Transforming Healthcare Delivery in Nigeria

This is a CMF Webinar Session Report 6#

 

Introduction

The Brain Drain, Brain Gain webinar, a brainchild of #CovidNigeriaMedics, highlighted the trend of doctors’ emigration from Nigeria and the impact of this trend on the healthcare sector and the Nigerian populace. The remote and immediate reasons for this, tagged “the push and pull factors” were presented and discussed by the key speaker. Opinions of some Nigerian doctors in diaspora were also shared. Participants also Interacted by expressing their views on measures to give back to the Nigerian system through the concept of brain circulation with various approaches suggested.

 

Webinar Structure

The Webinar was organized and hosted on the 28th August, 2020 by the coordinators of CovidNigeriaMedics from the UK, U.S., Nigeria and many other countries. Invitations to the webinar were distributed by the hosts through their stakeholder networks. The webinar had over a hundred participants including domestic and foreign based Nigerian doctors, health insurance staff and other allied members of the health sector. The total duration of the webinar was 1:35:04 (95 minutes). It began with an introduction and historical background of the organization by Dr. Sadiya Gumi, and then proceeded with the agenda of the webinar and order of proceedings. 

Key Speaker:

Dr. Jameel Ismail.

Other Speakers: Dr. Olufemi Sani, Dr. Ona Otuama, and Dr. Eburohuwa Oluwayemi.

 

Coordinator                                                        Moderators

Dr. Sadiya Gumi                                             Dr. Muktar Ahmad & Dr. Aminu Magaji

 

Overview of Keynote Topics

Dr. Sadiya Gumi delivered the opening speech of the webinar by providing a brief overview of #CovidNigeriaMedics, an upcoming group comprising concerned doctors of Nigerian decent practicing in various parts of the world who are interested in giving back to the Nigerian health system. She highlighted some short term achievements of the organization during the pandemic such as provision of face-shields across all states in the country. The impact of the COVID pandemic on the Nigerian health sector, particularly regarding inadequate personnel was also mentioned. She stated that efforts were underway to come up with a more permanent entity, andidentified three major areas which the organization aims to key into to give back to the Nigerian society and uplift the standard of health practice in Nigeria, such as facilitation of undergraduate and post graduate medical exchange programs through personal contacts and linked universities.

Next, Dr. MuktarAhmad gave a brief lay out of the webinar proceeding stating clearly the order or events. He introduced the topic of discussion and key speakers of the day. This was to be followed by a summary and finally, questions and answers sessions as well as other contributions from the participants.

 

 

Presentation by the Key Speakers

“Brain Drain, Brain Gain: Theory to Brain Circulation Paradigm, Rethinking the Future of Healthcare Workforce in Nigeria”

 

Dr. Jameel Ismail Ahmad, the key speaker, gave an overview of the topic “Brain Drain, Brain Gain: Theory to Brain Circulation Paradigm, Rethinking the Future of Healthcare Workforce in Nigeria”.

He gave examples of countries such as India, currently reaping the benefits of brain gain and brain circulation, hoping that Nigeria might learn from such. He defined high skilled migrants, doctors inclusive, listed the most desirable countries for emigration by these migrants, and quoted a World Health Organisation report of a global deficit of 4 million doctors, with sub-Saharan Africa being the most affected. The pluralistic nature of the Nigerian health system with gross underfunding of the public health sector by a meager 3.6% of the National budget, despite the large population, was highlighted as a harbinger for infrastructural decay, poor remuneration of doctors, ineffective healthcare delivery, all of which culminate in massive brain drain.

He introduced the concepts of brain abuse, brain drain, brain gain via reverse migration and brain circulation. Of major concern was the gross insufficiency of doctors in Nigeria, translating to a poor doctor-to-patient ratio, far from the WHO recommended ratio of 1:600 doctor to patient ratio. Available statistical evidence indicates the country isn’t producing sufficient doctors with over half of graduating doctors intending to leave. The push factors responsible for doctors’ emigration were identified to include poor remuneration, lack of residency placement, harsh economic environments, uncertainty about the future of one’s children, desire for better exposure and advanced training, and worsening political instability. The pull factors include relaxed and incentivised visa processing, politically stable environment, higher standard of training and practice, higher remuneration, and political stability. He noted that at the time of the study, over a half of Nigerian physicians received less than a thousand dollars monthly in salary, an amount which has significantly reduced to fewer than 500 dollars presently, due to depreciation of the Naira.

He juxtaposed the burden of disease in Africa, estimated to be about 24% of the global burden, with only 3% of the global manpower in reference to healthcare. He spoke about return migration and asked if Nigeria was ready for this? He proposed brain circulation model which allows for partnership between doctors across borders where highly skilled doctors in the diaspora temporarily visit and share their knowledge and skills without having to permanentlyrelocate to their motherland. The conditions which would favor brain circulation were identified to include development of joint educational programs between countries, easy access to visas through dual citizenship, etc. The need for medical entrepreneurship was emphasized, with recommendation for implementation of performance based remuneration system. Also, the role of telemedicine and its use would be helpful. He concluded by noting the huge infrastructural challenges with grossly inadequate human resources being compounded by brain drain which have become exacerbated by the COVID pandemic.

