Public Health Management and Leadership Essay

The Brain Drain of Medical Doctors in Nigeria

Long-term economic growth cannot be achieved without individuals possessing professional and technical expertise and entrepreneurial or managerial skills. According to Nwachukwu and Ekeopara (2012), the absence of such experts due to brain drain has adversely impacted Nigeria’s economic growth.

Suffering from the dearth of medical doctors, Nigeria alone contributes almost 10 percent to maternal deaths worldwide, although its proportion of the global population is only 2 percent (Imafidon, 2018).

The study conducted by Imafidon (2018) concluded that the scarcity of medical doctors indirectly derives adverse impacts in the whole healthcare system, especially the child-and-maternal health in rural areas.

Muanaya and Akpan (2018) reported that 2,000 medical doctors annually move to Australia, the United Arab Emirates, the United Kingdom, and the United States, which has cataclysmically resulted in the ratio of just one doctor to every 6,000 patients.

Brain drain refers to the movement of scientific, technical, and managerial experts from underdeveloped economies to developed countries believing that their human capital shall be valued there (Alem, 2016).

This movement of human resources has further worsened the economic situation in underdeveloped economies, as the citizens leave their homeland after benefiting from quality education, searching for better opportunities in other countries (Fraser, Castrucci, and Harper, 2017).

However, besides endemic poverty, lack of a congenial environment, and low prospects for career advancement, many medical doctors have described different reasons for their immigration (Adeyemi et al., 2018).

For example, they feel pretty embarrassed when they lack high-quality technology and machines in their homeland to practice their acquired knowledge and expertise (Muanaya and Akpan, 2018).

The history of brain drain in Nigeria began in 1960, i.e., when medical education and training started there. According to Hagopian et al. (2005), the number of individuals from this low-income country has been 11,000 to date. They practice mainly in politically and economically stable countries, such as the United States, United Kingdom, and Australia, for security and better living conditions.

World Health Organisation reported a shortage of more than 4 million healthcare workers across the globe, the majority of which constitutes Sub-Saharan countries as they have 3 percent of global healthcare workers and are burdened by 24 percent of global disease (Misau, Al-Sadat, and Gerei, 2010).

Impacts of outflow of most critical human assets include severe reduction of human capital, limited capacity for innovation, and eventually the decline in economic growth. The shortage of young, competent, and skilled physicians have affected the quality of the Nigerian healthcare sector quality (Adeyemi et al., 2018).

Significant impacts can be masked in urban parts of the country with relatively high concentrations of private and public healthcare centres, but significant effects can be seen in rural parts (Karan, DeUgarte, and Barry, 2016).

Health stakeholders in Nigeria recently alerted the government of the looming scarcity of more than 50,000 doctors and 137,000 nurses by the end of 2030. On the other hand, in some categories, specialists are almost none; there is only one cancer doctor to more than 1,100 cancer patients (Ogune, 2021).

Several reasons contribute to the poor situation of the health system in Nigeria. The economy faces a number of challenges that induce brain drain, including a corrupt political system and a shortage of basic necessities such as healthcare, sanitation, electricity, and clean water (Ogaboh, H. T. Udom, and Eke, 2020).

Public health organisations face several challenges due to the lack of effective stewardship of the healthcare sector, which results in the poor development of human resources (Uneke et al., 2012). The Federal Ministry of Health (2004) in Nigeria identified eight constraints that challenge effective leadership and governance in the health sector.

These include lack of proper definition of the roles and responsibilities of key actors in the industry, lack of use of adequate management, leadership, and governance tools, for example, acceptable regulatory policies and operational health sector strategic development framework.

The third constraint is the challenge faced is lack of coordinated response to critical needs of the health sector (Anaemene, 2016), as every industry needs to collaborate with different regulatory and other bodies to operate effectively.

Policy-related constraints include the failure to acknowledge and enforce the implementation of policies, the absence of a legal and constitutional framework to support the major policy thrusts, and the lack of definite roles in the private sector.

Significant constraints cited by Uneke et al. (2012) from FMOH’s paper include inadequate health sector funding. Further, no consideration for preventive and primary medicine in the health sector reform plan, as nothing was specifically budgeted for matters related to the promotion of health education, immunisation, or sanitation.

Another loss is the loss of investment in education and human resources training; according to United Nations Commission for Trade and Development, the estimated loss per migrating African professional is USD184,000 (Hagopian et al., 2004).

By the end of 2021, the mortality rate of infants under one year of age was 58.23, i.e., for every approximately 58 deaths per 1,000 live births. Likewise, the country recorded 917 maternal deaths per one lac live births, and the number has now grown even higher (Statista, 2022).

The study by Imafidon (2018) concluded several adverse impacts on public health created by the brain drain of medical doctors. The rate of individuals seeking employment within the country in the health sector is relatively slow; the government is employing more professionals at not the same rate as the departure rate of professionals from the country.

The resulting gap leading to the severe shortage of medical doctors is the root cause of several problems for the public health sector. After mixing up with endemic poverty, lack of fair and sustainable health sector’s financing, and neoliberal economic policies, a rising number of toxic impacts in the public health sector include lack of adequate access to quality healthcare, poor hygiene and malnutrition, corruption, and poor health infrastructure overall (Obansa and Orimisan, 2013).

Although the government and other regulatory bodies have introduced several reforms to improve the situation, the current health systems situation is still alarming. The Federal Government needs to explore ways to improve the access of Nigerians to primary healthcare, which will require actions on several fronts.

Obansa and Orimisan (2013) proposed that, just like Saudi Arabia, there should be a ban on funding of government officials moving abroad for medical treatments, which will motivate the individuals in power to direct sufficient investment in the healthcare sector.

