The exodus of nurses and midwives from Nigeria in the past five years has reached a concerning level, with over 75,000 healthcare professionals leaving the country in search of better welfare, pay, and working conditions. This trend has the potential to significantly impact the quality of healthcare in Nigeria, as lack of welfare, poor remuneration, and hostile work environments are among the reasons for the brain drain in the health sector.
According to the National Association of Nigeria Nurses and Midwives (NANNM), 3,383 Nigerian-trained nurses and midwives were licensed to practice in the United Kingdom in the past year, while 10,639 nurses and midwives currently practice in the UK. The regulatory body responsible for nursing and midwifery in the UK reported these figures.
In an interview with our correspondent, Oloruntoba Odumosu, state secretary of NANNM Lagos Council, attributed the mass exodus to factors such as poor remuneration, unfriendly work conditions, unsophisticated medical facilities, and the current economic situation.
The reasons for nurses leaving the profession are multifaceted and stem from both controllable and uncontrollable factors, including the attractiveness of other job opportunities and dissatisfaction with working conditions. One significant contributing factor is the disparity between the remuneration for nurses and the demands of their role. This has resulted in an exodus of nurses from the profession, leaving those who remain with an increased workload and inadequate pay. Additionally, the healthcare sector is also hindered by a lack of investment, uneven distribution of resources and power imbalances.
Second, we do not have a good level of investment in the health sector across the board. The Abuja Declaration recommends that in every country, at least 15 percent of the annual budget should be invested in healthcare. Nigeria has never crossed a single digit. Nigeria has not invested in healthcare. Many years of underinvestment in the health sector means that the infrastructure within this sector is already decaying, people have to use archaic equipment for work, and the environment is not very friendly for workers. For an average nurse, you work in a frustrating environment.
“Another good example is the fact that, ordinarily, by the way the healthcare system is designed, 70 percent of the health care interventions should be done at the primary healthcare level. 27 percent of healthcare interventions should happen at the secondary level and only three percent should happen at the tertiary level. Prevention is better than cure, and you need to take healthcare closer to where people are.
“Another good example is the fact that, ordinarily by the way the healthcare system is designed, 70 percent of the health care interventions should be done at the primary healthcare level. 27 percent of the healthcare interventions should happen at the secondary level and only three percent should happen at the tertiary level. Prevention is better than cure, you need to take health care closer to where people are.
However, the reverse has been the case; we have a huge amount of money being devoted to tertiary institutions, tertiary facilities, and secondary facilities; thousands of primary healthcare centers are deserted, poorly funded, and poorly resourced; and some of them do not have light, thereby taking delivery with lantern.
This means that management is not setting priorities correctly. These are some of the things that make the country’s healthcare system a bit frustrating. We have situations where we have different salary structures and doctors are going on strike, which means that the government is not putting a premium on the health system in the country.
With regard to the economic situation of the country, Odumosu stated that the absence of structured healthcare financing and lack of reward for nurses in Nigeria as opposed to other countries, where nurses are recognized, well-rewarded, and prioritized, are other factors contributing to the brain drain in the country.
In addition, the situation of the country, in terms of its economic prospects, is also a factor. Anyone who is being tasked with much work and labor will definitely leave when they do not see a bright future for themselves. In countries where nurses are traveling, the government has placed a premium on healthcare and nurses are properly rewarded.
They see their future secured in those climes, which is why they keep leaving and they will continue to leave, unfortunately, until the government is ready to do what is right for the health sector. We expect that the implementation starts as soon as possible so that more funds can be mobilized to ensure that healthcare financing is much more structured.”
He lamented the harsh working conditions in the profession, which resulted in chronic illnesses as well as the demise of many nurses.
“The health and education sector need a state of emergency. We are losing our members every now and then and many of them are coming down with chronic illnesses like hypertension and diabetes because of the level of stress they go through,” he revealed.
He further revealed NANNM’s efforts to mitigate the impact of brain drain on its members through calls for mass recruitment. However, he noted that challenges in terms of years of professional experience and retention of nurses degenerate the health sector.
“It is affecting us and we get more complaints from our members on the impact of the exodus. Some of the things we have been doing are to call for mass employment. For example, in Lagos state, through some of the interventions, there have been mass requests and recruitments at the primary healthcare level and health service commissions.
In addition, we want to put an exit replacement policy in place, which the governor has given approval for the employment of nurses, so at least when people leave now, the adverts will be placed to replace those that have left.
The challenge is that we need to get sufficient nurses to meet the quota. People cannot be equated to one-on-one. For a nurse with 10–15 years of experience, you cannot equate that person with a fresh person you are just employing. The level of job experience makes a significant difference. If you lose someone who has done 20 years and replace someone who has just graduated, the system is not going to improve.
While we appreciate these interventions, they are not adequate to cater to the needs of the healthcare sector. When they place job advertisements, they get people, but in the next six months, about 100 people are resigning. The problem is not being able to recruit; it is about retaining the people they have recruited. Policies must be directed towards retaining, not just opening up, the recruitment process, because in the next five years, if this trend continues, the health sector would have a critical decline of mid-level managers of doctors and nurses.
We would have just people at the tail end of their careers and those who are just coming in. The middle-man, who is the engine room of the system, will not be there again. People will not stay long enough to be promoted or to gather enough experience, which will be a serious capacity issue for the healthcare system to deliver optimally.
To address the issue of brain drain in the health sector, Odumosu urged the government to declare a state of emergency in the health sector. In addition, prioritizing the welfare of nurses, proper remuneration, and the provision of healthcare facilities are crucial.
“Essentially, if the government wants nurses to remain in the country, they need to declare a state of emergency in the health sector and listen to the issues befalling different health professionals, especially nurses, who constitute more than 50% of the professional healthcare in the system anywhere in the world. Ensure that you prioritize their welfare, they are properly remunerated, they have input in their workplaces, facilities are provided, provide services that support them, and we will not have this level of exodus.
“The global report of 2022 states that there is a total of 5.9 million global shortages of nurses, 85% of which exist in Africa. Thus, if the shortage is more for Africa, imagine the shortage for Nigeria; when they say Africa, Nigeria’s population is the highest. The place where there is a shortage of nurses is also experiencing the highest level of attrition.