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Health Sector Still Battles Poor Budgetary Allocation, Brain Drain

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ODIRI UCHENUNU-IBEH, in this report, examines some events that defined the Nigerian health sector in 2018

Like many other reports, the Healthcare Access and Quality Index, published in the 18th edition of the medical journal, The Lancet, placed Nigeria in the 140th position, lagging far behind many other African nations.

Stakeholders have however attributed the country’s poor health indices to poor budgetary provision and releases to the sector, non implementation of the National Health Act, industrial disharmony occasioned by frequent strikes, poor welfare and working environment. Of course, all of these formed part of the sad tale of the health sector in 2018 and as should be expected, they contributed partly to worsening the level of  brain drain in the sector.

2018 Health Budget In Retrospect

On November 7, 2017, President Mohammedu Buhari, presented the 2018 budget estimate of N8.62 trillion to the National Assembly. Out of this sum, a total of N340.45 billion was allocated to the health sector, representing 3.9 per cent of the total budget.

This is far from the Abuja Declaration signed by Nigeria and other African countries in 2001, where they pledged to devote at least 15 per cent of their annual budget to the health sector.

According to stakeholders, Nigeria cannot adequately tackle outbreaks of diseases in the country, communicable and non-communicable diseases, high maternal and child mortality rate and the many lapses in healthcare facilities across the country if it continues to allocate less than 15 per cent of its total budget to health. Indeed, funding for the health sector has been a serious concern with most states allocating paltry sums to this all-important sector. The matter is even made worst by the releases, which often times are way below expectations.

Implementation Of The National Health Act (NHAct 2014)

Four years after the enactment of the National Health Act, Nigeria is still struggling to operationalise it. According to the vice president, Commonwealth Medical Association, Dr Osahon Enabulele, this is making the country’s health indices worst.

Enabulele said non-implementation of the Act is worsening the travail of the health sector particularly at the grassroots where the greater burden of health diseases resides.

Indeed, the fact that that the Act has all the solutions to the challenges facing the country’s healthcare sector is not in doubt. But a law is only good to the extent that it is enforced.

As Enabulele noted, ’’the slow implementation has added to the financial burden of the citizens in their quest of seeking quality healthcare. It has also made Nigeria’s health sector to record one of the worst health indices in the world, with high infant, child and maternal mortality rates.

‘’Medical tourism is on the increase with the country losing billions of dollars to other country’s economy. We can’t continue like this. I urge government at all levels to prioritise and invest in the health of citizens as part of core objectives of advancing social justice and development as a healthy population is an economic asset.

‘’I also urge President Muhammadu Buhari led-administration to urgently implement the NHA (2014) as it will address the problems of brain drain, weak health system, absence of universal health coverage, medical tourism and even poverty. Our governments should begin to accord the health sector the recognition it deserves to save the lives of citizens.”

Brain Drain

While Nigeria has over the years, experienced brain drain, especially in the health sector, 2018 was not different. According to a consultant obstetrician and gynaecologist with the Ahmadu Bello University Teaching Hospital, Zaria, Dr. Solomon Avidime, Nigeria has about 72,000 medical doctors registered with the Medical and Dental Council of Nigeria (MDCN), with only approximately 35,000 practicing in Nigeria.

Avidime said going by the population, it means the country would need about 303,333 medical doctors now, and at least 10,605 new doctors annually to join the workforce.

He said an estimated 2,000 to 3,000 medical doctors are produced from across the medical colleges through out Nigeria annually, and taking it from a period of five years, this amount to about 10,000 to 15, 000 doctors that have been produced. “Whereas, the total number of doctors working in the country average 35,000 to 45,000.

The obstetrician said the World Health Organisation (WHO) recommendation is 1:600 doctors to community population, but in Nigeria, what is currently obtainable is a ratio of 1:4000.

According to him, as at December 2017, from the MDCN register, a total of 7500 doctors are currently working in Lagos state, adding that the community population ratio of Lagos state, which has the highest number of doctors, is 1:3000.

He said the reason why the country has lesser doctors working currently is as a result of the continuous migration of medical doctors to other countries for greener pastures, to work in an environment that provide for an up to date technology, efficient health care system and of course better welfare.

“An estimated 2000 doctors migrate annually from Nigeria to United Kingdom, Saudi Arabia etc. It is rather unfortunate that Nigeria will use her resources to train medical doctors that will now go and add value and improve the doctors population ratio of another country.”

The way forward according to him, was for the federal government to make the health system work, by providing better welfare package for medical practitioners and improve medical training institution to meet international standard in terms of infrastructure and capacity building.

In the same vein, the acting president of the Association of Resident Doctors, Lagos State University Teaching Hospital (ARD- LASUTH), Dr. Ibrahim Ogunbi said the massive migration of medical doctors started right from medical school.

Ogunbi said, “In the past, immediate doctors graduate, they automatically get placement for housemanship in Universities like Lagos University Teaching Hospital (LUTH), Obafemi Awolowo University, Ile-Ife, and other big teaching hospitals.

“The problem we have now with housemanship is that the housemen don’t even get employed to do internship in the country. People living in Lagos can go as far to the North to get a placement as a house officer. Some stay at home one year or almost two years without getting housemanship. That is enough reason for any doctor to leave this country for greener pasture.

“I have seen a consultant leaving Nigeria for Saudi Arabia, for a lesser job, like a medical officer, because there is no job in Nigeria. The salary/welfare package, working environment, security, the cost of living, can’t be compared with that of a consultant working in Nigeria. These are basic reasons why doctors are leaving.”

The way forward, according to Ogunbi is for government to institute structure policy for residency program, housemanship and medical schools.

He said, “Doctors will continue to leave this country for greener pasture if the welfare package is not up to standard and if there is no up to date equipment in our health facilities. I have seen an orthopedic doctor, not having equipment to work with in Nigeria.

“What is the essence of being a specialist in a hospital that does not have the necessary equipment to work with? If that doctor gets a job outside Nigeria, he will definitely go for it. It will surprise you that our doctors are performing excellently in the place where they are working outside the country.

“The doctor that performed the fetal surgery in the United State for an unborn child, is a graduate from Obafemi Awolowo University. That doctor would have contributed meaningfully to the wellbeing of Nigerians, if he was working here.”

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