Professor Mohammed Aminu Mohammed, the President, Medical and Dental Consultants Association of Nigeria (MDCAN) spoke with ISAAC SHOBAYO on the state of the health sector in relation to the economic hardship in the country, the Japa syndrome, and infrastructural decay, among other issues.
WHAT is the state of the health sector vis-à-vis the current economic hardship that has led to increase in prices of virtually everything, including drugs and health services in the country?
As it is now with every sector in Nigeria, healthcare is not an exemption. We are facing a lot of challenges, especially as it relates to manpower. What I mean by that is that the healthcare resource for health—both doctors and other healthcare professionals—has been reduced to a low number to cater for this, and we all know the reason. One, right from enrolment, not many people want to enrol in health-related courses because they are difficult and they stay longer in school and many other reasons, including the cost; those training in health are paying much more. Secondly, a lot of the well-trained, well-groomed manpower in the sector are also facing a lot of challenges that have forced quite a lot of them out of the country to seek greener pastures. We all know about the Japa syndrome, where a lot of them are being sought after all over the world, and this has to do with inadequate infrastructure. The welfare and working conditions of these staff are not encouraging, and we are in a very hard situation.
For the workers in the health sector, the issue of remuneration is another challenge; what a professional health worker is earning may not be able to support him, in spite of the fact that he spends most of his time in the healthcare facility rendering services. He has no time to even go to the farm like a civil servant to earn additional income. Also in our hospitals, we face a lot of challenges, including the issue of obsolete equipment and lack of state-of-the-art equipment that we need to practise our profession, and also non-renewal of those that have expired.
And the major one is welfare and working environment. You’ll find out that less than 20 percent of them have an office within the hospital environment; some of them have their offices or their bags in the corridors. Also, what we are being paid with the current economic situation is nothing to write home about. When I was a house officer 28 years ago, I earned [an equivalent] of about one thousand dollars, for example. But currently, I’m not earning up to one thousand dollars after 28 years, which ideally should be better with increasing experience and increasing years of service.
In healthcare, you are talking on both sides, the providers and those that are receiving services. You discover that the economy of the general population is also very low. Therefore, their own affordability in both accessing the services and also the drugs that they should use to get better is also grossly affected.
Therefore, you see patients with late presentations, and they don’t have what it means to afford the cost of medications, health services, because most of our healthcare accessibility is out-of-pocket payment. Then likewise, if you look at the cost of drugs, it is also another thing; the prices have gone up astronomically. Drug companies that were hitherto producing in the country are now gradually moving out because of the economic crunch. They are either not making profit, or the security situation of the country or also the economic environment, whereby taxation has increased.And, also, many other factors have forced them to shut down or relocate to another country. So, these are some of the factors that are making provision of health care and accessibility of services difficult in Nigeria.
So, what are the implications of all of these sir?
The implication is that we will continue to see more and more difficult cases to manage because hospitals are considered to be a last resort. What I mean by that is that people will think of food first and then everything else. The next, maybe their own housing, security, or whatever, and then probably health as the last in their scale of preference. So, health is not given the first point of call that it deserves, because people know that they will need to spend out of pocket to assess healthcare. And then, likewise, the issue of migration is another aspect of the problem. So, the problem now is that people will not assess health care service as and when it is due until they have no other option.
What are the statistics or ratios of the medical doctors that have left the country to seek greener pastures elsewhere in recent years?
The ideal ratio of doctors to patients is one doctor to 600. But in Nigeria, currently, from the statistics that were released by the Medical Council, out of the total number of doctors in their register, of the 130,000 that they have registered so far, only 58,000 renewed their licences to practise in Nigeria for 2024. If you remove probably those that are deceased, we can now say only about 50 percent remains. In one of the studies that we conducted in January this year for medical consultants—these are the specialists—those that are training both the undergraduates and postgraduate doctors and also providing specialised services in our teaching hospitals, federal medical centres, and specialist hospitals in the country, we found out that out of about 7,000 consultants in Nigeria, 1,700 have migrated in the last five years from different centres that we have across the country. Another thing is that, if that same number should also migrate in the next five years, then you can imagine what we are going to have. Another thing is that these doctors that have all the experience that is required to train at both postgraduate and undergraduate levels are also retiring at the age of 60 and what we discovered was that about 2,056 of them are also going to retire in the next few years. So, by the time you add about 1,500 to those that will be retiring in the next five years, including those that will be migrating, you will find out that in the next five years, we may probably end up with about 50 percent of these specialists. The issue here is that those who are going to train the future generation of doctors and specialists are leaving for retirement and are also leaving the shores of Nigeria, because they are being sought after all over the world because of the quality and the specialised services they provide. So, you can see that the future of the medical profession and healthcare service is at risk if nothing is done.
