Last week’s revelation by the Coordinating Minister of Health and Social Welfare, Prof. Muhammad Ali Pate, that no over 16, 000 medical doctors had left Nigeria for foreign practice in the last five years, has brought to the fore the dire situation in the health sector in Nigeria.
The Minister quoted available records as showing that more doctors, nurses and other healthcare workers have also indicated interest to leave Nigeria to pursue professional opportunities and experience abroad.
He made the revelation at the seventh annual capacity building workshop of the Association of Medical Councils of Africa, AMCOA, on the theme: “Integrated Healthcare Regulation and Leadership in Building Resilient Health Systems,” hosted by the Medical and Dental Council of Nigeria, MDCN. Its attendance included representatives that cut across Africa.
Decrying the development, the Minister said: “We are confronted with the challenge of an increasing number of talented healthcare professionals leaving to work in other countries. Obviously, this was driven by factors such as economic opportunities, better working conditions, advanced training, and superior research environments abroad.
“I, too, migrated in the early 1990s. In 1993, I started at the MRC Lab in The Gambia and the ECFMG pathway that many here know well. So, I understand the drivers because they haven’t changed. The migration of health professionals from developing countries is not new, but it has accelerated in recent years.”
The Minister, however, confirmed that steps were being taken to correct some of the identified challenges that could possibly herald the reversal of the “japa” challenge.
“We have doubled the quota for training in medical schools, pharmacy, nursing, and other health professions because our experience shows that when you train more, more might stay, and those who left often return.
“We are also correcting mal-distribution of the medical workforce. Over 40 percent of our doctors are concentrated in Lagos and Abuja, while many parts of Nigeria remain without adequate medical coverage. You can’t force doctors to relocate, but you can incentivize them with financial and non-financial rewards,” he stated.
Also, in his remarks at the event, the Minister of State for Health, Dr. Iziaq Adekunle Salako, suggested a reciprocal framework for a “train-for-train”; model, where nations recruiting local professionals are charged to invest in training new ones.
It was estimated that the cost of training one doctor exceeds $21,000; a figure that reflects the magnitude of public financing walking out of Nigeria for foreign practice which deeply affects the health systems, thus leaving many of our rural communities critically underserved.
AMCOA President, Prof. Joel Okullo, said the workshop stands as a monumental step in the collective quest to elevate the quality of healthcare services across Africa, particularly the issue of data collection.
“Our member states have grown, and more countries continue to express interest to become members. We need to continue promoting AMCOA with the aim of reaching as many countries as possible in Africa.
“More than a mere meeting, this workshop offers a rare opportunity for stakeholders within the healthcare realm to converge, share insights, and cultivate robust networks. Such collaboration is essential as we strive to enhance healthcare services throughout Africa,”; he said.
Chairman of the MDCN, Prof Afolabi Lesi, in his remarks, reminded the participants that as regulators of healthcare professionals, they were expected to ensure that the highest standards of training in curriculum and practice were adhered to, in line with the international best practices, while reflecting the unique peculiarities of their various countries.
He said: “The reality is that while we have committed and clear directions at the level of governance, implementation of actions is bedeviled by fractioned and fractious relationship among health workers who ought to be working as a team, with the patient (wellbeing and safety) as the primary focus of all our actions.”;
Just as Nigerians were trying to wrap their heads around the report of doctors’ massive emigration to foreign countries in search of greener pastures, it was again reported that about 15,495 nurses has also left Nigeria for foreign practice as of February 2025
This was disclosed by the President of the National Association of Nigeria Nurses and Midwives, NANNM, Haruna Mamman, at the end of the National Executive Council, NEC, of the association in Abuja last week.
He lamented that the situation was becoming alarming, and could pose a big manpower threat to timely and quality health care delivery services in Nigeria.
The development confirmed the fears expressed that many nurses and other health workers had equally travelled the same route and more would follow suit.
He partly blamed the government for being lackadaisical on the issues regarding nurses and midwives' welfare and conditions of service, particularly as it affects the scheme of service for the health workers, which was approved in 2016, but yet to be gazetted about nine years after.
“Another challenge is the issue of industrial court judgment that has not been implemented, as well as the request for the decentralisation of internship opportunities for those who have graduated from the nursing schools, and are seeking internship,” he added.
