Modupe Olalere
Nigeria is losing more than half its qualified doctors to foreign countries, draining the lifeblood of its health care system and jeopardising the health of over 200 million people. Recently, President Bola Tinubu approved a new and broad National Health Workforce Policy, a clear way to arrest the flow of physicians and other health professionals from Nigeria and get Nigeria’s doctors to stay home.
The options for doctors in Nigeria are limited. Many exit “because of the horrible conditions of practice that they have to endure, long hours, terrible working conditions, and poor facilities.” According to Dr. Victor Kolawole, the deputy registrar of the Medical and Dental Council of Nigeria (MDCN), only 58,000 of the more than 130,000 registered doctors in Nigeria renewed their licenses in 2023, which is a meaningful gap that threatens to negatively impact patient care in Nigeria.
Muhammad Ali Pate, Minister of Health & Social Welfare, said, “The National Policy on Health Workforce Migration is a comprehensive strategy to manage and reverse the migration of healthcare professionals. It aims to create a robust healthcare system where workers are well-supported and adequately rewarded”.
The new policy requires regular working condition reviews and introduces electronic medical records (EMR) and telehealth services. These innovations are expected to improve health care delivery and incentivize doctors to work and stay in family practice.
Improving Working Conditions: The Heart of Retention
Doctors in Nigeria face challenges related to old equipment, hospital overcrowding, and limited basic healthcare resources. These factors make daily work frustrating and unsafe. Dr. Kolawole states, “The reality is that many doctors feel overwhelmed and unsupported, which makes them look for better opportunities abroad.”
The policy addresses this by improving healthcare facilities and deploying essential support. Technology investments will also lessen some administrative demands on doctors so they can spend more time dealing with patients.
Benjamin Olowojebutu, Vice President of the Nigerian Medical Association (NMA), emphasised, “Stabilising the healthcare workforce through fair and equitable pay will ensure a system that is resilient, effective, and ready to serve future generations.”
Incentives and Fair Pay: Building Trust and Motivation
Fair compensation is a huge issue in Nigeria’s healthcare sector, and money leaves a huge mark behind, as they say, “money speaks.” The NMA has stressed the need for a standardised national salary structure. “We need a salary structure with a uniform national base pay that ensures healthcare workers receive fair compensation for the same job responsibilities and is adjusted for inflation”. Olowojebutu went on to say.
This structure would have standard increments for specialisation, years of experience, and years of service. It’s not only a matter of money; it’s also about predictability and trust. “Doctors and health workers should be rewarded fairly and consistently regardless of whether they served in rural or urban centres or at a public or private institution,” Olowojebutu continued.
Other nations (for example, Canada and the United Kingdom) use salary structures that adjust for regions so that no physician feels an economic disadvantage based on their practice location. These nations also position health professionals and advocate for underpopulated or underserved areas. “We are following such a model,” Olowojebutu said.
Policymakers are also exploring options to improve the registration process for divinely qualified professionals looking to return to practice in Nigeria and help reduce regulatory barriers. They are examining financial incentives of higher salaries, housing allowances, and loan repayment for workers returning to practice, especially in sections in the country with need for health human resources.
Doctors want more than money – they want the chance to thrive. Nigeria’s new policy aims to facilitate lifelong learning and career development opportunities nationwide. “Lifelong learning and career development are essential for all health care professionals,” Sophia Smith wrote in a recent review.
Workshops, training programs, and conferences are being expanded to provide opportunities for healthcare workers to update and enhance their skills and knowledge. This increases job satisfaction and also provides assurance that Nigeria’s health workers can keep pace with international expectations.
Access to quality education is also a pillar. Building and investing in medical schools and schools of training opens a pipeline of educated and skilled health professionals to practice in Nigeria. Additionally, the policy aims to provide health infrastructure support from contemporary hospitals to usable medical equipment and supplies. Having health facilities distributed throughout Nigeria with adequate equipment and supplies is key to recruiting and retaining an adequate health workforce.
Pate provided an overview of the philosophy: “We are taking the first steps toward a better, more efficient, data-driven health system.”
Voices from the Field: Why Doctors Leave—and What Would Make Them Stay
The numbers paint a vivid picture: Nigeria has lost over fifty per cent of its qualified doctors to foreign lands in the past decade alone, and the problem continues to grow. According to the doctors, the reasons are also obvious: poor pay, limited career advancement, inadequate facilities, and a lack of feeling connected to government policy.
“The trend is a drain on human resources, therefore eating away at the backbone of the healthcare system while carrying an enormous weight on the healthcare system that remains,” Olowojebutu said. “A healthy healthcare system cannot function effectively if its foundational workforce of skilled personnel is depleted and weakened, as is the case. Over 200 million Nigerians deserve better quality of care.”
He went on to argue that a standardised pay structure “builds bridges representing the Government’s commitment to support the healthcare workforce, allowing healthcare professionals to trust and commit to the national healthcare agenda and realise and contribute their skills and ideas to a system that supports, values, and invests in them.”
Bucket brigade: What next for Nigeria’s doctors? The new policy identifies it as action, not promises.
One of the most ambitious goals of the National Health Workforce Policy is to encourage Nigerian doctors working abroad to return to Nigeria. The policy aims to prioritise registration and support the reintegration of these doctors as part of a move away from historical issues in managing human resources for health and improve the experience of practising doctors in Nigeria.
Pate noted, “The policy will achieve this using a number of strategies, including changing the working conditions of the health care systems and better incentives.” Nigeria expects that doctors abroad will bring experience, skills, knowledge, and additional commitment to improving health care in Nigeria.
Modern-day health care is driven by data and digital technology; the National Health Workforce Policy seeks to use proven health technology, such as EMR and telehealth services, to enhance the effectiveness of health care delivery and justly distribute health workers across the federation.
Pate remarked, “By establishing a comprehensive Health Workforce Registry, Nigeria will be better able to track, deploy, and support its healthcare workforce, taking a huge step forward toward a more efficient and data-driven health system.”
The implications of losing doctors are enormous, contributing to longer waits, reduced access to good health care and increasing pressure to keep working for those who do not leave the system. The stakes raised by this skill loss are high for a population of over 200 million.
Sophia Smith said, “The skills gap of healthcare workers in a country is serious for the population. It means longer wait times, a reduction in access to quality care, and care of patients can be compromised”.
The new policy is an ambitious effort to change the story and build a healthcare system that works for all Nigerians.