Dr Babatunde Rosiji, Chairman of the Nigeria Medical Association’s South West Zone and also the NMA’s chairman in Ekiti State, tells ABIODUN NEJO that government can halt the spiralling brain drain by addressing the push and pull factors
Doctors in public hospitals in Ekiti State say they are being owed arrears of salaries; what is the NMA doing about that?
Our colleagues working with the state government at the Hospital Management Board are owed two months; those at the local governments are owed five months, and those at Ekiti State University Teaching Hospital are owed three months. This happened when EKSG said it was using two allocations to pay one month’s salary, skipping salaries, and stuff like that.
The state government, however, has in the last three weeks paid a month’s salary to our colleagues in the local governments, which is a step in the right direction. We only wish the government good luck in expediting the process of clearing the remaining backlogs.
Brain drain has been an issue in the health sector, especially among doctors. Do you see a way out?
There is a solution, but unfortunately, the government is only paying lip service to it. The simple solution I proffer is by asking questions: “Why are these doctors leaving their jobs? Where are they going when they leave their jobs? What are the factors pulling them in the direction they are going?”
There are both push and pull factors. The push factors are those driving them away from their jobs in Ekiti, other states and Nigeria. Address the problems like insecurity, poor welfare, poor working conditions, poor pay, and a lack of definite and proper equipment leading to poor job satisfaction and put them in proper perspective. Come to the pull factors, i.e., the favourable factors in the other climes they are going to pick jobs, and begin to replicate those factors attracting them where they are going — they are going because the pay on the other side is better; why don’t you work on the pay here?
What can be done?
Let us work on what doctors normally use their money to purchase here in Nigeria: car loans. If you are a doctor or somebody in the health sector, we will start a car scheme for you, and you will pay over five years. In essence, what you have done is keep those people for at least five years. You can also bring up a special housing intervention for the health sector; we will deduct this from your salaries over so many years. These are the reasons people are getting out of the system: you have taken care of mobility and shelter, you are giving them a reason to stay, and you are giving them the conviction that this system appreciates them.
You now go to other systemic things, like the security issue. We conducted a survey recently among our members. Let me localise it to Ekiti State. We asked how many of you are certain you will be employed by the Ekiti State government for at least the next two years. We were shocked that less than 30 per cent said they would remain in Ekiti State in the next two years. That is worrisome. More worrisome is the fact that the majority of the 30 per cent are retiring soon. That means if care is not taken, in the next two years, a lot of young people will have left the system, and we will now be left with elderly people with months or a few years to retire.
When we asked about the factors discouraging them from staying here, over 80 per cent of them said they don’t feel safe at work and also fear for their families’ safety when they are at work. Over 65 per cent also say they are dissatisfied with their jobs. The government can see where the problems are.
How is it affecting healthcare delivery in the Southwest?
Let me talk a little about the generality of the nation. Nigeria has about 218 million people. The World Health Organisation recommends one doctor for every 600 patients but Nigeria has been able to produce only 93,000 doctors since independence.
Today, we have only 24,000 remaining doctors to practise in the country, meaning that in Nigeria, the doctor-patient ratio is 1 to 9,000 citizens. That means Nigeria will require 363,000 doctors if we are to get to the ideal number of 1 to 600. If we follow the trajectory at the moment, our 37 medical schools across the country can only produce 3,530 doctors per year, so it will take us 103 years before we can get enough doctors to take care of our population.
Recently, a politician came on air and said we have enough doctors; another said we know brain drain is a problem but they have given express approval to hospitals to replace the doctors, and I said that is a criminal statement. If a professor of medicine who has almost 30 years of experience leaves for Saudi Arabia or the UK and you make the population believe that you can replace him with a fresh medical graduate, that is the deceit of the highest order.
Even among the final year medical students, we conducted a poll and observed that over 80 per cent of them have passed foreign licencing examinations and are only waiting for their housemanship to finish and jet out. Many of them are not even willing to do the mandatory national service. These are the people the politicians are counting on to replace the workforce. We are playing with fire in this country.
This implies that Nigeria trains doctors for other countries…
The cost of training a medical student is about $36,410, meaning that to train an average medical graduate will cost the economy N27.5m, which is about N750 to a dollar. We expect that an average doctor graduates at the age of 30, and we expect him or her to contribute at least 30 years of active service to the Nigerian economy. If you use a single compound interest formula, treating those 30 years in economic terms, that means the Nigerian economy is losing $1.2m for every doctor that leaves, which is N900m. The government blames a lack of funds for not taking care of doctors’ welfare but if you are not taking care of their welfare, the economy is losing N900m for every doctor that leaves.
As I said earlier, we have produced 93,000 doctors but we have only 24,000 left. That means we have lost 70,000 doctors to emigration, death, or whatever. There is a golden law in business: “Cut your losses and begin to retrace your steps.” That means it is not too much to invest N63 trillion to reclaim these hands so that we will not continue to lose them.
In Ekiti, people complain about doctors in public hospitals. Why is this so?
Talking about Ekiti, we expect a minimum of two doctors in each of the 16 local governments, i.e., 32 doctors to take care of the 349 health centres at the primary healthcare level but unfortunately, at the last count, there were only 12 doctors.
Out of the 12 doctors, two of them just resigned because they got federal appointments, leaving us with only 10 doctors. Two of the remaining 10 will be retiring next year.
At the secondary level, which comprises three specialist hospitals and 15 general hospitals, ideally, we need 306 doctors (270 medical officers, consultants, senior doctors, and 36 house officers) to run the hospitals but at the moment, we have 80 doctors, a deficit of 226. In Ekiti State, there are general hospitals with one doctor. That doctor is expected to provide 24 hours service for 365 days but we have forgotten that that doctor also has a wife and children that need his presence. When citizens get to that hospital and they don’t meet that doctor, the next thing you hear is a politician calling to ask, “Why is there no doctor in that hospital?” Do you want that doctor to kill himself? The best are general hospitals, where you have two doctors. The two doctors will be the ones to do everything. It is a problem with our system.
Across the board, from primary to secondary to tertiary, the system is leaking. We are just one major crisis away from having the healthcare system collapse in Ekiti State. There is fire on the mountain; we need to run fast to save the health sector, especially in Ekiti State from total collapse. We only pray that the appropriate authorities concerned will listen and do the needful because, as I said jokingly, I hope it will not get to the point where we will be seeing native doctors in our hospitals.
Is the situation that hopeless?
I said that because where we are today, we are putting up advertisements for the employment of doctors, and nobody is responding. That shows you how unattractive working with the state government has become. If we are not attractive, people will have other options, and we will only have ourselves to blame.
What is your advice to Ekiti State’s new governor?
I would like to put it on record that the NMA is ready to partner with the government to deliver good healthcare to the people of Ekiti. As I said earlier, he should address those push factors and replicate the pull factors in the service of Ekiti State. He must domesticate pay parity across all levels of healthcare in Ekiti State such that a doctor in the local government, Health Management Board, or teaching hospital gets exactly what his colleague in the federal establishment is paid. Also, he should make the job of the state government more attractive and appealing to doctors with schemes such as car and housing loans.
