BRAIN DRAIN AND HEALTH PROFESSIONALS
Authorities should improve the work environment of doctors
For a country facing a worsening healthcare crisis, the new General Medical Council report that no fewer than 4,691 doctors have relocated to the United Kingdom in the last three years is worrying. The figure put the total number of Nigeria-trained doctors currently practising in the UK to about 15,692, the largest sources of foreign-trained doctors in Britain after India. Besides, significant numbers of Nigerian-trained doctors are also practicing in Canada and United States, thus straining general service delivery across the country. Even more devastating is the constant depletion of specialists and consultants in fields ranging from anaesthesia to paediatrics surgery, and in the process leaving overwhelming pressure on the few doctors remaining in the country.
The brain drain among doctors and indeed other medical professionals did not start today. Documented studies have confirmed a steady outflow for years. The deteriorating working environment is evidently prompting many more to leave to where they can be better catered for. Last year, the Coordinating Minister of Health and Social Welfare, Muhammad Pate revealed that over 16,000 Nigerian doctors have left the country in the last five to seven years for greener pastures in other countries. This trend, according to Pate—who also lamented that nurses and midwives are also leaving the country in droves—is not just about people leaving, it represents a fiscal loss. For context, Nigeria had trained 90,000 medical doctors as of May 2018, according to a former Minister of Health, Isaac Adewole, but about 70 per cent of them have migrated to other countries where they feel their services are better valued.
The reasons for the mass exodus of doctors, trained largely at public expense, are obvious. Many of them are overworked, and some have actually dropped dead while on duty. In addition, doctors work with inadequate and ageing infrastructure, and are poorly remunerated. Agreements with the government are hardly honoured hence in some states of the federation, doctors are being owed salaries for months, thus prompting frequent industrial actions. Only a few days ago, the Nigerian Association of Resident Doctors (NARD) suspended its planned nationwide strike over delayed salaries, and other welfare related issues. In addition, security has become a vital issue. In the face of the prevailing insecurity across the country, many doctors have become easy victims of kidnap for ransom, with some losing their lives in the process.
This apparent neglect of the health sector is encouraging medical tourism among the middle-class and the wealthy. Nigerians are spending a fortune outside the country on health. The British Broadcasting Corporation (BBC) once reported that Nigeria spends about $1billion annually on medical tourism, particularly to India. This is a lot of money that would have made a difference if ploughed to the health sector at home. Meanwhile, the estimated cost of training one doctor exceeds $21,000, “a figure that reflects the magnitude of public financing walking out of our countries,” according to Pate.
A few years ago, many were outraged when then Minister of Labour and Employment, Chris Ngige made light of the serious issue of the health professionals’ haemorrhage. Ngige, himself a medical doctor, asserted falsely that Nigeria had more than enough doctors to take care of its health needs. This was at a time agencies of the United States, Canada, South Africa, United Arab Emirates, and many other countries were routinely conducting recruitment exercises in a country of one doctor to more than about 2600 patients, a far cry from the World Health Organisation (WHO) recommended ratio of one to 600.
To reverse the country’s worsening health sector, and retain the very best professionals at home, authorities must improve the present work environment. Health professionals must be paid competitive salaries in addition to modern equipment in the workplace.
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JOASH AMUPITAN’S BAPTISM OF FIRE
YAHAYA ETILA urges the INEC boss to focus on delivering credible elections
Joash Ojo Amupitan, SAN, the recently appointed chairman of the National Independent Electoral Commission (INEC), has set a record as the first chairman who is enmeshed in a national controversy upon assuming office. He has dissipated more energy on justifying his suitability for the job, and in explaining that he is non-partisan and not sympathetic to the All Progressive Congress (APC) above others. I am going to assume the contentious X handle belonged to the INEC chair. A post from his account predicted victory for the APC in the 2023 presidential election. What is wrong with that? At the time, he was a university don. He was not under any form of restrictions with regard to his political views and aspirations.
We are all partisan.
Those who blew this trumpet were mischievous. They succeeded in putting the INEC chairman on the spot. Have they not ever posted something on social media that later conflicts with their new position and interests? We are all partisan. It is in our DNA. The leaders of the opposition parties have won and lost elections in Nigeria. They all know there is always an interest to protect. They also know that INEC is the place where all political strategies begin and end. They were at some point beneficiaries of INEC’s “magnanimity”. It would be wishful thinking to think we can have a truly national, independent electoral commission. I am very frank. Let’s call a spade a spade.