With all these scenarios you have painted, can you shed more light on the danger this trend portends for the health sector and Nigeria as a whole?
Well, we all know that health care provision is one of the obligate responsibilities of government. And then if they are lacking in terms of human resources for health, in terms of constrained service provision, in terms of the cost of both procedures and drugs and other consumables in the system, then we really need to act fast in order to forestall any catastrophic event in the health care system. The reasons are not far to seek because we all know that by the time we now go to provide service and then we couldn’t meet the specialist to provide the service, or the specialist will do all the necessary examination on the patient and he cannot appropriately investigate the patient, or you do everything that you are required to do and you get the diagnosis, and you either do not have the drugs or you don’t have the facilities to take care of that particular diagnosis, then the system will not be as effective and will also be less confident to provide such services. So, these are some of the problems. If you don’t take care of the trainers and also make sure that the trainees are comfortable to assess the training and become specialists or become doctors and other health care professionals, then there is always a problem. And then likewise, if the economic and security situation of the country does not improve, then it will continue to drive more people to move out of the country for greener pastures, and all this, cumulatively, will render the health care service we provide in the hospitals ineffective.
But can this ugly trend be reversed through budgetary allocation?
Yes, one of them is what you’ve mentioned, the issue of budgetary allocation for health care services for infrastructure, welfare, and remuneration for the service providers. There was an Abuja declaration in 2005, where all heads of government from Africa converged on Abuja for a conference, and then they agreed that for the minimum basic provision of health care, all governments should, at least, allocate 15 percent of their total budget to health care provision. As it is now, only three or four countries out of the 52 in Africa are living up to that expectation. In Nigeria, to be specific, it was a little short of five per cent of our total budget that is allocated to health. And I think this trend needs to change so that we can improve the infrastructure and improve accessibility of this service. Then the issue of welfare of members or health care professionals needs to be addressed. Because they are human beings, they also go to the same market as other Nigerians.
They also need to feed and take care of their families, especially bearing the fact that they don’t have enough time to go and do anything. They don’t have any other extra income-providing activities. Therefore, they need to be taken care of adequately so that they can have a relatively fair working environment and also welfare. Also, there is a need to provide infrastructure that will help them so that they can complement their diagnostic acumen and provision of making fast diagnoses with reducing the cost so that the populace will be able to afford those services that they provide.
You need to provide state-of-the-art working equipment so that patients can have their diagnosis readily and handy without going through much economic hardship to be able to afford that. And then we need to improve the working environment of health care providers such that, at least, they can have some comfort when they take some rest within their working environment to reduce burnout and also to reduce fatigue that would make them think of moving out of the country. So we feel that the situation will improve drastically if they make all these available. We know that there is no future in any profession or in any service provision if you don’t train adequate number that will replace either the ageing, the retiring or those that are moving out. The government needs to do much more in this regard by increasing the retirement age either from 60 to 65 or 70, so that those that are still strong and agile can still train more people in their various areas of specialization. This will help in retaining highly experienced trainers of healthcare and providers of specialist services to remain in the country.
What is the position of your association with the statement credited to the Nigerian Bureau of Statistics (NBS) that Nigerian doctors and other medical professionals receive bribes from patients before treatment?
We are not working in secret because people come to the hospitals. The general public is in a better position to even comment on this because our comment or response to this will be as if we are hiding something. I feel that at least a quarter or half of Nigeria’s population, that is, we are talking about 110 million, go to the hospital at least once a year. They can justify whether what this allegation is true or not. We have all been servicing the healthcare; people have been coming. What proportion of patients have ever been asked to pay something before they are seen in a public hospital? Apart from the statutory reduced, highly subsidised consultation fee or cost of services, doctors do not receive or ask for bribes before they give their own service. We all know that we have been told several times that our work is humanitarian and we should continue to work even in hard situations and hard conditions.
Now you can find a doctor in Nigeria working for 24 hours, sometimes without rest. But still, that doctor may not be able to fight for his right. The public are the ones that should come in defence of the doctors because they access services provided by them and then how many of them have been asked to pay bribes. Healthcare is a humanitarian service; we are trained to save lives, and that is our priority from conception till the last breath. S we continue to vehemently disagree with them. But in the event of one or two situations, then that should not provide a platform for generalisation.
Don’t you think people might resort to self-treatment if the cost of accessing medical treatment continues to soar?
Yes, that is the reason I told you that, sometimes, people will have to exhaust other situations before they now come to the hospital. And by the time they come to the hospital, it is almost late or the disease has reached an advanced stage and it will be more difficult to treat. That is why we are calling on the government to specifically focus on health care because health care is also a form of security for any nation.
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