It can be quite devastating when your doctor tells you that the specialist care you urgently need is not available in Nigeria. I have been there before, so I know what it feels like. First you count the cost of treatment -- including travel -- converting naira into dollars, dirham, pounds, or euro. Then you worry about the emotional and economic cost on your family. But thankful that you have a chance at life, you do what you must to ensure that your health is restored.
This is however not an option for many Nigerians who pay over 70% of their healthcare costs out of pocket. The need to travel out of the country would be a catastrophic expenditure for patients, and many have made the difficult choice of prioritising their family's wellbeing over their treatment. So, they hang on, hoping that a medical miracle will find them where they are. But any hopes that one may have of this happening are dashed as Nigeria continues to experience a medical brain drain.
Data on the General Medical Council website reveals that as of November 2022, more than 10,000 Nigerian-trained doctors were registered in the United Kingdom (UK). A further breakdown reveals that over 1,000 of this number were licensed between 1 January and 30 September 2022.
The Diaspora as Nigeria's Brain Gain
However, this brain drain, though problematic, could also serve as a pathway to improve the health sector. For this to happen and for Nigerian healthcare professionals in the diaspora to return, the "pull" factors back to Nigeria have to be favourable -- so their return would be either partially or fully, enabling them to contribute their expertise and acquired knowledge to the Nigerian health system. "The people who taught me in medical school went abroad, but they came back," said Dr Babaseyi Oyesola, Chief Executive Officer/Founder of Anesthesia and Critical Care Consultants and founder, Doctors for Change. "Our set went but didn't look back and more people kept leaving and increasingly, there has become a gap between the people who trained us at the time and we who should have trained the current ones and the gap is getting wider and wider. It is now so wide that there are now some specialties that are not even represented in our post graduate medical colleges," he added.
The need to tap into the vast resources of Nigerian doctors in the diaspora was discussed expansively in the 2018 Nigeria Health Watch Future of Health Conference. The theme -- The Diaspora as Nigeria's Brain Gain provided an opportunity for Nigerian healthcare professionals who were working in the diaspora or had returned to Nigeria, to share insights and knowledge garnered from the experience of engaging or re-engaging with the health sector in Nigeria. They agreed that the move back to Nigeria for healthcare professionals in the diaspora, was not for the fainthearted. Notwithstanding this, there was clear evidence that the Nigerian healthcare system had benefitted from their expertise and skills.
Doctors for Change
Doctors for Change (DFC) started as a WhatsApp group to serve as a platform where returning healthcare professionals -- and those interested in giving back to the society from the diaspora -- could convene. According to Dr Oyesola, "It was a conversation that started from the fact that there are so many of us Nigerian doctors trained in the diaspora, who are coming home. But we did not have a forum for exchanging thoughts and ideas, bouncing off, taking advice, seeking each other out from the various specialties and enhancing the quality of our practise through a network."
From an informal chat group formed by friends, DFC has grown into an over 300-member group of Nigerian healthcare professionals from different backgrounds, across diverse specialties practicing in Nigeria and in the diaspora, committed to transforming the Nigerian healthcare system. On Saturday, 19 November 2022, the group held its first convention where members who had previously only communicated virtually were able to meet, some for the first time. Members discussed the innovations they introduced into areas like cardiovascular and cancer care, interventional and general radiology, spine and joint replacement surgery. It was clear that while they ran for-profit businesses, more than anything else, their focus was always on ensuring the comfort of the patient and offering quality health care.
From primary care to interventional radiology, geriatric care, anaesthesia and critical care, all specialities are represented in the group. "There are even specialties in this country now represented by Nigerians who trained abroad, that there are no training programmes for in Nigeria. So, we now have specialists practising beyond the scope of Nigeria's or West Africa's ability to train" Dr Oyesola added.
Also deliberate about knowledge transfer, members train colleagues, residents and medical students and support infrastructural developments at different levels in the country.
Incentivising Healthcare Sector Delivery
Taking the bold step to return comes with its own pitfalls and Dr Pamela Ajayi, President, Healthcare Federation of Nigeria (HFN) said, "some of the doctors in the diaspora have tried to come back or tried to give back, but they've had their fingers burnt in so many ways".
"Before you come back, check with a psychiatrist to make sure you're making the right decision. I actually did because it is the hardest thing I've ever done," said Dr Adeyemi Johnson, a seasoned interventional cardiologist who moved back to Nigeria after 28 years in the diaspora, adding that "... coming back is the best thing I have done. We now provide services that were not available before then".
Dr Oyesola said people were incredulous when they heard of his decision to move back to Nigeria from the UK. "In fact, the rumor that was going round was that I must have been sacked or gotten into trouble. It didn't occur to people that you can leave a place of comfort where people want to go and go back to the place people are trying to run away from."
As part of their advocacy for policies that would enable the return and seamless integration of doctors in the diaspora, HFN has worked with the Federal Ministry of Health, the Nigerian Investment Promotion Commission (NIPC) and the World Bank, on a policy called 'Incentivising healthcare sector delivery'. According to Dr Ajayi, embedded in the document, which is currently waiting to go through the Federal Executive Council (FEC) to be made law, "is what we hear a lot of our people ask for. So, all we have to do is have that policy enabled and it will help drive investment into the sector and create opportunities which will encourage our medical personnel in the diaspora to come back," she added.
Closing the Gap
The "push" factors in Nigeria's health system are currently stronger than any pull factors. To encourage a brain gain, Dr Oyesola suggested that government make the pull factors back to Nigeria stronger by making it attractive for senior level Nigerian medical personnel in the diaspora to return. "Once that starts to happen and the patients know they can get their care, and students know they can get their training, it will go a long way."
Speaking at the conference, the Honourable Commissioner for Health, Lagos State, Dr Akin Abayomi said government can further reverse the brain drain by paying more attention to the welfare of health care professionals, improving the circumstances under which they work, promoting an environment for specialisation and for government to continue encouraging a congenial business environment.
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If implemented, this will help boost the objectives of the DFC who have committed to working with the government to develop the Nigerian health system. They are also working to ensure an enabling environment for healthcare professionals in the diaspora who are willing to return.
Throwback to 2018 Future of Health Conference
In addition, as DFC and the HFN continue to work with individuals, private organisations and the government to transform the Nigerian health system, it is critical to bring these calls-to-action from the discourse at the 2018 FHC to the fore. They remain relevant now as they did previously:
Standards in the health sector should be developed by Nigerians for Nigeria that would be accepted internationally.
Public-Private Partnerships will improve the quality of healthcare
The government should create an enabling environment for health professionals in the diaspora who want to come back
The model used to re-build the healthcare system in India should be replicated in Nigeria
It is important for the poor and vulnerable to have access to quality health care. It should not be based just on ability to pay
Nigerian health professionals in the diaspora should be prepared to share knowledge and skills
Collaboration is important. Knowing when and how to collaborate is key
Understand the people's needs and see if what you are providing is what they really want
Passion, patience and patriotism is needed to make the difference
Listen to young people. Engage them, include them in the health care solutions.
