JAPA: Nigerian Hospitals Reduce Outpatients, Surgeries As 4,000 Doctors Migrate

The migration of doctors and other health workers to other countries is taking a toll on hospitals across the country as the institutions have reduced the number of their outpatients and surgeries due to a shortage of manpower.

The PUNCH investigations on Sunday showed that almost all the health institutions were battling with the shortage as they could not cope with the high number of patients who thronged the government hospitals, which were affordable compared with the private ones.

The Chairman of the House of Representatives Committee on Health had on Wednesday raised the alarm that not less than five wards with about 150 beds, had been closed down at the Lagos University Teaching Hospital, Idi-Araba, due to a shortage of health workers.

The Chairman of the Committee, Dr Amos Mogaji, said the five wards had to be shut because there were no workers to operate them despite the large number of patients received at the institutions daily.

Findings by The PUNCH showed that LUTH was not the only hospital battling with the problem as health workers lamented the heavy workload because their counterparts had left the country.

Although the Nigerian Medical Association and the Nigerian Association of Resident Doctors could on Sunday not give the exact number of medical doctors that had left the country, the NMA had a few years ago said 2,000 health workers were leaving yearly.

Also, the NARD had in January 2023 stated that a survey it conducted indicated that more than 2,000 of its members left the country in 2022.

However, the harsh economic conditions in the country have been pushing many doctors to leave the country as 1,197 doctors had moved to the United Kingdom since May 29, 2023.

With health institutions including the Lagos University Teaching Hospital, the Federal Medical Centre, Abeokuta; Aminu Kano University Teaching Hospital, Kano and the Obafemi Awolowo University Teaching Hospital, Ile-Ife losing close to 1,000 doctors to japa in the last two years, there are strong indications that over 4,000 doctors might have left the country in the last two years.

In the FMC, no fewer than 200 doctors, including 50 medical consultants have left the country for greener pastures abroad.

Because of the shortage of doctors, it was gathered that the hospital was forced to reduce the number of its outpatients attended to and elective surgeries.

According to veryhealth.com, an “elective surgery” is the term used for a procedure that can be safely delayed without great risk to a patient’s health, such as cataract surgery. A nonelective (or emergency) surgery is a procedure that must be performed immediately for lifesaving or damage-preventing reasons.’’

In Kano State, The PUNCH gathered that no fewer than 789 nurses and 162 doctors had left the state, while about 50 doctors had left hospitals in Benue State.

One of our correspondents gathered that as many as 65 doctors left the OAUTH, Ile-Ife, in the last year, while about three wards had stopped admitting patients over inadequate manpower in the hospital.

An official of the NARD in the hospital, who spoke on the condition of anonymity, said, “65 doctors left OAUTH last year. 45 of them completed their training and left, while 20 abandoned their training and left for other countries.”

He also said about three wards in the hospital had stopped admitting patients due to inadequate manpower.

“Out of three units we have in the emergency section, only one is admitting patients. Two other units in the emergency ward are not admitting patients due to inadequate staff.

“Also, the psychiatric unit is not admitting new patients because we don’t have enough nurses. The Paediatric Unit is seriously understaffed. Generally, we don’t have enough staff in the hospital. Some people are available to work, but they are not employed,” he said.

OAUTH management could not be reached for reaction to the claim, as calls to Kemi Fasooto, the hospital Public Relations Officer, rang out and she has not responded to a text message sent to her by our correspondent, as at the time of filing this report.

FMC Abeokuta

At the FMC, Abeokuta, the Chairman of the Medical and Dental Consultant Association of Nigeria, Dr Jimoh Saheed, stated that in the last four years, the hospital had lost about 50 consultants and 150 resident doctors to the japa syndrome.

He said, “The japa syndrome has really affected and is still affecting the healthcare system in Nigeria. About 50 medical and dental consultants left FMC Abeokuta alone in the last four years. The number of resident doctors who left for greener pastures should be times three the above number.

“Therefore, the implication is that there is a severe shortage of manpower in the hospital, which has hampered the service delivery and care of patients. We have had to reduce the number of patients seen per clinic and also, and the elective theatre cases per day also dropped.

