The shortage of medical doctors in Nigeria

This post is influenced by a Daily Trust video (YouTube) on the state of medical education in Nigeria, in which it was reported that only 1 in 48 applicants in Nigerian universities gain admission to study medicine in to any of the country’s 46 recognised medical schools, in a country with a population of over 180 Million people.

This is a guest post by Habeeb Tunji Ololade, currently a Senior Physiotherapist with the Medical Rehabilitation Therapist (Registration) Board of  Nigeria. He is engaged in the academic training and curriculum activities that have to do with the training of physiotherapists and occupational therapists in Nigeria. He is @habeeb011 on Twitter.

The fear of sitting long in the hospital is the beginning of recovery from malaria. If you must see a medical doctor in a public hospital in Nigeria, you must have gone to the hospital as early as 4am to wait for a doctor that will arrive at 8am. I once had to visit a clinic some time ago after I had tried self-prescription (just to avoid the hospital hustle) but the symptoms persisted, after long hours of waiting in the queue and shouting at the nurses who will sometimes make their friends and relatives jump the queue, claiming all sorts (and those ones too will still blame government for corruption), I became exhausted to the extent that I didn’t know how to describe the symptoms of what I was experiencing to the doctor.

In Nigeria, public hospitals are where the average everyday people mostly go for medical attention, mostly due to profession experience (absence of quack doctors) and “subsidised” (cheaper”) health care costs. Unfortunately, in Nigeria’s case cheaper things don’t always come cheap in reality, they are often accompanied by several additional hidden costs that the service user will have to pay for alongside the real cost. For instance, quality of service and long duration/delays in service delivery. But what will that poor individual who doesn’t want to die in pain do? Perhaps, pay for the poor service with all he or she has (financially, physically and spiritually), while hoping that things will get better. Many diseases that could have been detected at their early stages are left at times too late before being diagnosed due to lack of accessible medical service; they are not detected until they become so obvious and advanced to irreversible stages before they are detected and then treatments commence, which often become too late and eventually lead to the deaths of the victims. This is usually the case with many of the non-communicable diseases like cancer, diabetics and hypertension in Nigeria.

Some people are of the opinion that doctors in Nigeria are non-caring; they claim doctors in the country are not well trained, lazy, play with people’s lives. Can all these be true? Well I doubt it,  but if you ask that one level medical student in your family or your neighbourhood, if you have a way of assessing wickedness, laziness, passion for life etc. kindly do the assessment, which ever instrument you use to measure them, you will most likely find out that that year 1 medical student is not any of the negative attributes some people attribute to medical practitioners in the country.

So, what changes in some medical practitioners in the country, if any of the claims against them is true?

Now, let’s get down to the real issue. Doctors are not machines and are not dealing with machines either (the patients). An average physician (which is usually the first point of contact) attends to about 50 patients daily in a public hospital in Nigeria, often comes into the clinic refreshed and sharp minded but I tell you once he or she has attended to about 20 patients tiredness and fatigue will probably set in for the day.

A lot of people like to reference their experience or that of their relatives, friends or associates in foreign hospitals and how amazed they are at how doctors are well detailed in everything and their contrary experience in hospitals in Nigeria. However, doctors in Nigeria are trained to render similar services, but it takes on the average one hour to provide a high quality medical assessment for a new patient. The question is – how will a doctor that arrives at work at 8 am and already has about 45 patients waiting for consultation be able to render the type of service most patients in hospitals in Nigeria crave for?

A lot of doctors trained in Nigeria are excelling in different parts of the world and factors like welfare and work environment have been cited in the past as reasons for their successful integration into foreign medical systems, however, most commentators who cite such factors seem to overlook the issue of the heavy workload on an average doctor in Nigeria as a major factor that hinders the quality of service provided in public hospitals in the country. Subject any doctor in any part of the world to similar conditions of attending to 50 patients on daily basis while he or she treats patients with little or no ancillary service, the outcome will definitely be a failed system.

Assessment is the most important stage in patient management, some assessments need up to 7 days of continuous observation before treatment can commence but unfortunately there is an acute shortage of beds in public hospitals in the country such that even accident and emergency (A&E) patients can’t access beds at times. Also, most assessments in public hospitals take place within a very limited amount of time on the average, hence, one shouldn’t expect same quality of service when the same assessment is conducted within more allocated time.

If every patient is sent for proper medical test(s) before being treated, most diseases will still get complicated either while the patient is waiting on the queue for his or her turn (due to availability of few machines or their non-availability) or due to cost while the patient is running around to find money for the test (high cost of assessments: the higher the number of patients for a test, the higher the cost! It seems Nigerian economic theory is the higher the demand the more expensive the good is!

You hear of instances where patients are asked to go and conduct medical tests from one state in the country to another state in another region of the country, travelling hundreds of kilometers on the road!

Late responses and poor management of patients’ medical conditions in the country in most situations can be attributed to factors like inadequate supply of medical facilities, medicines and practitioners. Nigeria has about 35,000 trained medical doctors to a population of over 180 Million people while the World Health Organization (WHO) recommends a ratio of 1 doctor to about 20 patients (and 1 doctor to a population of 1000 persons) for optimal health care provision.

Sometimes people complain about lack of medical equipment in hospitals but in my opinion this equipment problem is not as fundamental as the shortage of built hospitals, personnel and the high ratio of doctor to patients. Even if you give doctors all the equipment they need, it wouldn’t attend to the issue of the doctor to patients’ ratio that presently exists in the country. For instance, Zamfara state with a population of 4.7Million people has just 46 qualified medical doctors in its public hospitals!

A population of over 180 Million people need more hospitals and doctors than there are presently in the country. Even if the government decides to start building hospitals today, where are the qualified doctors that will provide consultations in them?

This article was edited by Abdulghaniy Kayode Otukogbe.The facts, opinions, views or positions expressed or established in guest posts represent that of their writers and not necessarily of  

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  1. says: Dr Ayodipupo Sikiru Oguntade

    The writer has indeed nailed the meat of the discourse.
    Perhaps the major challenge in health care delivery in Nigeria is the inadequate manpower in the sector especially medical doctors.
    Nigeria has about 50,000+ medical doctors and about 8000+dentists registered with the medical and dental council of Nigeria in 2016. Only about 30000+ of these individuals are currently practising in the country. Some have died while many have sought greener pastures.
    At least, in my department presently, 6 doctors left the shores of this country to seek better opportunities while I know a score of others about to leave the country soon.
    This is tragic giving our population of over 160million. To compound matters, health care budget in Nigeria is grossly inadequate. There is no health insurance for many except the few privileged registered with the NHIS and those in the organised private sector.
    This means that the average Nigerian who lives on less than 1dollar/day has to pay out of pocket and stretch the meagre finances of relations and friends.
    The queue in our hospitals is another eye sore and it is saddening that patients often have to spend many man-hours waiting to see the few doctors in the hospitals.
    How do we measure the lost productive man hours, the stress of securing case files and making payments for care in our hospitals?
    In the hospital where I work, the management just introduced a new payment system where patients buy an electronic plastic card before accessing care and then have to queue to load funds on the card before they can get their lab and other investigations sorted.
    Many hospital accountants have learnt to cook the books and operate several accounts and receipts therefore duping patients and the government of their funds and income.
    State of the art equipment and facilities are virtually absent and doctors have to rely on aphorisms and clinical acumen most of the time to make diagnosis.
    This comes with its challenges of missed and incorrect diagnosis.
    There is an urgent need for change in health care policies in the country.
    This subject will be further discussed in future.

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