Nigeria’s broken healthcare system is worsening. There is no better evidence than the zero response to Kwara State government’s advertisement for the recruitment of doctors. Its hospitals are operating with just 99 doctors. The tallies for other paramedics are not better either. The crisis is not limited to the state, but is a national human resource epidemic, which the states in the North are more afflicted with. Under Atiku Bagudu as governor, eight years ago, Kebbi State experienced the same shock of “No doctors to recruit” when it advertised for their services.

The malady, without question, is an existential threat, which requires an urgent and effective policy roadmap, beyond extant flip-flop measures. The phenomenon is the net effect of decades of the mass exodus of skilled medical personnel to other parts of the world, especially to Europe and the Americas, for greener pastures, for which the country has no antidote just yet.

The Executive Secretary, Kwara State Hospitals Management Board, AbdulRaheem Malik, who revealed this terrifying situation in the state’s healthcare delivery services at its 2025 first quarter media briefing, said the governor had tried to mitigate the situation with an increase in the salaries of doctors. This attracted three doctors, who had earlier emigrated, to return, thus minimally raising the doctors’ workforce from 96 to 99 in the state’s 45 healthcare facilities. This is lamentable.

The daily harrowing experience of patients as a result, is better imagined than experienced. To reduce the suffering of patients, a software application has been developed to provide information to them on the number of doctors available before visits are made, to avoid endless waiting for attention and the possibility of collapsing, as is often the case in these circumstances.

A similar mind-boggling shortfall of medical doctors and other personnel has been observed in Jigawa State, where the State Executive Council (SEC) had to approve the recruitment of 2,124 health workers in December 2024, with N959.2 million provided for the attendant financial implications. In early January, resident doctors in the Federal Capital Territory, Abuja, embarked on a three-day warning strike over unpaid salaries. This category of doctors in Ondo State also began an indefinite strike in December 2024, over unpaid hazard allowances and discrepancies in their salaries.

In many teaching hospitals across the country, resident doctors are often embroiled in trade disputes with the Federal Government over poor wages, unfulfilled welfare promises and debilitating hospital conditions. Sadly, many of them who have completed their trainings now preoccupy themselves more with how to exit the country or japa, than seeking jobs here, or focusing on deploying their expertise when employed.

As doctors emigrate, so are nurses, pharmacists, laboratory scientists and technicians following them. Their destinations are mostly the United Kingdom, United States, Saudi Arabia, Canada, Australia and the United Arab Emirates (UAE), among others.

The urge to leave Nigeria is not only that of young doctors. Already established senior consultants are also on the move, having become totally fed-up with a system that is grossly underfunded and ill-equipped, without any indication of improving soon. The practice has denuded tertiary medical institutions of specialist doctors. Inevitably, it has spiked the number of Nigerians seeking medical attention abroad at great cost. According to the Minister of Health, Professor Mohammed Pate, this sucks away about $2 billion annually in medical tourism. Not done yet, Mr Pate said 16,000 doctors have left Nigeria in the past seven years. The figure could be staggeringly more when stretched to the past 20 years or more.

The tally of registered doctors, in 2021, as disclosed by the then President of the Nigerian Medical Association (NMA), Innocent Ujah, was 80,000. But the current NMA President, Bala Audu, recently said that mass exodus has left only 30,000 doctors practicing in the country. In 2023, the NMA branch chairperson for Jigawa State, Aminu Abdullahi, disclosed that the doctor/resident (patients) ratio was 1/21,000. “The ratio is similar to that of nurses and other health workers in the state. This is one of the worst ratios in the country.”

Undoubtedly, healthcare in the state is anything but deliverable, with this doctor/patient ratio mismatch, which is nowhere near the global standard of 1/600, as recommended by the World Health Organisation (WHO). Closing this gap is a tall order in a country where poor salaries conflate with poor working conditions and ravaging insecurity, to drain the enthusiasm of health workers to stay in the country.

Doctors have become constant targets of kidnapping. One of them, Ganiyat Popoola, a registrar at the National Eye Centre, Kaduna, was abducted on 27 December, 2023. She remained in her captors’ den till September 2024, with this earlier sparking an indefinite strike action by resident doctors in that state, in demanding for her release.

To change this eerie landscape requires more than the tokenism of pay increase, which, in real terms, is of no value presently, as inflation has effectively eroded the value of the naira. The working environment must be made conducive through conscious efforts at equipping our hospitals and providing opportunities for in-house training and retraining. Equally important is the necessity of easing the difficulties in the housemanship system in our teaching hospitals, which is a crucial source of building up our critical mass of doctors.

Health, as it is often said, is wealth. Where the Nigerian State cannot provide it, this lays the foundation for failure in other spheres of our national life – economy, productivity and education. Health, taken together with education, as as acritical element of human development should be taken seriously by all levels of government. The production of doctors and other health personnel begins with the provision of sound education, beginning from the basic level.

Unfortunately, education is not given the priority it deserves, leading to the collapse of the public primary school system in the country. The haunting spectacle of dilapidated school blocks, leaking or blown off roofs, pupils sitting on the bare floor to learn, insanitary environments and teachers, and pupils arriving late to schools, would greet any inquisitive visitor. These inhibitive scenarios are replicated across many public secondary schools.

Where a basic science teacher, Musa Abdul, in Yobe State, has not been paid his N70,000 salary since he was employed in 2022, as PREMIUM TIMES reported last week, does not prepare the stage for the grooming of brilliant pupils who would become future medical doctors.

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A country where budgeted funds for the building/equipping of primary healthcare centres are looted by some corrupt lawmakers in the National Assembly, through dubious constituency project contracts, cannot encourage the retention of doctors within its system. BudgetIT, a non-profit that tracks government expenditure, has provided copious evidence of the non-existence of many of such projects in the budget, through its meticulous search for them, which turned up nothing.

The decadent state of University College Hospital (UCH) Ibadan, bogged down by epileptic electricity supply as a result of its inability to foot a N99 million monthly bill, chronic water shortage, inability to carry out medical tests for prompt treatment, the cancellation of surgeries, and the forceful demand of some patients to be discharged in order to seek treatment elsewhere, coupled with the dearth of vital equipment, have opened the door for many of its specialist to emigrate. Other teaching hospitals are mired in similar rot or dysfunction.

When a state like Lagos, with its huge finances, underfunds its health sector, evident in the N46 billion it released to its Ministry of Health in 2024, as against N162 billion provided in the budget for health services, this speaks volumes about what less endowed states go through; and why the health sector in the country offers no nectar to medical personnel.

Yet, this is a critical challenge that must be addressed. Studying and possibly toeing the line of how Cuba manages to run its health system efficiently, despite not being in the wealth league of Western nations, is an imperative, for lives to be saved in Nigeria. This is what leadership is about, not mere rhetoric.