“As it stands, some segments of our emergencies had to be collapsed for the unit to work efficiently. The implication of all these will mean that we can’t function optimally and the japa wave has affected service delivery, training of medical specialists as well as research.”

Jimoh said the way forward was for the government to declare a state of emergency in the health sector, which would include massive recruitment of various health personnel, and equipping the hospitals to international standards, among others.

Similarly, the Chairman of the National Association of Nigeria Nurses and Midwives, Ogun State Hospital Unit, Ijaye, Abeokuta, Mrs Lola Idowu, said nurses that had left the hospital in the last three years could not be less than 40, including those who had retired.

The Benue State chapter of the NMA confirmed that more than half of the number of medical doctors working in the state Health Management Board had left the country to search for jobs in better locations.

The NMA Chairman, Dr Usha Anenga, described the situation as pathetic.

Anenga said, “We used to have over 100 doctors at the Health Management Board but now there are less than 50 left. We used to have a consultant and epidemiologist at the Federal Medical Centre but they have left. The gynecologist at the University Teaching Hospital has also left.”

At the University of Jos Teaching Hospital, Plateau State, about 100 resident doctors have left the facility as the remaining ones at the hospital lament the shortage of manpower in the health institution.

The President of the ARD in JUTH, Dr Ishishen Artu, stated that last year, more than 70 resident doctors had left the hospital.

“What is happening across the country about japa syndrome is not different from the situation here in JUTH. When I came on board as ARD president about 11 months ago, we had 410 members.

“But during our last nominal roll from the accounting department, we were about 340. So that is to tell you how doctors have been moving away from the hospital,” Artu stated.

He blamed the manpower shortage on poor welfare packages, insecurity, and inadequate equipment, and called on the government to intervene to avoid an imminent collapse of the health system across the country.

He added, “Some of us who are still around are not finding it easy. Many of our mates outside the country including Ghana, and South Africa are receiving three to five times what we are receiving in Nigeria.

“They want to come home to practice but they can’t come under the present situation. That is why the government has to look at the issues holistically to address them so that the health sector will not break down completely in the country.”

 

Kano hospitals hit

Over 789 nurses and 162 doctors have relocated outside Nigeria from Kano State alone, according to the NMA in the state.

Similarly, over 162 medical doctors relocated to other countries across the world within the same period under review.

The Chairman of the Kano State Chapter of the Nigerian Medical Association, Dr. Abdullahi Sulaiman, disclosed this in a telephone interview with The PUNCH on Saturday.

“Many medical doctors and other categories of healthcare workers are exiting the state in droves. So, I cannot tell you the exact number of doctors and nurses that have left the country. I can only give you an estimate.

“It is a bad situation and this is across almost all healthcare workers, not only doctors. They are leaving for Gambia, Somalia, Rwanda, Saudi Arabia, and many others every week,” he said.

According to him, the shortage of such personnel was causing a lot of problems, as those left behind were forced to bear the brunt in the form of overwork, exhaustion, and burnout in a non-conducive working environment.

“About two years back, we wanted to open some wards that were constructed and donated by some wealthy individuals at the Aminu Kano Teaching Hospital, but because there were no healthcare workers to man the places, we had to suspend the opening until later,” Sulaiman stated.

He stated that recently, five anesthetic doctors were employed by the AKTH but three had since abandoned the work and relocated abroad.

“We have been talking about the issue but the government is not taking deliberate steps to address the problem.

“To prevent doctors and other categories of health workers from going out of the country, the government must take deliberate action to address the issue,” he added.

1,197 doctors move

Findings by The PUNCH showed that approximately 1,197 Nigerian-trained doctors moved to the United Kingdom since May 29, 2023, to date.

At the moment, Nigeria is set to overtake Pakistan and become the country with the second-highest number of foreign-trained doctors in the UK. Currently, India remains the country with the highest number of foreign-trained doctors in the UK.

This is according to the register of the General Medical Council of the UK. The GMC is a public body that maintains the official register of medical practitioners within the UK.

