‎Nigeria’s health sector is grappling with a critical shortage of medical personnel, as the doctor-to-patient ratio stands at a staggering 1:10,000 , far below the WHO’s recommended 1:600. In this interview, PATIENCE IVIE IHEJIRIKA speaks with the President of the Medical and Dental Consultants Association of Nigeria (MDCAN), Prof. Apollos Chidi Ndukuba, who describes the situation as a national emergency requiring urgent and visionary leadership

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‎Based on WHO standards, what should Nigeria’s doctor-to-population ratio be, and what number of doctors would that translate to for our current population?

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‎The World Health Organisation (WHO) recommends a minimum doctor-to-population ratio of 1:600 to ensure adequate coverage for primary healthcare interventions. With Nigeria’s population estimated at over 218 million people, this standard would require us to have approximately 363,000 doctors.

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‎Tragically, we are astronomically far from this target. The most recent data indicates that Nigeria has approximately 74,543 registered doctors. However, this number is misleading, as it does not account for those who have migrated, retired, or left the profession. The reality is that the doctor-to-patient ratio is estimated to be around 1:9,000 to 10,000, or even worse , which still falls critically short of the WHO standard.

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‎The shortage is not just serious; it is a full-blown crisis threatening the very foundation of our healthcare system. The situation is most acute in tertiary and secondary facilities, which are meant to handle complex cases but are crumbling under the strain.

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‎Teaching hospitals and federal medical centres are experiencing a catastrophic brain drain. For instance, the Lagos University Teaching Hospital (LUTH) was forced to close five wards (approximately 150 beds) in November 2023 due to a shortage of doctors and nurses. This means hundreds of Nigerians are denied critical care daily because there is no one to attend to them.

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‎The chairman of the House of Representatives Committee on Health, Dr. Amos Magaji, aptly described the rate of migration as a “national embarrassment.” The Nigerian Medical Association (NMA) has warned that the country might lose over 50 per cent of its skilled healthcare workforce by 2025 if the current exodus continues.

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‎The crisis is even more severe in rural areas. Available data show that healthcare workers are overwhelmingly concentrated in urban centres, leaving rural populations with virtually no access to qualified medical personnel.

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‎A doctor reportedly died recently after being on call for 72 hours. How are the ongoing shortages and excessive working hours impacting the mental health and overall well-being of doctors?

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‎The mental and physical toll on the doctors who remain is immense and unsustainable. The story of the doctor who died after a 72-hour shift is heartbreaking but it is also a symptomatic example of the conditions our doctors face. They are routinely forced to work inhumanely long hours to cover the gaps left by those who have left the system.

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‎Beyond exhaustion, doctors suffer from moral injury, the psychological distress of being unable to provide the standard of care they know patients deserve due to systemic failures, lack of equipment, and understaffing. They are forced to “improvise due to the lack of resources, for instance, using a carton as an incubator or performing surgery by candle or mobile phone light.” This creates a profound sense of helplessness and guilt.

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‎The tragic death of Dr. Vwaere Diaso, who died in a faulty elevator at her residence after numerous complaints were ignored, underscores that the risks are not just professional but also existential . Many doctors work in environments where their physical safety is compromised by inadequate infrastructure and insecurity.

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‎Key factors driving doctor emigration often referred to as the “Japa Syndrome”, include remuneration. Nigerian doctors earn significantly lower salaries compared to their international counterparts (e.g., average annual salary of about $5,911 in Nigeria versus $316,000 in the U.S.). This vast pay gap is a primary driver pushing many doctors to seek financial security abroad.

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‎Poor working conditions, including long hours, inadequate equipment, unsafe infrastructure, and frequent power outages lead to burnout and make the job unsustainable. Additionally, welfare demands, disputes over salary structures, and limited job opportunities for new graduates create uncertainty and frustration among healthcare professionals.

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‎Widespread insecurity, including kidnappings and assaults, combined with general socioeconomic hardship, further pushes doctors to seek safer environments for themselves and their families.

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‎ What risks does the current doctor shortage pose to patient safety and the quality of healthcare?

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‎The direct correlation between manpower shortage and patient harm is undeniable and devastating., Nigeria is already the highest contributor to global maternal deaths, accounting for 28.5 per cent (82,000 deaths) of all maternal deaths worldwide in 2020 . Infant mortality stands at a dire 72 deaths per 1,000 live births . These figures will only worsen as the exodus continues.

