No, Nigeria is in trouble about doctors

Nigeria’s health minister, Prof Isaac Adewole, recently drew the flak from Nigerians when he seemingly underplayed the intractable challenges that the country’s health sector grapples with.

Speaking at the 38th Annual General Meeting and Scientific Conference of the National Association of Resident Doctors of Nigeria last Friday, Adewole, a former President of the association said, amongst other things, “No serious shortage” of doctors exists in Nigeria as is popularly believed.

And of course, the minister justified his position. He explained: “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 practising and that gives us a ratio one doctor to 4,088 persons…Compared to many other African countries, the ratio is not bad, for example, in South Africa, it is one (doctor) to 4,000; in Egypt, it is one to 1,235; 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.”

Unfortunately, rather than strengthen Adewole’s stance, this argument revealed his dwarfish aspirations for the health sector he superintends as well as reasons why Nigeria, in spite of its human capital and natural endowments, cannot boast of a functional health system let alone an enviable one.

In dishing out these figures, the minister was obviously reminding us of Nigeria’s often taunted status as the giant of Africa, which is doing much better than most other countries on the continent. That is in spite of the fact that his own figures showed that Egypt and South Africa have better doctor to patient ratios than the country whose superiority he tried so much to project.

Although very few countries in the world meet the World Health Organisation’s doctor-to-patient 1:600 ratio, a country of Nigeria’s endowments should aspire to attain the record of countries like the United Kingdom and the United States which have 2.3 doctors/1,000 lives and 2.8 doctors/1,000 ratio respectively rather than glory in the swamp with countries that do not necessarily measure up to Nigeria’ status. To think that in spite of its significantly impressive statistics, the UK, according to a report by Africa Check, a fact check website, admits 12 Nigerians who have attained primary medical qualifications before travelling out of the country and that 5,250 Nigerian doctors were practising in the European country as of April 25, 2018 is another reason why policymakers should not suggest that Nigerians have nothing to worry about.

The minister tried to convince that rather than the dearth of doctors, the uneven distribution of practitioners between the rural and urban areas was the serious problem. He also rightly indicated that most of the problem was with state governments who do not employ doctors and deploy them to the rural areas. But that the health minister would ventilate this reveals either a superficial appraisal of the issues or a deliberate attempt to hoodwink Nigerians.
Granted that state governments have a huge role to play in ensuring effectiveness at the primary and secondary levels of health care delivery. It is also within reason to suggest that most state governments have failed in this all-important duty. However, it is only in situations of obvious inefficiencies like this that federal agencies remember that Nigeria is a federation. Even then, the minister sits over the National Council of Health, which is the highest decision-making body in the country’s health sector and comprises state commissioners for health, heads of Federal Ministry of Health’s agencies, permanent secretary in the Federal Ministry of Health and other leading figures in the health sector. The inability of the council to get states to adopt and execute policies that work in the best interest of the vast majority of Nigerians who live in the hinterlands is a clear pointer to the failure of the council to properly articulate effective policies.

Much unlike the normal structure wherein the Federal Government controlled-tertiary medical facilities stand as the end of the supply chain, the inefficiencies at the primary and secondary levels now put so much pressure on tertiary institutions, many of which operate at very low capacity as a result of lack of adequate personnel and infrastructure.
But the minister does not seem to regard this as a serious and present problem. An unfortunate handicap of the tertiary level of healthcare in Nigeria is, for example, dearth of qualified specialists yet the minister suggests that there is no evident programme in that.

Responding to questions on the difficulties encountered by doctors who desire to get into the residency programme, the minister reportedly said: “It might sound selfish, but we can’t all be specialists. We can’t. Some will be farmers, some will be politicians. The man who sews my gown is a doctor. He makes the best gown. And some will be specialists, some will be GPs, some will be farmers.”

Now, unless Adewole is suggesting that Nigeria already has enough number of medical specialists to cope with its growing and unchecked population, this is a very unfortunate position to take.
But even if we assume that Nigeria currently has enough specialists in every possible area of medicine however, how does a country without a succession plan hope to survive in the increasingly competitive world ahead of it? But there is a yet more worrisome issue.

While the fact that doctors are almost officially expected to present recommendations from political heavyweights including governors, members of the National Assembly, traditional rulers and the like for any chance of securing placement in any residency programme, what is even scarier is the trouble graduates of medical schools go through in the process of securing the mandatory housemanship experience.

A report in the last edition of Saturday Punch indicated that records from the Medical and Dental Council of Nigeria in 2016 showed that Nigeria produces about 4,355 doctors out of which only 2,926 are able to secure places for housemanship annually. The implication of this is that about 1,429 medical graduates roam the streets every year. Yet, the health administrators in the country fail to see the ungodliness that denying people who have spent almost all their lives achieving the ambition of becoming doctors the opportunity to attain even though the country needs them!

It is preposterous to suggest that the current pilot of the national health sector is responsible for the monstrosity of the challenges of healthcare delivery in the country, but utterances like the one he made on Friday put his leadership under suspicion.

There are far too many issues from the supply and demand aspects of the sector than statements that undermine the problem. Critical and urgent attention needs to be paid to the training of doctors and other health personnel with the creation of an enabling environment that allows them to attain their highest potential. There is the issue of the remuneration which is commensurate to the essential service they provide and the need to improve the quantum of work that one single doctor has to deal with at a particular period. There are instances where doctors are believed to attend to between 100 and 120 patients in a day yet the country demands the best from them.
And then there is the patient’s end, which should include stepping up the national attitude to health information as an important ingredient for prevention as well as the improvement of access through the provision of facilities and personnel. Most importantly, government must do everything to ensure that the people are able to afford this service which is why efforts to democratise the National Health Insurance Scheme should be more urgent.
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