For example, investment in high-quality medical equipment, training and education, and primary and preventive medicine will eventually motivate citizens to pursue their careers within the homeland rather than seeking job opportunities abroad. Incentives can also serve as the motivating factor to lessen the rate of brain drain in the medical profession, for example, pay for performance bonuses and other such programs.

Being a motivator factor will result in improved delivery of supplies and foster a positive work environment. Obansa and Orimisan (2013) also suggested a need to re-examine overall systems to make up for the loss faced by the healthcare sector over the past few decades.

More specifically, the federal government should look for ways to save investment to prevent diseases and spread hygiene awareness and education. Onwe et al. (2015) regarded motivation as a ‘veritable’ tool for effective leadership in the healthcare sector: management in the health sector can explore and utilise some motivational techniques such as increment in salary packages of healthcare personnel, participative leadership, job enrichment, and positive reinforcement.

Leadership in public health organisations should give their subordinates a sense of belonging and provide them with the opportunity to put forward their views in setting goals and priorities for better public health management.

To sum up, Nigeria possesses a wide variety of natural and human resources; still, lack of effective stewardship and poor management of the resources has forced the human assets to move overseas in search of job opportunities, security, and better quality of life and high earnings.

While the brain drain of human capital, especially from the medical profession to developed economies, has deprived the whole economy of intellectual resources, inhabitants are also suffering the consequences.

These include inequitable access to healthcare, quality of services, demographic shifts, limited capacity to innovate, and eventually, the severe decline in economic growth. Despite introducing several reforms, the healthcare sector is still underperforming, with results on the health of residents; for example, Nigeria is counted among the economies with the highest diseases and mortality rates.

To conclude, the country needs effective leadership and management aimed at equitable distribution of resources, and that can strategically explore and implement ways to stop the human capital flight to other countries by inducing motivating factors within the own country.

References

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Alem, A., 2016. Impact of brain drain on sub-Saharan Africa. The Reporter.

Anaemene, B.U., 2016. Health sector reforms and sustainable development in Nigeria: A historical perspective. J Sustainable Dev Afr, 8(4), pp.50-66.

Federal Ministry of Health, 2004. Health Sector Reform Programme: Thrusts with a Logical Framework and Plans of Action, 2004-2007. Abuja: Federal Ministry of Health. Available at: https://www.worldcat.org/title/health-sector-reform-programme-strategic-thrusts-with-a-logical-framework-and-a-plan-of-action-2004-2007/oclc/434449803

Fraser, M., Castrucci, B. and Harper, E. (2017). Public Health Leadership and Management in the Era of Public Health 3.0. Journal of Public Health Management and Practice, 23(1), pp.90–92.

Hagopian, A., Ofosu, A., Fatusi, A., Biritwum, R., Essel, A., Hart, L.G. and Watts, C., 2005. The flight of physicians from West Africa: views of African physicians and implications for policy. Social science & medicine, 61(8), pp.1750-1760.

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Imafidon, J., 2018. One way traffic: Nigeria’s medical brain drain. A challenge for maternal health and public health system in Nigeria. UCLA. Retrieved from: https://escholarship.org/uc/item/5q36r5xq

Karan, A., DeUgarte, D. and Barry, M., 2016. Medical “brain drain” and health care worker shortages: how should international training programs respond? AMA Journal of Ethics, 18(7), pp.665-675.

Misau, Y.A., Al-Sadat, N. and Gerei, A.B., 2010. Brain-drain and health care delivery in developing countries. Journal of Public Health in Africa, 1(1). https://dx.doi.org/10.4081%2Fjphia.2010.e6

Muanaya, C. and Akpan, A., 2018. ‘2,000 medical doctors leave Nigeria yearly’. The Guardian. Available at: https://guardian.ng/news/2000-medical-doctors-leave-nigeria-yearly/ [Accessed on 20/02/2022]

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Obansa, S.A.J. and Orimisan, A., 2013. Health care financing in Nigeria: prospects and challenges. Mediterranean Journal of social sciences, 4(1), 221-221.

Ogaboh, A.A., H. T. Udom and Eke, I.T., 2020. Why brain drain in the Nigerian health sector? Asian Journal of Applied Sciences, 8(2).

Ogune, M., 2021. Nigeria to suffer shortage of 50,120 doctors, 137,859 nurses by 2030. The Guardian. Available at: https://guardian.ng/news/nigeria-to-suffer-shortage-of-50120-doctors-137859-nurses-by-2030/ [Accessed on 20/2/2022].

Onwe, S.O., Abah, E.O., Nwokwu, P.M. and Paul, M., 2015. Motivation as a veritable tool for effective leadership in the Nigerian health sector. Public Policy Adm Res, 5, pp.1-9.

Osigbesan, O., 2021. Medical Br Medical Brain Drain and its E ain and its Effect on the Nigerian Healthcare Sector on the Nigerian Healthcare Sector. Walden Dissertations and Doctoral Studies. [Online]. https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=12099&context=dissertations

Statista, 2022. Mortality rate of infants under one-year-old in Nigeria as of 2021, by gender. [Online]. Available at: https://www.statista.com/statistics/1203486/infant-mortality-rate-in-nigeria-by-gender/#:~:text=As%20of%202021%2C%20the%20mortality,in%20Africa%20are%20very%20high. [Accessed on 20/2/2022]

Uneke, C.J., Ezeoha, A.E., Ndukwe, C.D., Oyibo, P.G. and Onwe, F.D., 2012. Enhancing leadership and governance competencies to strengthen health systems in Nigeria: assessment of organisational human resources development. Healthcare Policy, 7(3), pp.73-84.