Dr Chris Ngige, Nigeria's minister of labour and employment, on Channels TV claims that Nigeria has enough medical doctors to cater for its health needs.
The minister was responding to a question on brain drain and the deliberate recruitment of Nigerian doctors by foreign embassies in Nigeria to the detriment of the nation’s health sector.
“Who said we don’t have enough doctors? We have more than enough. You can quote me," Ngige said.
How true is Ngige's claim that Nigeria has enough doctors, Legit.ng finds out in this fact-check.
Emigration of medical doctors has become a front-burner issue in Nigeria, one that many Nigerians and medical specialists constantly worry about. In March 2019, hundreds of Nigerian doctors took a test conducted by the Saudi Arabian health ministry.
It was the qualification exam required to take so as to get work placements in Saudi Arabia -- and other countries abroad.
Weeks before the attempt by Saudi Arabia to lure Nigeria's greatest medical talents, dozens had sat the regular Professional Linguistic Assessments Board (PLAB) exams at the British Council. Once they pass, it will enable them to work in the UK, according to a report by Al Jazeera.
British, American, South African, Emirati and Saudi Arabian agencies operate in Nigeria to recruit the best doctors. Many have blamed the mass exit on poor working conditions.
A 2017 survey by Nigeria's polling agency, NOIPolls, in partnership with Nigerian Health Watch, found that most Nigerian medical doctors seek work abroad.
"The trend of doctors emigrating to other countries is at an all-time high.
"Our survey … showed that 88% of doctors are considering work opportunities abroad," Chike Nwangwu, head of NOIPolls, told Al Jazeera.
There are 72,000 doctors registered with the Medical and Dental Council of Nigeria (MDCN); over half practise outside the country. Only approximately 35,000 are practicing in Nigeria.
"Nine in every 10 doctors are considering work opportunities outside Nigeria. And it is projected to keep rising as doctors continue to face systemic challenges," Nwangwu said. "I actually think [Nigeria] is already at the state of emergency with the availability of medical doctors."
Ratio of medical doctors to patient in Nigeria
The Nigeria Medical Association (NMA) has once earlier raised an alarm over the low ratio of medical doctors to patients in the country.
Professor Mike Ogirima, the president of the association, expressed the concern in an interview with The Nation newspaper.
Ogirima said that at the moment Nigeria had a ratio of one medical doctor to 6000 people in a given community.
The NMA president said this was grossly inadequate as the World Health Organisation (WHO) recommended a ratio of one doctor to 600 people in a community.
Nigeria which has an estimated population of 180 million currently has about 45,000 medical doctors in the country, Ogirima said.
He further lamented that Nigeria, with such a poor ratio, could not afford to absorb products from her medical schools.
Many medical doctors had been left without jobs while many others had gone to seek succour in other countries, the NMA president also noted.
“We have almost 3000 medical doctors being produced annually by medical schools. But we do not have the facility to absorb all of them.
“If we don’t have the facilities then government needs to get the facilities in place to absorb the number of the medical doctors we produce,’’ Ogirima told The Nation.
He added that the house officers (those rounding off their training in medical schools) lack places to do their one-year compulsory training in the country.
“Some of them have to wait for two years or three before they can get a placement.
“After their youth service, they often have nowhere to be engaged and this is not to say that we do not need them.
“There is no fund to employ them even in private hospitals.
“This was not happening in the past and, therefore, government needs to do something to redress the situation.’’
Nigeria's health budget since 2001 is less than five percent; against 15% recommended benchmark by the African Union (AU) as annual budget to health sector.
Nigeria's health minister speaks
Professor Isaac Folorunso Adewole, Nigeria's health minister, said Nigeria has a ratio of one doctor to 4,088 patients. He, however, also argued, like Ngige that there is no shortage of medical doctors in the country.
“There is no serious shortage of doctors in Nigeria, people are free to disagree with me but I will tell you what the situation is across in Nigeria and many other African countries.
