As I sat in the pew on that brisk October day, I found myself among roughly thirty graduates in the class of ’97 from Nnamdi Azikiwe University Medical School. We were undergoing the solemn induction ceremony conducted by the Nigerian Medical and Dental Council (MDCN), a rite of passage that formally ushered us into the esteemed ranks of the medical profession.
For my peers and me, this moment signified the culmination of a lifelong ambition—a dream that had materialised through years of relentless sacrifice. The pleasures of adolescence, the carefree indulgences of youth, had been willingly traded for arduous study and sleepless nights. My father, with his characteristic wisdom, had forewarned me about the sacrifices that would be required if I truly aspired to become a doctor. He had been right. As I sat there reflecting, I felt an overwhelming sense of gratitude that he was alive to witness this day. Sadly, my mother was not; we lost her under circumstances that could have been easily avoided in a society with a functioning healthcare system, just a month before my final examinations.
As the legendary pathologist, Professor WIB Onuigbo delivered his unforgettable induction lecture, aptly titled “Historical Hints in Humaneness,” my mind drifted between absorbing his words and contemplating the uncertainties of the future. Born without the advantages of wealth or privilege, I was fully aware of the obstacles that lay ahead. Yet, I believed that graduating near the top of my class would afford me at least one certainty—a placement for the mandatory year of housemanship at my alma mater. I soon discovered how misplaced that confidence was.
Despite assurances that the top ten graduates would be granted automatic placements, merit swiftly became a casualty of nepotism. As it turned out, family connections and external influences proved far more valuable than academic excellence. That was my first encounter with the harsh reality of a system where meritocracy is often sacrificed on the altar of favoritism.
I faced many more harrowing experiences, each one chipping away at the small hope I once held. I won’t waste anyone’s time with the specifics here, but it was in those moments that the Nigeria I had envisioned—a place where, despite its imperfections, effort and excellence attract some reward—revealed itself to be nothing more than a fantasy. Instead, I encountered a nation where opportunities were scarce, and the hope for growth or advancement felt like a distant dream.
This growing disillusionment pushed me to seek opportunities beyond the borders of my homeland, ultimately leading me to the United States in the aftermath of the 9/11 attacks. The dream I had once nurtured in Nigeria was no longer within reach, but the search for a better future was far from over.
My journey is nothing unique; it echoes the experiences of countless Nigerian doctors and nurses including Prof. Muhammad Ali Pate, Nigeria’s current Minister of Health, who like me, became disillusioned with a system that offered little more than roadblocks to their ambitions. Since that bitterly cold day in January 2001, when I boarded a flight to the United States, thousands more have followed the same path—fleeing their homeland in search of refuge in countries where their skills are valued, and where the opportunities they were denied at home could finally be realised.
In recent years, Nigeria has faced an alarming exodus of medical professionals. Prof. Pate reports that between 15,000 and 16,000 doctors have left the country in just the last five years. According to Dr. Victor Kolawole, Deputy Registrar of the Medical and Dental Council of Nigeria (MDCN), only 58,000 of the 130,000 registered doctors renewed their licences in 2023. What happened to the rest? Well, they have sought opportunities abroad, migrating to the UK, North America, South Africa, Saudi Arabia, Trinidad and Tobago and other countries that offer an escape from the dire situation at home.
In 2021, Nigeria had only 3.95 doctors per 10,000 people, far below the World Health Organisation’s recommended doctor-to-patient ratio of 1:400–600. It has since gotten worse to the point where this grave concern prompted the WHO to place Nigeria on its “red list” of countries facing a critical healthcare workforce crisis.
A study published in PubMed, a free database of biomedical and life sciences literature, maintained by the U.S. National Library of Medicine revealed the primary reasons for this mass exodus: inadequate remuneration (91.3%), rising insecurity (79.8%), overwork without proper compensation (61.8%), and a severe lack of diagnostic tools (61.8%). Additional factors include nepotism, poor leadership, inadequate regulation of medical training, and the desire for a better quality of life for families.
The situation in the nursing sector is equally, if not more dire. According to the National Association of Nigerian Nurses and Midwives (NANNM), about 75,000 nurses and midwives have left Nigeria over the past five years, with 42,000 departing in the last three years alone, citing the same reasons as doctors. This trend threatens to leave Nigeria’s healthcare system in a comatose state, where nurse aides and assistants may soon replace qualified professionals even in tertiary care facilities.