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‎Understaffing is a critical factor in patient safety failures. Studies on patient safety culture in Nigerian hospitals reveal that areas like staffing, non-punitive response to error, and frequency of event reporting have high negative responses from nurses, directly linking understaffing to a higher risk of errors and patient harm . Patients face longer wait times, misdiagnoses, and inadequate care.

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‎The departure of seasoned professionals undermines efforts to tackle infectious diseases, maternal and child mortality, and non-communicable diseases, potentially leading to the “imminent collapse of the healthcare system” .

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‎Those who can afford it seek care abroad, spending over $1 billion on medical tourism in 2022 alone . This drains the national economy and further impoverishes families. For the vast majority who can not afford it, they are left with little choice but to “rely on luck or accept death.

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‎What tangible steps has the government taken to tackle the critical shortage of medical personnel, and how effective have these efforts been?

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‎Rather than addressing root causes, the government has floated ideas like a bill mandating five years of compulsory service for medical graduates before being granted a full license to practice. This has been met with strong resistance from medical associations, who view it as a coercive measure that ignores the reasons why doctors leave .

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‎The government is in constant, often tense, negotiations with medical associations over welfare demands. Recent talks have concerned the withdrawal of a controversial circular on medical salaries and the implementation of a corrected salary structure . While dialogue is ongoing, tangible, lasting solutions have been elusive.

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‎To what extent is the current recruitment and retention strategy succeeding in reducing doctor emigration, popularly known as Japa Syndrome?

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‎Current strategies are not effective in curbing the “Japa syndrome.” The fundamental “push” factors, inadequate remuneration, poor working conditions, and lack of investment in infrastructure, remain largely unaddressed.

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‎Retention requires a holistic approach that looks beyond mere recruitment. Proven strategies mentioned in the context of other Nigerian industries include: Competitive compensation packages (including health insurance and performance bonuses), Investing in strong workplace culture and leadership training, creating clear career advancement pathways and opportunities for professional development, and implementing flexible work policies where possible.

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‎Until the government and hospital management adopt a similarly comprehensive and strategic approach to retaining their most valuable asset—their staff, the exodus will continue.

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‎What concrete steps are medical associations like yours taking to push for equitable manpower allocation and better workplace conditions?

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‎Medical associations like the MDCAN, NMA and the Nigerian Association of Resident Doctors (NARD) are advocating on multiple fronts: We are constantly engaged in negotiations with the government on behalf of our members, demanding the implementation of binding agreements on wages and better working conditions . We present data-driven arguments to highlight the crisis, as seen in the provided statistics.

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‎We use media engagements, like this one, to bring public attention to the dire state of the healthcare system. Public pressure is a powerful tool to compel action from policymakers.

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‎We advocate for solutions that address the root causes of brain drain rather than trying to force doctors to stay through compulsory service laws . We believe in creating an environment where doctors want to stay and work.

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‎While challenging under the circumstances, associations are increasingly focusing on the well-being of members, highlighting the mental health crisis within the profession and advocating for support systems.

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‎In your view, what is the way forward to resolve the healthcare manpower crisis and other pressing challenges facing Nigeria’s healthcare system?

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‎The manpower shortage in Nigeria’s health sector is a profound emergency that demands urgent, visionary, and sincere leadership. The solutions are well-known and have been repeatedly outlined: Urgent Investment in Workforce Welfare: Immediately implement a competitive remuneration package for healthcare workers and address all outstanding welfare demands.

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‎The government needs to modernise hospitals, ensure consistent power and water supply, and provide essential equipment and drugs. The lives of both patients and staff depend on it.

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‎Also, there is need to address crushing workloads by employing more staff, ensuring job security, and protecting healthcare workers from violence and insecurity as well as adopting evidence-based retention strategies from the corporate world, focusing on career development, positive workplace culture, and leadership, and everage the diaspora: formulate intelligent policies to engage the vast network of Nigerian doctors abroad for knowledge transfer, training, and investment, rather than viewing them as traitors.

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‎Without these decisive actions, the collapse of our healthcare system is inevitable, with unthinkable consequences for the nation. The time for rhetoric is over; the time for action is now.

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‎-Leadership