Though about 1,197 Nigerian-trained doctors were licensed between May 29, 2023 and December 1, 2023, the total number of Nigerian doctors licensed to practice in the UK is now 12,198.

This figure, however, excludes Nigerian doctors who were trained in other countries.

Presently, there are 73 Nigerian-trained doctors in the field of anaesthetics and Intensive Care Medicine, 61 in the field of emergency medicine, 241 for general medicine, 207 for obstetrics and gynecology, 17 for occupational medicine, 16 for ophthalmology, pediatrics field with 164, and 50 for pathology.

There are 35 of them for public health, 357 for psychiatry, 29 for psychiatry and 135 for surgery.

The rate of migration of medical doctors has recently become a matter of concern. The Nigerian Medical Association, while lamenting the high rate of medical brain drain, had said Nigeria might import doctors in the future.

In 2015, only 233 Nigerian doctors moved to the UK. The number increased to 279 in 2016, while the figure was 475 in 2017. In 2018, the figure rose to 852, while it further increased to 1,347 in 2019.

In 2020, the figure was 833 even though the GMC closed operations during the COVID-19 pandemic. The figure for 2021 was put at 932.

The Chairman of the Committee of Chief Medical Directors of Federal Tertiary Hospitals, Prof. Emem Bassey, commenting on the brain drain said, “Some African countries are also beginning to poach from Nigeria.

“The West Coast is looking for our specialists. So many people are now going to places like Sierra Leone and Gambia and the wages they earn $3000 to $ 4000. It is about three to four times what they earn back home. So we are beginning to see that people are leaving for other African countries too.

“The health sector is currently undergoing a major crisis in terms of manpower. What we are seeing is that medical specialists, not just doctors, even nurses even more nurses are leaving. Doctors, nurses, laboratory scientists, physiotherapists, radiographers, and all manner of health professionals are leaving the country in droves.”

On his part, the NARD Chairman at the Lagos State University Teaching Hospital, Dr Salmon Abeeb, explained that the number of medics who had left the hospital was significantly high.

He stated, “LASUTH is the closest to the airport, so it affected us. Whenever the system employs, within a month or two they usually leave. Last week, LASUTH employed 18 to 20 doctors and consultants, I can tell you that before next month, half of them would have gone.”

Abeeb added that doctors were now getting sick due to heavy workload. He revealed that LASUTH was also getting close to shutting down wards due to insufficient manpower.

“The workload is now becoming more we are the ones doing the job of everybody and there is burnout, doctors are getting sick every day because of the burnout.

“We are yet to shut down but we will soon get there because the workload is too much and resident doctors are already complaining.”

A medical consultant in one of the federal hospitals in the South-West, who spoke on the condition of anonymity, said, “The issue of the shortage of manpower is nationwide. It cuts across all government hospitals and the reason why we have this shortage is because people are moving from Nigeria to other countries. The salaries that health workers are receiving are below small

“In addition to that, the lack of facilities to work with is an issue. I have personally experienced a lot of stress doing my job. Even though some medical directors know how to muddle their doctors to make sure that work is going on, there are hospitals that will tell you that you should not bring more than one major and one minor case in a day because the health workers available have been overstretched.

“In my unit as a consultant, I am supposed to work with two senior registrars and four registrars but as I speak with you, I only have a house officer to work with.”

He said that improved facilities in hospitals across the country and an increase in wages of health workers would encourage health workers to shun the idea of migrating for greener pastures while stating that legislation to ban medical tourism would force political officeholders to improve the country’s health sector.

“Our leaders know what to do. The first thing is to increase the salary of health workers. Also, the infrastructure within the hospitals should be improved. For example, you may want to operate on a patient and the patient needs ICU cover while the ICU may be available, there may not be ventilators and when both are available, electricity could be a problem.

“I have a friend who is also a health worker who has left the country. The last time we were talking, he told me he was getting his one-year salary in Nigeria in one month over there.

“Lastly, if there is a law to force political office holders to access medical facilities within the country and only be allowed to travel except the situation warrants it, they will be ready to improve the nation’s health facilities. If all these are done, health workers will be willing to stay,” he said.