The brain drain is a wake-up call to tackle the challenges of governance and development, writes Toluwani Oluwatola
In the past few weeks, a lot of light has been beamed on the subject of “medical brain drain in Nigeria.” This is due to the recent strike by members of the National Association of Resident Doctors (NARD), which lasted more than two months. The issue was further exacerbated by the recruitment exercise for mid-career medical personnel carried by Saudi Arabia Health Authorities, which got wide media coverage.
Medical brain drain in Nigeria is not new; medical personnel has been on the lookout for “greener pastures” since the 1980s, when the country started experiencing economic downturns. However, it has assumed a worse trend today. In a 2017 survey conducted by NOI polls and Nigeria Health Watch, eight out of 10 Nigerian doctors expressed their desire to emigrate to another country. There have been social media reports of how some departments in certain teaching hospitals no longer have specialists as everyone, including the HOD, has sought greener pastures.
Medical brain drain is not all bad, but its net benefit in the Nigerian context is negative, coming at a huge cost to the country’s health system, which is ranked very low in the comity of nations. It also typifies a double jeopardy case as public medical education that produces more than 70% of Nigeria’s doctors is highly subsidized by the government, and its beneficiaries are lost to developed nations. On the flip side, while Nigeria continues to grapple with health system-related challenges due to medical brain drain, high-income countries that are beneficiaries of the drain continue to benefit from the influx of Nigerian-trained doctors to the country. A study published in 2011 showed that Nigeria had lost about $650 million to medical drain while four of the top destination countries have saved about $4.55 billion from brain drain in nine African countries. These figures have multiplied in recent times. The Punch newspapers recently reported that over 4,500 Nigerian-trained doctors have migrated to the UK between 2015 and July 2021; worse still, those on the waiting list exceed those who have successfully emigrated in large numbers. This trend portends grave consequences for Nigeria’s health system and should be addressed as a matter of urgency.
In lieu of the dangers this trend portends if unmitigated, I propose three solutions that policymakers can adopt to address the challenge of medical brain drain in Nigeria.
A Strong Political Will: The most important step in reversing the tide of the medical brain drain crisis is the political will to address the issue by policymakers across all levels. As it stands today, key government functionaries are still in denial of the magnitude of this crisis. It is important that key stakeholders come to terms with this reality of human capital flight in the health sector and human capital retention becomes a priority in governments’ plans across all levels in Nigeria. A strong political will would translate to formulating and implementing appropriate policies to tackle the brain drain challenge. However, if this will is absent, the country’s health system is headed to the brink of collapse.
Earmarking Brain Drain Tax/Restitution: At the core of Nigeria’s brain drain crisis is a health financing crisis. According to the 2017 Nigeria Health Watch and NOI survey, the three most prevalent reasons doctors are seeking greener pastures abroad bothers around health financing. Nigeria’s minister of state for health also emphasized this point recently when he stated that lack of funds is responsible for Nigeria’s health sector woes. A permanent solution to this crisis is an adequately financed health system. Increasing the fiscal space for health has been very challenging for the nation, which has been worsened by the current macroeconomic challenges in the country. To plug the health financing deficits in the nation, innovative financing approaches need to be adopted.
One of such approaches might include diplomatic relations with the recipient countries to get “restitution fund” based on the value of the contributions of Nigeria-trained migrants to the recipient nation’s health system. Another approach could be through a brain drain tax (a proportion of the income of migrants) which is implemented through a tax treaty with recipient nations to prevent incidences of double taxation and worsening fortunes for the migrants. These funds should be earmarked for investment in health and medical education not channeled through the general government budgets. One key factor that will be crucial to the success of either of these approaches is designing responsible and effective usage of such funds for the strengthening of the nation’s health system to create a health system that is more accommodating in the long run. These approaches are not as straightforward as they sound, they will require policymakers to think through its pragmatism in our local context and the diplomatic relations that is required with benefiting countries to be successful.
Private Sector Participation: Private sector investment in the Nigerian health sector will also help to provide a long-term solution to the brain drain challenge. The country’s private healthcare sector has recently witnessed an influx of government support and foreign direct investment to develop world-class healthcare facilities. The development of world-class infrastructure within the country will help create an enabling environment that will attract more medical personnel to practice in the country. However, this needs to be complemented with an adequate compensation package for healthcare workers in these facilities, a career development pathway, and professional development opportunities to make them reach the pinnacle of their careers.
On a final note, it is important to note that the development of the country’s health sector, which is the ultimate solution to the brain drain challenge, will not occur in isolation. It will require the development of other sectors of the economy. Therefore, the medical brain drain challenge is a wake-up call to leaders across all levels to tackle the challenges of governance and development affecting the nation. Tackling the brain-drain challenge is more important now than ever to prevent a complete breakdown of the nation’s healthcare system.
Oluwatola can be reached at: toluwanioluwatola@gmail.com