He noted that the issues had lingered for a long time, and unfortunately, nurses are not expected to participate in an industrial action that could affect seamless health service delivery due to the sensitive nature of the role they play in the health care facilities
“However, we are using wisdom and diplomacy to address the issues,” he stated.
National Secretary of the Association, Dr. Thomas Shettima, in his remarks, warned against the growing proliferation of nursing schools across the country, insisting that such actions were not the solution to the ‘japa’ challenge being experienced in the health sector, but will instead breed official quacks.
“By the time you have produced those that you cannot employ, and they have already acquired the knowledge, and are unable to go outside, they remain in the society. And if they are in the society, and are jobless, and they have the knowledge and they are approached for their services, they will definitely go and render those services. And in rendering the services, some could go outside their ways because they must survive.
“Therefore, if we want to curtail the “japa” syndrome, we must first ask ourselves why people are going outside the country. If we get the answer, then we will be able to address it,”; he submitted.
A nurse in a government health facility in Lagos, Nnenne Adimora attributed the exodus of health workers, including doctors and nurses to poor condition of service. “People are moving outside Nigeria, in fact, health professionals like nurses and doctors are moving outside Nigeria because of poor welfare; their conditions of service and welfare are not good enough.
“For instance, there are some allowances of nurses and midwives that have not been reviewed for over 30 years now.
“And any call to review that is met with resistance. For a more durable solution, the government needs to sit with the relevant authorities, particularly in the case of the nurses and midwives, to discuss the way forward.
“Opening 1,000 schools of nursing in every state will never be a solution to ‘japa'. People will still be going to look for a better condition of service.
“But if we improve ourselves here, and then train qualified persons to handle our health care, I want to believe it will put an end to ‘japa' syndrome on the part of health professionals.”
Also a private nurse, Mrs. Motunrayo Adelaja noted that the prolonged delay in the implementation of the approved Scheme of Service for the nurses, which was approved in 2016, is a contributory push factor to the ‘jaba syndrome.’
“This was one of the push factors for nurses and midwives who are apparently fed up with the poor remuneration, and are seeking better opportunities abroad.
“It's important to note that it's the nurses among other health care workers in this country that their scheme of service has not yet been gazette,”; she told DAILY POST.
She challenged the Association to work closely with the Nursing and Midwifery Council of Nigeria, NMCN, to step up and strengthen their monitoring system to ensure that quality and standards are maintained across all nursing and midwifery training institutions in Nigeria
Also, offering his own perspective to the disturbing trend, Dr. Uche Okenyi of the Nova’s Place Hospital, Festac, Lagos, categorised the push factors into economic, professional and environmental.
Looking at the economic factor, he lamented that salaries, allowances and emoluments that are paid to both young and old doctors cannot guarantee a decent standard of living in Nigeria today.
He stressed that faced with such an economic dilemma; most doctors would readily leave the country if they have the opportunity to practise in a better clime where their salaries could meet their economic needs without much stress.
On the professional level, he told DAILY POST: “The working environment in most health facilities is pathetic. From basic mandatory infrastructure like power and water to diagnostic equipment/reagents, standard infrastructure for routine/sophisticated surgeries and drug availability in the pharmacies, the working environment is frustrating.
“As a result, doctors cannot function at their optimum and so cannot give their best. There is also the lack of opportunity for further training and paucity of funds/grants for research.”;
On the environmental level, Dr Okenyi equally decried the lack of basic infrastructure like transportation, power, housing, and above all, insecurity, stressing that such basic infrastructure are very important conditions that doctors consider before they decide to relocate.
He, however, noted that the implications of the development on the health sector is that all levels of care, from primary to secondary and tertiary will all be negatively affected.
“Dearth of general duty doctors, family physicians and specialists at different levels of care will ultimately lead to the collapse of the healthcare system, leading to a structure where epidemics/pandemics can spiral out of control,”; he said.
He also noted that maternal and child mortality would increase and avoidable deaths from conditions that could have been well managed would equally increase.
“The country will end up losing so much of what it invested to train the doctors and also lose humongous foreign exchange to increased medical tourism,”; he submitted.
On what the government’s responsibility should be to arrest the ugly trend, he said: “There should be complete re-evaluation and radical improvement in the conditions of service of doctors
“The government should upgrade health facilities and provide the enabling environment for further training and research.
“The government should also improve infrastructure like power, transportation, housing and others, as well as secure the lives and property of doctors and other health workers in Nigeria.”;
