Brain Drain in Health Sector Requires Urgent Attention – Adenekan



Brain Drain in health Sector Requires Urgent Attention - Adenekan
Dr Adetunji Adenekan

Chairman of the Nigerian Medical Association (NMA), Lagos State Chapter, Dr Adetunji Adenekan has called on the Nigerian government to demonstrate a more serious commitment towards ending the continuous brain drain syndrome in the health sector.

Speaking in an interview with Pharmanews recently, Adenekan, an ophthalmologist at the Lagos University Teaching Hospital (LUTH) and lecturer at the College of Medicine, University of Lagos, lamented the rate at which trained and experienced health workers are jetting out of the country, stressing that there is shortage of qualified hands in the health sector already and things may get out of hand if not addressed urgently.

Adenekan also urged Nigerians to take good care of their eyes, while avoiding self-medication when confronted with eye problems, noting that it is not all cases of red eyes, or irritations that require steroids.

Below is the full interview:

What is your assessment of the Nigerian health sector?

While I would say the Nigerian health sector is not performing at its optimal, the sector has also recorded improvements in some areas. However there are many areas that need to be worked on. There are some challenges facing the sector over the years, one of which is the issue of disharmony among the healthcare professionals. I believe this is getting better and of course we are still trying to understand ourselves more. We are conscious of the fact that it is on that ground that we will be able to deliver good healthcare service.

Another challenge has to do with government support on the ability to provide good and quality healthcare service to the country.

Talking about harmony among the healthcare workers, what is the situation like in Lagos where you happen to be the chairman of NMA?

Well, Lagos is the foremost commercial centre of the Nigerian economy, with the largest population. There is a huge healthcare workforce in Lagos that is about 35 per cent to 40 per cent of the total health workforce in the country. What we have been able to do now is to keep talking and discussing our differences, and making sure that we work together as one.

I would say that our relationship in Lagos is much better than other parts of the country. In Lagos, we can’t afford not to work as one. NMA Lagos has always worked in the interest of all.  Even if there are differences, NMA always makes sure we speak for all health workers. During this period of COVID-19, we have continued to work together, because we are all frontline workers.


Does this include pharmacists?

We have been speaking for every healthcare worker. We have been having meetings and I know we will be having another one soon. We have been meeting at various points for official and non-official meetings, and even at government meetings. We will continue to work together with all sense of responsibility and humility.

Nigeria has been facing a mass exodus of healthcare workers to Europe and other countries. How do you view the development?

It is a serious issue in the Nigerian health sector. We discuss the issue in our state official meeting just a few days ago. The situation is sad. It is worrisome. It is alarming and it is disappointing. Something drastic must be done, as urgently as possible, before it gets out of hand.

I know two competent consultants that just resigned and if consultants at that level resign, the cost of the brain drain is huge because they are relocating. They have secured jobs elsewhere – where there is better remuneration, better security, better management and welfare. It is a huge loss for this country.

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Doctors are leaving, so also are pharmacists and many other healthcare workers. Professionals are leaving in thousands. The situation is so bad that if you call for an interview, only few will respond. And even if you employ many people, within few years, if not months, many of them will resign, when they see the situation on ground.

Many healthcare workers now see employment in Nigeria as a temporary engagement for them to stabilise, after which they leave. The state of the brain drain in the country now is really worrisome. I must also say that there is what we call internal brain drain.

Can you explain that?

Internal brain drain involves health workers moving from one state to another to work. For instance, a lot of healthcare workers from other states want to work in Lagos for better welfare and remuneration. Also, because of insecurity, especially in the north, many healthcare workers are relocating.

Internal brain can also occur within the state where workers will want to move from the state hospital to federal hospital because of better payment and better conditions of service. It could also be from a private hospital to a federal hospital within the same state. All these need to be looked into holistically and addressed.

There should be an enabling environment that will enable private hospitals to pay well, as much as government. However, I must say that the problem goes beyond the payment itself; the question is, when you get the money, what do you want to use it for? Feeding, housing, paying children’s school fees are among the things everybody in the country are struggling to do. And health workers are not exempted from the hardship in the country. Truly, we are one of the highest paid workers in the country, but when you compare it with what is obtainable in other countries, you would know that it is a far cry from what it should be.

This is what is making our people to leave for where there is better management, better payment, insurance, better security and conditions of service. Although they have to really work hard over there, they know what they are working for. As a matter of fact, we have been discussing brain drain for a very long time, and I can tell you that the statistics is increasing every day.

When you have a specialist that is being trained with tax payers’ money and after spending a huge amount of money on the specialist, you then lose him to other country, how do you describe it? And I can tell you point-blank now that there are many people that are still considering leaving. Some are already half-way between; many are using different means to leave. It is really sad.

Are you saying there is shortage of healthcare workers in Nigeria?