 

Push Factors as Key Determinants of Brain Drain

Dr. Olufemi Sani expressed his satisfaction with the presentation and attendance of the webinar.

His opinion was that the push factors were the most significant determinants to brain drain. He re-emphasised the desire for a higher standard of practice and security of health workers also being important. The role and benefit of telemedicine as a bridge between doctors in the diaspora and Nigeria was also discussed.

 

Effective Partnerships and Policies as Tools for Effective Healthcare Delivery in Nigeria

Dr. Ona Otuama shared her perspective from the US. She explained the role of telemedicine in bridging some health service gaps in the U.S, such as interpretation of x-rays. She spoke about the favourable import- export policy in India which served as solid foundation for reverse migration and brain circulation, a policy which she anticipates Nigeria can imbibe. She spoke on the need for cooperation and understanding between diaspora and home based doctors to avoid interpersonal conflict and rivalry. She concluded that partnership between health institutions in Nigeria and the Africa CDC through the Emery University platform will be helpful in increasing knowledge and practice as among health practitioners abroad and within the shores of Africa.

 

Emigrate or Abide? Why I Choose to Leave Nigeria

Dr. Eburohuwa Oluwayemi gave an insight to the motivating factors which precipitated her decision to emigrate from Nigeria and the influence of it is having on her practice. Some of her reasons for leaving Nigeria included frequent strikes, inability of patients to afford healthcare translating to helplessness on both the physician and the patient, high prevalence of disease nearly extinct in other climes, particularly infectious disease, inadequate facilities and equipment for efficient patient care, delayed payment of salaries, and her desire to be properly trained in a standard environment. She acknowledged the initial challenges of settling into a new system, but generally, she felt her decision was worthwhile and she was finding her footing and hopeful of the future. She expressed her intention to give back to the Nigerian health system in the future.

 

Challenges of Nigerian Doctors in Diaspora

Dr. Muktar Ahmad enumerated some challenges of doctors in diaspora and some of the limitations the hindering their return to Nigeria, and Africa as a whole. Some of the major setbacks are lack of appropriate facilities commensurate to their training such as robotic operating systems, non- motivating work environment, and the challenge of remuneration. He admitted the existence of challenges such as racism and xenophobia which are often encountered, urging intending migrant doctors to anticipate and develop coping mechanisms.

He acknowledged that most Nigerian doctors, given a convenient and safe environment, would rather remain or return to their motherland.

 

 

Ordeal of a Covid Survivor

Dr. Dalhat Afegbua narrated his ordeal as a COVID survivor. He spoke about the discomfort he went through on account of his symptoms, the anxiety of waiting for his test result, and the quality of care he received. He spent a total of 17 days at the isolation centre with some members of his nuclear family also contracting the illness at that time.

 

 

Summary:

The key points from the webinar include:

• There is a gross deficit of man power in the Nigerian health sector and this is being compounded by brain drain.
• There are “push and pull” factors responsible for migration of doctors, with remuneration, lack of adequate facilities, and poorly funded health systems being key push factors by developing partnerships between domestic and foreign based doctors, particularly of Nigerian descent to improve the quality and coverage of healthcare delivery in Nigeria.
• There is need for improved funding of the health sector in Nigeria to curb the menace of inadequate facilities and lack of equipment, improved training in the number and quality of health personnel, and expanded health insurance coverage for the majority of Nigerians who are unable to access basic health care. This will help curtail the trend of emigration of doctors from Nigeria.
• The problem of brain drain can be curbed through brain circulation and reverse migration. This can be achieved through collaboration between Nigerian doctors in diaspora and those in Nigeria.
• Telemedicine has a lot to offer in breaching the gap between diaspora and Home based doctors. If properly applied, it can serve as a means of consultation and training.
• There are challenges for both diaspora and home based doctors, which can be mitigated through mutual cooperation, a goal which CovidNigeriaMedics aims to achieve by nurturing and fostering mutual cooperation and partnership on both sides of the divide.

 

 

Discussion

Dr. Aminu Magaji summarised the charts in the chart box with a good number of participants requesting a recorded copy of the webinar. The email of the organization covidnigeriamedics@gmail.com was also shared with participants urged to end emails which will be responded to.

 

The Q&A session was interactive. They were some interesting contributions from the participants. Some notable contributions were by Dr. Ayo Adene who gave further insight into the poor funding of the health sector in Nigeria, the proportion of which he considered abysmal.

He was of the opinion that for any significant gains to be made, stakeholders and other concerned doctors might have to return to Nigeria at some point I their career to become policy makers and not just render advice to policy makers.

Dr. Ona Otuama stressed the need for improved health financing and institution of a solid National Health Insurance Scheme to go hand in hand with the private sector in-order to improve health access for Nigerians, particularly at the emergency points.

Dr. Aminu Yusuf raised a valid point on the need for a National data base for skilled Nigerian experts in the health sector for ease of access as often; patients are left flustered when in need of experts in some medical specialties with no point of reference to locate them.

 

 

Conclusion

The webinar ended with an announcement of the next webinar scheduled for 2nd September, 2020 and titled “Epidemic and pandemic preparedness and response, what does the future looklike in Nigeria?”