What is the history of INEC, and which of its chairmen since 1999 has not been accused of partisanship? The opposition parties always have something to say, not necessarily out of conviction, but out of fear that their past will come around to haunt them. They were mostly products of this “magnanimity”. Why is Joash’s case different? I think he missed it when he tried to defend himself. If I were him, I would have taken ownership and simply stated that it was in my past before my appointment. And no law forbids those in academia from holding and expressing their political views. Is there also a law that bans Nigerians from holding and expressing their political views?
Even though the 1999 Constitution (as amended) and the Electoral Act 2022 stipulate that the INEC Chairman and National Commissioners must be “non-partisan” and persons of “unquestionable integrity.” The INEC chairman is not a registered member of the APC, and as such, he has fulfilled a constitutional requirement. His integrity as a university don and administrator is unquestionable. He also fulfilled a second constitutional requirement. The last time I checked, our constitution is not based on assumptions. The fact that he made a social media post three years ago should be taken as a fact that he is partisan. This is not logical.
I think most times we dissipate energy on things that are not important. This is where I think some civil society groups get things wrong. It seems like their advocacy is based on popular demand and not on the strength of the issues. For example, a tech entrepreneur, Fisayo Durojaye, accused Prof. Amupitan of maintaining a “partisan social media presence” under an alias. He made it look like it was grave and a constitutional violation. The opposition parties and civil society groups went into a jamboree of ethical interpretations of the supposed revelation. The substance of their position was feeble, but successful because Amupitan panicked. I can make an excuse for him. He is new to the terrain, and a test for his resolve to write his name in the sands of time in the conduct of elections in Nigeria.
This is what the opposition political parties have preoccupied themselves with. And some reputable civil society groups and NGO’s have run to town with this without pausing to reflect on the alleged action as either a violation of the electoral act or any other laws of the land. In recent times, it appears civil society groups see themselves as an extension of opposition parties rather than advocates for good governance, transparency and accountability. In Nigeria, opposition parties criticise why a bridge was not built where there is no river. And civil society groups would tag it as an infrastructure deficiency and run to town with it, forgetting that the area in question has no river and doesn’t need a bridge.
It is better to be simple.
I elected to address the controversies around the INEC chairman in a simple way. A lot of grammar has been written and said about the controversies. INEC has issued a report of a forensic audit into the claims linking the said X account to the INEC chairman. I read the statement and wasn’t impressed. I was rather impressed by an article authored by Dr Tunde Olusunle titled “ON JOASH OJO AMUPITAN”, and published in some of the major dailies. He argued that the INEC boss is a man of integrity. He wrote thus: “Amupitan promised us upon his inauguration that he intends to lead an INEC which will conduct the kind of elections which will be decided at the ballot, not the courtroom. I prayed Nigerians to believe him.” Does he deserve the benefit of the doubt? This should have been emphasised by INEC in its various responses.
Aside from a social media post, what other previous actions of his have violated the laws of the land? It was not a case of a recorded tape where he confessed to rigging the elections in favour of the APC. We should look at things from simple logic in most instances. I am writing this piece on the strength that even if he was the owner of the X account and indeed wrote the post. I wonder why a 2023 post that didn’t influence the outcome of the presidential election should be magnified and its author vilified. This, in my opinion, is the height of political mischief and a regime of civil society ignorance.
The INEC chairman made a post in 2023 urging the APC to victory. I am not aware if he was a member of any APC standing electoral committees during the elections. His known appointments were Deputy Vice-Chancellor (Administration), University of Jos, and Pro-Chancellor and Chairman of the Governing Council at Joseph Ayo Babalola University. He could have made the social media post out of excitement for various reasons. This is permissible for humans. We all have our moments of hysteria. Maybe that was his moment, assuming he owned the account, and so what? The opposition outcry is mischievous. It is not ignorance.
And it reflected in their conduct. In my personal assessment of Prof. Joash Amupitan, he is a decent man, caught up too early in the mischievous political environment of Nigeria. His transition from academia, where you are mandated to state issues empirically, to a regime where facts are given several political interpretations. The political world is a citadel of learning. Politicians don’t learn. They outsmart, and anything goes. I empathise with Joash Amupitan over his baptism of political fire. He should take it in good stride and focus his energy on delivering what he promised.
Etila, a public affairs analyst can be reached via Yahaya.etila@gmail.com.