Yes, there is a massive shortage of healthcare workers in the sector. I am speaking from my end as the chairman of NMA in Lagos and also as a practising physician, a surgeon precisely. I can tell you the number of fellows that I have participated in training that are no longer here. We are just producing them and sending them away to other countries like Saudi Arabia, Australia, US and Europe, even to South Africa.

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Could the shortage of hands be responsible for the rampant medical tourism, especially among the elites, including the president?

If we look at it holistically, three things are responsible – which are human resources, equipment and infrastructure. Go to foreign hospitals, you will notice that the buildings may be small, whether government-owned or private-owned but when you enter, you will know that you are in a hospital. From outside, you may not know that it is a hospital, but when you enter, the ambiance, the equipment you will see will surprise you; they also have good service.

Some of the hospitals that our big men in Nigeria travel to are not even as big as some of the hospitals in Nigeria, in terms of physical building. But the difference is service and human resource. There is nothing they have over there that we can’t have here, if we place priority on human resource, service and equipment with maintenance.


COVID-19 is still shaking the world, including Nigeria. How have doctors in Lagos state been able to cope and manage the situation till date?

In every state, there is a COVID-19 incident commander and our incident commander in Lagos state is the Governor, Mr Babajide Sanwo-Olu. The deputy incident commander is the Commissioner for Health, in the person of Prof. Akin Abayomi. The kudos first goes to those two people. Prof. Abayomi is one of our distinguished members. He has done a lot of work, just like his predecessor also did a lot of work.

I must say here that Nigerian health workers are very committed. We are dedicated. When there is trouble in the land, we don’t chicken out, even when we don’t have kits to work with. Even when we were shouting that there was no Personal Protective Equipment (PPE), we were still working.

Healthcare workers in Lagos state are very committed. Money is not really the drive, because if it were, most of us would not be in the system again. It is not as if we do not like to be taken c

are of, but when we see a sick person, other thoughts disappear and the only focus will be how the sick person will receive treatment.

In Lagos, I must say that we are glad – along with our incident and deputy incident commander – that we have worked and we are still working. I can assure everyone that we are going to beat Covid-19.  That doesn’t mean we have not lost some of our members; many healthcare workers have died in the line of duty because that is what we have sworn our oath to do. We are doing all we can to beat the pandemic. We have beaten the first and second wave, we are winning.

But some countries are already talking about a third wave?

Yes, while we are hoping and praying that the third wave will not come, we are here and committed to doing our best. But our people also need to do their best by teaching everybody around on the safety guidelines of COVID-19.

I must also say that COVID-19 has really united all healthcare givers, because we are all facing one common enemy. It has made us to understand ourselves better. We are appealing to Nigerians to do their part by wearing their masks because it is not yet uhuru.

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There have been talks for and against the COVID-19 vaccines, what is your take?

Yes, we call it vaccine acceptance and vaccine hesitancy. It is an issue we have to deal with. Before the vaccines came out, there were several rumours based o ignorance. So, we have to keep educating people.

I want to recommend that we look in the area of using women in educating Nigerians because there is a saying that when you educate a girl, you educate a nation. A woman can easily convince her husband.

Although some strategic leaders have taken the vaccines to convince the people, but I can tell you that most of the leaders don’t move the people and that is because the people don’t trust them. But I can tell you categorically that healthcare workers still move people. When a patient see that his or her doctor has received the vaccine, he or she will be convinced and willingly take it.

Nigerians trust health workers than Nigerian politicians. But I would say it is better and I would rather take COVID-19 vaccines than to wait for the virus infection to give me immunity.


You are an ophthalmologist, what is your message to Nigerians with regard to their eyes?

Eyes are the gateway to the soul and that is why you can predict certain ailments by mere looking at someone’s eyes. The eye is not just an object of sight but also an object of beautification and that is why people will look at you on the eyes and say you are beautiful.

There are many causes of eye impairment all over the world. Studies have also shown that, apart from death itself, the next thing that put fear in people – that is, what they don’t want to lose – is their sight. When you lose your sight, you are connected to death.

But our primary concern is to let people know how to take care of their eyes. So I want to enjoin Nigerians that if anything happens to your eyes, don’t just apply anything, because chemical injury can occur. People should know that it is not on every red eyes or irritation that you apply steroid. If you have complaints with your eyes, see a physician or your healthcare workers, so that they can direct you on what to do. Nigerians should imbibe the culture of checking their eyes regularly.


What is your message to the government on the brain drain issue in the health sector?

Government needs to do something urgently and fully address the issue. The situation is getting worse and that is why government needs to do something urgently. I know a meeting with the president ought to have come up but such a meeting needs to be with sincerity and must be purposeful like the COVID-19 committee meeting that is known for immediate action and without any delay.

During the first term of President Buhari, there was a meeting where we discussed, but what has happened? To date, people are still talking about hazard allowance. The condition of service is poor. There are many issues in the sector that need to be addressed holistically and solved, not solving one and ignoring the others.



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