again but says that would depend on whether things improve in Nigeria.

"It's already a problem and nobody seems to care. People can't tell you to stay when they aren't giving you solutions."

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