“The data obtained from the Medical and Dental Council of Nigeria as of May 30, revealed that 88,692 doctors are registered in their books. Of these doctors, only 45,000 are currently practicing and that gives us a ratio one doctor to 4,088 persons,” Adewole said during the opening ceremony of the 38th Annual General Meeting and Scientific Conference of the National Association of Resident Doctors of Nigeria (NARD).
The health minister said what is perceived as a shortage of doctors is actually the uneven distribution of practicing doctors within the country, which he said it is as a result of the emigration of Nigerian trained doctors.
He said: “The problem that we have in Nigeria is that there is a huge imbalance and disconnect between urban and rural areas, the north and the south; and about 50% of the doctors in Nigeria can be found in Lagos and Abuja axis whereas many of the facilities in the north and rural areas have no doctors.
“Federal Government is concerned about the disparity and has set a special committee to look into the issue of the brain drain and what can be done to keep doctors.”
He further argued that Nigeria's doctor to patient ratio is better when compared to other African countries.
“Compared to many other African countries the ratio is not bad, for example, in South African it is one (doctor) to 4,000; in Egypt it is one to 1235; in Tanzania it is 1: 14,000; in Ethiopia, it is one to 1 to 118,000, in Kenya, it is one to 16,000 and in Cameroon it is one to 40,000,” he said
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Verdict
The claim that Nigeria has enough medical doctors by Ngige, and Adewole, is false.
Yes it is true, as Adewole noted, that Nigeria has one of the highest doctor to population ratio in Africa.
But how can one say Nigeria has surplus medical doctors when the country clearly falls short of the globally acceptable benchmark/standard for measuring sufficiency of doctors across the world, that is, the WHO recommendation is one doctor to 600 population?
The argument by Adewole that Nigeria's challenge is uneven distribution of doctors also cannot stand when subjected to logical and mathematical reasoning. Or, how do you evenly distribute 35,000 (or 45,000) doctors among 180 million people and have sufficiency of medical doctors.
Dr Aduragbemi Banke-Thomas (@abankethomas), a Fellow in the London School of Economics (LSE) Department of Health Policy, in his article, The Emigration Of Doctors From Nigeria Is Not Today’s Problem, It Is Tomorrow’s, argues that Nigeria needs to urgently rethink its policies towards the training and retention of doctors.
Banke-Thomas, citing the survey by NOIPolls earlier referenced in this report and factoring it with national population estimates, said there is a deficit of over 260,000 doctors in Nigeria and a minimum of 10,605 new doctors need to be recruited annually to meet global targets.
He said: "This gap is particularly critical for a country like Nigeria which has some of the poorest health outcome indices in the world, including the fourth highest maternal mortality ratio and the eight highest infant mortality ratio. So, to be clear, there are not enough doctors in Nigeria!"
In the summary of its own survey, NOIPolls said Nigeria needs 303,333 medical doctors now, and at least 10,605 new doctors annually to join the workforce.
"Nigeria has about 72,000 medical doctors registered with the Medical and Dental Council of Nigeria, with only approximately 35,000 practicing in Nigeria. This is according to the Registrar of the Medical and Dental Council of Nigeria (MDCN) and the Chairman, Association of Colleges of Medicine of Nigeria.
When these figures are compared with the World Health Organization (WHO) recommended doctor to population ratio of 1:600, we easily deduce how poorly we are performing against this benchmark," NOIPolls stated.
Though the figures (of the new doctors needed) given by Banke-Thomas and NOIPolls slightly vary, they both sufficiently prove that there is a deficit of doctors in Nigeria.
Conclusion:
The claim that Nigeria has enough medical doctors is false and misleading. Nigeria's doctor to patient ratio (one to 5000/6000) clearly falls short of the WHO recommendation; 1:600.
The labour minister's statement, apart from being misleading, could propel other medical doctors in the country to consider leaving.
"...if this trend continues, a few years from now, the number of doctors remaining in Nigeria will be so limited, it will be a huge problem for the country," Banke-Thomas noted.
According to the UK General Medical Council database, the numbers of Nigerian doctors settling in the UK doubled in 2016 compared to 2006, with over 5,000 Nigerian doctors registered to practice in the UK.
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