Chito Nwana
More Doctors on their Way Out of Nigeria
The Chairperson, Guild of Medical Directors (Abuja chapter), Chito Umenyi Nwana, is an American trained Obstetrician/Gynaecologist and Medical Director of Tabitha Medical Center Jabi, Abuja. In a chat, which was more like an outburst of anger, feeling of neglect and reluctance on the part of authorities to tackle the problem, Nwana tells Stanley Nkwazema, that more doctors will be on their way out, crippling the already beleaguered system

I t is no longer news that Nigerian doctors are dumping this country in their thousands, running away from the crushing economic hardships for better opportunities outside this country. Even Ghana is becoming a destination of choice for these Nigerians. Several reasons have been highlighted in the past as the causes. It however looks like there is no remedy in sight any soon.
Since 2015, different agencies of government within Abuja and other parts of the country have descended on private hospitals with duplicitous multitude of crippling taxes. The government through its agencies is making life difficult for health care practitioners and will ultimately force many to close. This will have a devastating effect on health care delivery in the FCT as private hospitals currently treat up to 70% of patients requiring health care.
The Chairperson, Guild of Medical Directors, Abuja chapter, Doctor Chito Umenyi Nwana agrees, saying, “It is a true observation that there is exodus; medical doctors, medical practitioners and other allied health workers are walking out in their large numbers. This is having a significant negative effect on our nation and the citizenry. From my perspective, I don’t think health is seen as a priority. I think that not being able to properly invest in the health sector is affecting us negatively. Nigeria is one of the countries that spend the lowest percentage of their budgets on health care. It makes no sense to me; this is a country where most citizens are not healthy?
“The private health sector suffers already from lack of hospital financing options, high cost of equipment and medical supplies. So, it is quite unfair that instead of the government to support or partner with us, we are daunted by multiple taxation and levies, illegal collection and extortions, especially from the local government councils. It seems that government and its agencies do not realise the vital importance of private hospitals in meeting the health care needs of Nigerians.”
Showing letters and threatening notices from various agencies, Nwana stated that private hospitals in Nigeria run under very small margins because their revenues are consumed by unnecessary government taxes which affect their standard of care and survival.
She said: “For instance Abuja Municipal Area Council (AMAC) is a major culprit in this regard. We are regulated by what is called the FCT Primary Health Establishments Registration and Monitoring Committee (PHERMC); they inspect and certify that you are able to practice or have the right things to operate a hospital. Then AMAC sends another team that has no expertise in this area telling you that they have to inspect and you have to pay another fee. We pay to Abuja Environmental Protection Board very high fees (approximately N1million/year for a 6 bed hospital) for solid wastes and then AMAC comes to harass you to pay for the same wastes. “So, are we to pay to both when only one of them can clear the waste? We have multiple taxes and levies that we categorize as non-operating expenses. For example, tenement rate, environmental audit report, notification of environmental services/inspection, radio and television tax, signboard/advert fees, operational permit/trade license (shop/kiosk) to mention but a few. These fees are in hundreds of thousands. The worse part of it is that sometimes we are asked to pay to the private account of their technical partners which I consider fraudulent.
“Health establishments are being taxed to death by various agencies within the FCT in a manner that is guaranteed to force many out of business. The danger of this to the community is that it will not only further deplete the medical workforce but also diminish quality access to health care services. It is pertinent to emphasize the distinction between a purely commercial entity and private health facilities that render an essential social service.
“I listened to a political speech recently where some programmes that were set up to improve health care were highlighted. I was curious to know who the beneficiaries of these programmes were. There is no success in any programme until it is properly implemented to have its desired impact. We just have too many policies but no implementation. We also hope that legislation will come up that will protect the private health sector from multiple taxations. According to the reports, last year the Senate approved mandatory treatment for gunshot victims without considering the fact that this may not be achieved if the private facilities can’t afford to provide these services.
“This year, the Senate also called for a state of emergency in the public health sector without realizing that the key is private public partnerships. So you see some legislators are not even aware of the importance of the private sector that provides approximately 60-70% of healthcare to the citizenry of Nigeria and especially the FCT. We were so relieved when we met Senator Mao Ohabunwa (Chairman, Primary Health Care & Communicable Disease) who not only listened to us but understood our plight. He was quite concerned about the state of the health sector and promised to support us as we strive to provide quality care. He went further to lay our petition on the floor of the senate and we are expecting to be heard by the Ethics, Privileges and Public Petitions Committee.”
Interestingly, Dr. Nwana is one of the medical practitioners that returned from the Diaspora: “I guess I went the opposite direction. It is going to affect us because we don’t have many specialists, and we don’t have that many doctors. Based on a recent report, there are only 72,000 registered medical practitioners in Nigeria of which only 35,000 are currently practicing in this country. Nigeria needs about 333,000 doctors to satisfy its healthcare needs and an influx of 10,500 new doctors annually to cater for the population growth rate. Of the current number of doctors serving here, 80 per cent have applied to work overseas.
“When I interview health professionals, I usually ask them where they see themselves in five years. More than 80 per cent see themselves either training or working abroad. Most of these doctors are super intelligent but they do not see a clearly defined career path so they seek it overseas. This has led to significant brain drain in the medical field and reduced access to care for the population.
“It is important to note that to achieve Universal Health Coverage (UHC), there must be enough health facilities to meet the needs of the population. At presently, Nigeria lacks adequate public and private health facilities and is unable to meet the need of its citizenry. There has to be better partnerships, collaboration and cooperation between the public and private sector to develop a system that will improve access to healthcare. It is however unfortunate that this important relationship is lacking in our country. Private health establishments are being overburdened by multiple taxation charges and levies that have forced some establishments to close or reduce their standard of care in order to remain open.”