The impact of this shortage is devastating: prolonged waiting times for patients, overwhelmed practitioners, reduced doctor-patient interaction, higher consultation fees, and a steep decline in the quality of care. Without urgent intervention, Nigeria’s health system will continue to deteriorate, leaving millions without access to adequate medical services.
How do we tackle these pressing issues? The solution is not elusive; it simply requires genuine commitment—far beyond mere appearances—to address the root causes. A comprehensive strategy is essential, involving both the expansion of medical education and the mitigation of factors driving emigration.
First, enhancing medical education requires significant investment in our medical schools. This includes streamlining admissions processes, upgrading infrastructure, and increasing the remuneration for clinical educators. Such measures would alleviate the constraints of our current system, which consists of 37 fully accredited and 7 partially accredited institutions, with a total annual intake of just 3,990 students, as reported by a December 2022 PubMed study.
To curb the brain drain of our medical professionals, it is imperative to boost funding for the health sector. This includes improving salaries of not just doctors but other healthcare workers and providing essential diagnostic equipment and facilities. Despite the Abuja Declaration’s commitment for African countries to allocate at least 15% of their annual budgets to healthcare, Nigeria has allocated an average of only 4.7% over the past two decades. Meanwhile, substantial funds are diverted to luxury expenditures for politicians, and extravagant purchases by the president persist.
Redirecting the funds currently spent on medical tourism abroad into developing our healthcare infrastructure could profoundly impact the system. Doctors would experience greater job satisfaction and be less inclined to leave, while the financial burden of medical tourism would be significantly reduced. This shift would bolster the economy and enhance the national healthcare system’s reputation.
The recent announcement of a National Policy on Health Workforce Migration by the Federal Government aims to address this issue. It proposes comprehensive measures to strengthen the health sector workforce, curb the emigration of healthcare professionals, and encourage those abroad to return. While the policy appears promising in theory, the real challenge lies in bridging the gap between policy intentions and practical implementation. Although there are no quick fixes for systemic issues, with genuine political will, viable solutions are not out of reach.
Consider the swift passage of the Police Amendment Act 2024, which extended the tenure of the Inspector General of Police. The bill advanced through all readings in the Senate with remarkable speed and no opposition. Also, when the president and his team decided that all of Nigeria’s problems were due to our national anthem, he had the National Assembly pass a bill to reinstate the old anthem with a speed unprecedented in the legislative process. Bola Tinubu is President Über alles with larger-than-life influence that could similarly be deployed to address our healthcare crisis if he chooses to.
However, the current approach by the Ministry of Health, which frustrates healthcare professionals’ attempts to migrate by stalling necessary paperwork, is a misguided strategy. This short-term tactic may create additional difficulties for medical practitioners but will not stem the tide of emigration.
Addressing the fundamental issues—such as inadequate salaries, insufficient infrastructure, and lack of professional opportunities—is the only sustainable solution. In accordance with the natural law of demand and supply, as long as there are willing buyers and sellers, transactions will persist despite obstacles. From what we know about the Nigerian dynamics, the beneficiary of such policy will not be Nigeria but likely staffers in the Federal Ministry of Health, responsible for such approvals. Don’t ask me how.
The irony is that those enforcing these punitive measures, including the current Minister of Health, owe their positions to the very opportunities they now deny others. Today, mass migration out of Nigeria is not limited to healthcare professionals, so why single them out for punishment? Furthermore, the elites behind these draconian policies hypocritically indulge in medical tourism abroad and send their children to foreign schools, while expecting the middle and lower classes to endure a failing healthcare system.
Health is a fundamental need for all, irrespective of socio-economic status and we are all victims of this systemic failure. The tragic loss of President Buhari’s Chief of Staff and prominent billionaires during the COVID-19 lockdown underscores the stark reality that a failed healthcare system is an equal opportunity destroyer. It is unconscionable to obstruct those trying to escape from a raging fire.
In the words of a British-Somali poet, Warsan Shire: “No one leaves home unless home is the mouth of a shark.”
•Agbo is a US-based medical doctor and author. His works include, Black Grit, White Knuckles: The Philosophy of Black Renaissance and a fiction work titled The Velvet Court: Courtesan Chronicles. His latest works, Pray, Let the Shaman Die and Ma’am, I Do Not Come to You for Love, have just been released.
