What Nigeria needs to achieve Universal Health Coverage – LASUTH CMD, others

…Say brain drain in nation’s medical profession having negative effects on quality care

…Seek improved welfare package for health workers

Kasara Chukwuma

Fresh indications have emerged that Nigeria has over nine decades to go before achieving a Universal Health Coverage (UHC) as a result of the massive brain drain in the medical profession.

Already, the National Health Insurance Scheme (NHIS) which is a vital tool in achieving UHC is constantly faced with leadership crisis, which has led to only five percent coverage since its establishment in 2005.

Stakeholders say the current structure of the scheme which makes health insurance voluntary has hindered progress in the health sector.

Besides, the nation’s health sector is bedeviled with so many other problems ranging from poor funding, lack of equipment, shortage of manpower, strikes by health workers, poor health indices, high maternal and infant mortality rate, non functional primary healthcare centres, and out of pocket payment for healthcare services among others.

The Daily Times gathered that it will be impossible for Nigeria to achieve UHC by 2030 with the current trend of brain drain in the health sector as many doctors are leaving the country on daily basis.

Reports show that Nigerian doctors have been migrating to the U.S, Canada, Saudi Arabia, the UK and many other nations across the globe.

The Chief Medical Director, Lagos State University Teaching Hospital (LASUTH), Ikeja, Prof. Adetokunbo Fabamwo, is not happy with the trend as he has expressed concern at the rate at which many Nigerian-trained medical doctors are migrating to other countries in search of greener pastures.

Amid this challenge of migration, Prof. Fabamwo said Nigeria requires 237,000 doctors to achieve a Universal Health Coverage (UHC) which he noted would take the country 100 years to produce.

According to him, only 40,000 out of 91,000 doctors on the Medical and Dental Council of Nigeria (MDCN) register are practicing in the country.

He said the number was grossly inadequate and far from the 237,000 doctors needed for Nigeria to achieve universal health coverage.

Prof. Fabamwo disclosed this in Lagos recently during the Ordinary General Meeting of the Medical Guild – association of doctors under the employment of Lagos State government with the theme: “Challenges of Inadequate Human Resources in the Health Sector: Way Forward.”

The LASUTH boss, who was the Keynote Speaker in his lecture, said: “There are about 40,000 doctors that are practicing in Nigeria now.

“So, where are the remaining 51,000 since MDCN has 91,000 names on its register?

“It is interesting to note that 80 per cent of those 51,000 are abroad, while 20 per cent have been affected by internal brain drain.

“Internal brain drain is where a doctor stops practicing medicine and starts doing something else.”

Fabamwo, who is a Professor of Obstetrics Gynaecology, said that brain drain had become a major problem confronting quality healthcare delivery, stressing that the country was faced with gross shortage of medical personnel contrary to the recent claim by the Minister of Labour and Employment, Dr. Chris Ngige, that Nigeria had enough doctors.

“We need 237,000 doctors to achieve a Universal Health Coverage.

“Statisticians have calculated that it is going to take the country 100 years, at the rate we are going, to produce the number of doctors that we need”, he said.

Brain drain in the nation’s medical profession has been having negative effects on the quality care offered to patients as the ratio of medical practitioners to patients in the country is very low. Official records reveal that Nigeria currently has one doctor to attend to 3, 500 patients which is a far cry to the World Health Organisation (WHO) recommendation of one doctor to 600 patients.

On why Nigeria was faced with the problem of inadequate manpower in the health sector, Prof. Fabamwo blamed it on insufficient production of medical personnel, internal and external brain drain, lure of overseas travel, economic reasons, lack of job satisfaction, poor working condition, among others.

He, however, listed the way forward by asking the Federal Government to declare an emergency in the health sector and to also reappraise the sector master plan.

He also recommended a special welfare package for all health workers while urging the government to implement the National Health Act, assuring that its provisions would better the lives of Nigerians.

In his remarks, Chairman of Medical Guild, Dr. Babajide Saheed, urged the Lagos State government to take the issue of brain drain in the state seriously.

He noted that for Nigeria to achieve UHC, there must be political will on the part of leaders and right structures in place.

“What we need is to restructure our health system. There are three levels of care – the primary, secondary and tertiary.

The main one is the primary because it is close to the people. We have to make sure that we rejuvenate the primary health centres as a lot of problems can be prevented at this level.

“Universal Health Coverage implies that everybody must have access to quality health care delivery.

The government must also increase health care funding by making sure that the budgetary allocation for the health sector aligns with the recommendations of WHO which stipulates that the health budget should be 15 per cent of the total annual budget of a country”, he said.

The Nigeria Medical Association (NMA), had earlier described as “unfortunate” Ngige’s statement on brain drain in the medical sector.

Ngige, who spoke during a television programme recently, said he was not bothered that medical doctors are leaving Nigeria in droves, saying that the nation has a surplus of them and must therefore “export” to other countries.

The NMA president, Dr. Adedayo Faduyile, said Nigeria had not enough doctors, calling on the government to ensure the country retains its medical personnel.

He said: “That is an unfortunate statement which shows that he has done nothing in medical practice.“

“The WHO stated that, for optimal healthcare to be achieved, we need doctor/patient ratio of one to 600.

“In Nigeria, we have 40,000 doctors taking care of 200 million people.

“It’s unfortunate, we do not have enough doctors. Maybe he is looking at the monetary part, but there is opportunity cost.

“We have the maternal mortality that is about the highest in the world. To correct it, we need health professionals around.”

To achieve a UHC in Nigeria, the NMA President said the Federal Government must restructure the NHIS as well as operate a mandatory health scheme.