­­Recently social media was flooded with reactions from various Nigerians to a tweet thread by two Nigerian Doctors. One of the doctors, @Aproko Doctor duly cited a doctor who attends 100 patients a day in Nigeria for 110,000 Naira, while in Saudi Arabia he sees a mere seven patients a day for almost 1.5million Naira.

Though we may not ascertain the facts given by the doctor, we cannot deny the increasing number of doctors who are leaving the country in the past year. Doctors have attributed the immigration to poor working environments, salaries and incentives. According to a report by Aljazeera[1], “while the annual healthcare threshold per person in the US is $10,000, in Nigeria it is just $6.”

This is complicated further by the established fact that there are not enough doctors in the country. According to data from the World Health Organization, Nigeria’s physician to patient ratio is four doctors per 10,000 patients; a long stretch from the WHO standard of 1 doctor to 600 patients.

Research carried out by the Nigerian Polling Organisation in partnership with Nigerian Health Watch revealed that “about 8 out of every 10 medical doctors in Nigeria are currently seeking work opportunities abroad” and this finding cut across different levels and specialisations.

With the rise in migration, coupled with inadequate facilities at health centers, it is likely that infant mortality and maternal death especially in conflict affected regions will rise.

 

The high ratio of patients to doctors has caused an increase in waiting times for expecting mothers and infants. This was confirmed in an interview with a medical doctor who pleaded anonymity. The medical doctor who works in the ‘mother and child’ unit at one of the general hospitals in Lagos state informed us that during the long waiting period, some of the pregnant women get exhausted. The waiting times are usually between four and six hours in her hospital. She also lamented that some childbirth emergencies are not attended to on time, as doctors are usually busy in the theatre performing emergency caesarean sections.  In the case of antepartum haemorrhage (bleeding during pregnancy) and depending on the severity, the woman may bleed to death as there might be reduced blood supply to the baby, resulting in foetal death. The doctor also accounted that on average, they attend to 30-40 patients in a day; this overworking coupled with poor remuneration could sometimes affect the quality of service the doctor gives to the mother or infant. And in their fatigued state of mind, they can make mistakes.

Another effort to uncover the effect of an insufficient number of physicians on infant mortality and maternal death was made during a visit to Ejire Public Health Center. Following the recent development by the Primary Health Care (PHC) around Itire and Lawanson Road, only one functional PHC runs for 24 hours while the rest suffer from dilapidation and a shortage of physicians.

For instance, cases that need urgent attention and could cause serious complications if not tended to correctly, are transferred to the Ejire PHC. According to the observation, the Anjorin PHC had no doctor on duty on arrival. The nurse who attended said that they don't operate for 24 hours and that serious issues would be attended to in Ejire PHC. At the Airways branch, the PHC that runs over there only operates for 18 hours and sometimes nurses are exchanged for qualified doctors.

The assistant head officer, Savage Simisola said that out of all the PHC around Itire-Ikate Local Council Development Area (LCDA), only Ejire runs for 24 hours and this is due to the shortage of physicians available. During another visit to the Ejire PHC, patients were attended to by nurses. There was no doctor on duty to attend to patients.

These are just a few of the numerous cases of the dearth of health workers and the unsavory tales it brings to Nigerians. Treatment is deteriorating rapidly in North-East Nigeria with high level of insecurity (kidnapping and bombing) in the region further de-motivating physicians to work in these regions.

Physicians who are committed to stay back to work are faced with the scourge of few facilities to work in, as a result of destruction of infrastructures in those regions. In a report by the International Committee of Red Cross (ICRC), only half of the 700 health-care facilities are functioning. In January 2020, an ICRC-supported facility in Rann was burnt down. Health centers in Sabon Gari and Damboa have also been attacked. This has taken a toll on child-birth, with infant mortality death at 150 per 1000 live birth in the region. This is higher than the national average of 36 per 1000 live births.

To keep up with the declining stride of infant mortality and invert the rise of maternal deaths and to align with the SDG target of 25 per 1000 live birth and 70 per 100,000 live birth for infants and mothers respectively, we must equip our health care centers with enough physicians who would adequately, effectively and timely attend to these mothers and little Nigerians.

 

 

 

[1] https://www.aljazeera.com/indepth/features/nigeria-medical-brain-drain-healthcare-woes-doctors-flee-190407210251424.html