Emeka Madu’s life was thrown into chaos last week when his nursing wife suffered a sudden health emergency. He rushed her to a clinic in Isolo, Lagos, hoping for swift and expert care. However, his hopes were dashed when a general practitioner misdiagnosed her, claiming she had a brain clot and must urgently have a surgery.
Deeply concerned and skeptical, Madu sought a second opinion at the Lagos State University Teaching Hospital. There, a specialist correctly diagnosed his wife’s condition, thankfully avoiding an unnecessary surgery.
Relieved that his wife was stable and recovering, Madu still grapples with the trauma of the misdiagnosis.
“I could have lost my wife due to a lack of proper specialist care at the local clinic,” he lamented, highlighting the critical shortage of specialists in Nigeria’s healthcare system.
Key specialists such as neurosurgeons, endocrinologists, cardiothoracic surgeons, orthopaedists, neurologists, anesthesiologists, among others, are in short supply in Nigeria, according to BusinessDay findings, leaving the healthcare system struggling to meet the demands of Nigerian patients.
Hospitals are forced to rationalise expertise or strike ad hoc deals with specialists to tackle a critical shortage of skilled health workers exacerbated by low production from medical institutions and a constant wave of migration, popularly known in the streets as japa.
This limited pool of professionals not only hinders the development of expertise over time but also jeopardises patient outcomes and inflicts immense emotional distress on families facing medical emergencies.
“My wife has only been seen by three neurosurgeons since we arrived here five days ago. Yet, there are several patients like her in the ward. I don’t think these three are enough. They have to joggle from theatre to wards,” Madu told BusinessDay.
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Shortages of specialists in numbers
According to the West African College of Surgeons, 46 out of 67 candidates who passed the member examinations were Nigerians but only 40 surgeons achieved fellowship status in 2024.
However, the distribution across specialties reveals a concerning imbalance. A majority are general surgeons (19 out of 40), while crucial areas like neurosurgery (5), cardiothoracic surgery (3), and pediatric surgery (5) have significantly fewer specialists.
According to the Medical and Dental Council of Nigeria (MDCN), there were 49,495 medical doctors in Nigeria in 2022.
As of 2024, only 55,000 were left in the country.
As of 2021, Nigeria had 97 neurosurgeons, with fewer than 400 orthopedic surgeons (2017), according to the International Society of Orthopaedic Surgery and Traumatology.
As of 2024, Nigeria had around 80 heart surgeons, according to the Association of Cardiovascular and Thoracic Surgeons of Nigeria.
Currently, the country has an estimated 500 radiologists. This shortage is particularly acute in private hospitals, further exacerbating the challenges facing the Nigerian healthcare system.
Despite the graduation of health professionals from training institutions across the country, Nigeria faces a ratio of 1.83 health workers per 1,000, according to the 2023 National Policy Document on Health Workforce Migration.
The World Health Organization (WHO) recommends a health worker density of 4.45 per 1,000 population.
This uneven distribution directly impacts the quality and accessibility of healthcare. It sometimes forces patients to travel long distances to reach qualified specialists, leading to delays in treatment and increased financial burdens.
When faced with immense pressure from the healthcare system, the limited number of specialists seek better opportunities abroad.
Why specialists are leaving
Adekunle Onilede, a plastic surgeon and Fellow of the West African College of Surgeons, said the overriding challenges facing surgeons and forcing them to exit the country are poor economic conditions, the lack of standard working facilities and poor environment.
“It is the challenges we have that make people take up that decision. Traveling out is also a compromise,” Onilede said.
Hammed Ninalowo, a vascular and interventional radiologist, said the challenge of ‘brain drain’ is particularly evident in radiology, where a significant number of registrars or trainees leave the country before completing their residency programmes.
He estimates that 60 percent of radiology trainees pursue opportunities abroad, leaving Nigeria with a severe shortage of radiologists.
The situation has positioned the country as the largest exporter of healthcare professionals in Africa and among the 37 nations facing a critical shortage of healthcare workers.
More specialists planning to leave
Over 3,000 physicians requested letters of good standing from the Medical and Dental Council of Nigeria (MDCN) to process migration in 2022.
The United Kingdom was the primary destination for 68 percent of Nigerian medical and dental professionals who migrated through the MDCN in 2022.
About 1,020 physiotherapists sought letters of good standing from the Medical Rehabilitation Therapists Board of Nigeria (MRTBN) to facilitate their departure in the same year.
According to the General Medical Council in the UK, about 12,198 Nigerian-trained doctors were licensed to practise in the UK as of 2023.
Data from the Medical and Dental Council of Nigeria also show that about 281 Nigerian doctors were working in other African countries in 2023.
Read also: Zulum moves against ‘japa’, sponsors 150 doctors for residency programme
Government intervention
In an attempt to retain and attract Nigerian health professionals, the federal government unveiled a series of incentives last year, including credit facilities for workers and tax holidays for health investors.
Muhammad Ali Pate, minister of Health and Social Welfare, said the migration policy document aims to bring back over 12,000 Nigerian health professionals scattered abroad.
He explained that the policy would deploy a holistic set of interventions to manage migration systems, striking a balance between the needs of the healthcare system and the aspirations of healthcare professionals.
According to the policy document, meaningful incentives to health workers in the country would be provided, especially for those serving in rural and deprived parts of the country and those in training programmes, providing the necessary equipment and commodities to deliver quality care.
However, much of this remains paperwork, although the government has made efforts to ramp up some medical infrastructure across the country.
A medical professional at Lagos State Teaching Hospital, who does not want his name in print, said migration remains a persisting challenge, though it seems to have slowed.
According to Onilede, earlier quoted, who is a surgeon who practices at the University College Hospital Ibadan, the government should implement the proposed incentives and adopt a holistic solution to Nigeria’s economic and security challenge.
“These are the things that are driving people away. Security is a major aspect of it,” Onilede said.
Ninalowo, earlier quoted, suggested that the government leverage technology to attract expertise abroad.
The US-trained radiologist, who co-founded Accuread Radiology, a tele-radiography company, added: “We can do it with technology. About 90 percent of our clients do not have a radiologist who sits in their hospital. However, they have 25 different radiologists abroad that work for them at all times. And what if you think about finances for most hospitals? You cannot hire a subspecialty radiologist in every specialty.”
