LAGOS, Nigeria – Nigeria’s Healthcare has witnessed an unprecedented crisis. This is evidenced by the distortions of COVID, skyrocketing foreign exchange, the high cost of drugs, the exodus of doctors and the collapse of a system.
Confirming this situation to our correspondent, the Chairman, of the Lagos State Chapter of the Nigeria Medical Association, NMA, Dr Saheed Babajide said with the dwindling infrastructure, a mass exodus of healthcare workers, and skyrocketing treatment costs, Nigeria’s healthcare system stands on the brink of collapse.
Babajide warned that without urgent intervention, the nation faces a medical disaster, reports Vanguard.
He specifically pointed out the damaging effects of unstable power supply to hospitals which he said is turning incubators into empty boxes. He queried, how can we save newborns when life-saving equipment is left in darkness? Excerpts:
State of Healthcare
The state of healthcare is in a sorry state, and it is alarming. The best word to use here is that Healthcare is in a state of helplessness. That is the best word because the healthcare system has gone down seriously. If you compare the state now with the previous administrations, in the sense that the providers, which are the healthcare providers are no longer there.
Secondly, the infrastructure is not even there, and the other one is the patient himself. The patients no longer get the maximum care they require. The care is challenged by the high cost of drugs and treatments and the financial hardship in the country.
In terms of the healthcare provider, everybody knows that japa syndrome is increasing every day in Nigeria due to the lack of complete trust in the system by the healthcare providers.
When the remuneration is poor and the welfare is nothing to write home about, most of the healthcare providers decide to leave the country for countries where they are valued and well remunerated. This is one of the major reasons these healthcare providers are leaving the country.
It is very unfortunate for the government, both at the federal and state levels, not to be serious about the Japa syndrome, which is a major problem affecting the healthcare system.
It looks funny, when you see the people at the hem of affairs of the healthcare of the country, thinking of building more medical schools, nursing schools, and other health institutions, in the face of increasing japa syndrome.
At the end of the day, what do you have? Nigeria has now become the country of exporters of doctors and healthcare workers in the world.
That means that, as we are producing, we are supplying outside. I wonder what happens to the maintainers? Maintainers are the ones going to take care of the increase in population. At the end of the day, what do you get? You get negativity, the health system becomes worse. All those efforts of increasing the number of schools will go down the drain.
The problem the government claims to be solving will now create more problems. In the sense that, by the time you are producing more doctors, therefore, the number of people looking for housemanship in limited health institutions will increase. We will now go back to the era, about five or six years ago, when doctors, had just finished spending two years looking for a place to do housemanship.
We are gradually going back to that level. Even the increment in people applying for horsemanship has increased tremendously currently. You see people moving from pillar to post to get their children a place to do horsemanship.
At the end of the day, what are we doing? We are producing more doctors, we have limited space for them to do horsemanship. After the horsemanship, what they do is that some will do NYSC, while some will not do but port.
When they port to other countries, at the end of the day, what happens to maintenance?
Now, for example, you produced 100, 70 is out, 30 are remaining. In the next year, 20 will go. After some years, another 10 will go.
We are left with only 5% or 2% of the doctors produced.
What happens to that system? We now bring new ones. There is no continuity. There is no experience. We now see people treating themselves despite the increase in the population.
What have they achieved? They are making a fool of the system. It’s unfortunate. We have the minister, we have the commissioners of health, who are doctors.
They cannot think out of the box and solve this issue of Japa… Therefore, the health system will continue to get worse if we don’t solve the issue of Japa.
Health infrastructure
There is improvement in some of the hospitals. But the other major thing that is happening in the hospitals is power supply. Power supply has reduced, and even erased any infrastructure development the government is doing.
Can you imagine a hospital that cannot power a neonatal unit where there is an incubator? At the end of the day, what happens to that incubator? In some cases, you have 10 but 5 is out because of power. By the time you know it, the number goes down to three or nothing. The incubator will be switched off for a longer time. And for a pre-term baby, the incubator will not be working or the light is off for hours.
First, the government should stop the increase in the number of these buildings and concentrate on the maintenance of the ones already built. You want to increase the infrastructure and specialisation, where are the doctors, where are the nurses that are going to do the job?
The priority of a serious CMD of government health institutions is to restore power supply first. They can do it through the national grid. They can do it through the PPP system. They can also do it through the solar system. The ministers, the governors, the president, and the commissioners of health should think about how to resolve the issue of power first. Can you imagine what is happening in UCH, LASUTH and LUTH? The power supply is erratic. The people cannot work.
The patients are also suffering. That’s the first thing to do and stop all these moving around without solving the problem.
Patient care
The issue of the patients, you cannot tell a country with a high level of illiteracy in terms of orthodox care to go to a hospital with a high cost of payment. Nigeria has a high level of poverty. Nigeria is one of the poorest countries in the world.
Therefore, the standard of living is poor. The financial capacity is poor. The only thing that can help them is to put them on insurance.
How will they put them on insurance? The insurance that we have is only a few per cent of the country’s population. About 5 percent. While in the state, only 80 or 90 per cent of people are involved? That means that we have failed to have an insurance system for people.
There is no insurance system for everybody, with a high cost of drugs, and high cost of treatment, what do you expect them to do? They will patronise alternative medicine.
They will not patronise the orthodox medicine. At the end of the day, we will now have, an increase in mortality, an increase in mobility, and all sorts of things will happen. We will not lose.
What happens if the population loses? When their health system is poor, the GDP will be poor because the working capacity will also be poor. When a person is sick, what happens? That means that the capacity of the person to be productive will also be low.
At the end of the day, the GDP of the country will also be low. Who is losing? The government is losing. The health institution is losing.
The population is also losing. When you now combine everything in terms of auditing the system, because those are the ones that make up the auditing of the system for the health sector. The provider, the institution, and the consumer. When all these three indices are not increasing, they are not gaining anything.
We have very poor indices for the health system in this country. Very poor, in the sense that unfortunately, the managers of the health system, are looking at another angle. They are not facing the problem.
Ways to tackle Japa
They have never been serious about Japa. I don’t think they want to be serious about Japa. They will continue not to be serious about Japa because they feel that solving Japa is by increasing the number of medical and nursing schools. That’s their thinking. By increasing that, you increase the number of supplies to other countries.
Number one is welfare package. We have said this several times. Welfare package in terms of housing loans or mortgages. If you have put in 3 or 4 years in the system as a doctor, you have a different mortgage at your comfort for 10 or 15 years. If you have 10 or 15 years with the government where are you going?
All these places our people are moving to are not rosy. You can see many doctors are not even working as doctors there but they are frustrated. But they prefer to be in those places and not come back to a place where there is hopelessness. That is it.
The second one is the car loan. If a doctor can get a car every 5 or 6 years, then they will deduct all this money from their salaries , it will reduce Japa syndrome. Doctors are not rich. Doctors don’t want to have so much money. All that the doctors need is comfort. What is the basis of being a doctor? Doctors don’t want to be billionaires.
If I have a house in Lagos, the other domestic things can be sorted out. School fees can be sorted out. If they can be deducting my money there, for that mortgage, why will I not stay? Because Iam paying, where do I want to go?
Again, remuneration. It is a very simple way to stop japa. We are not telling the government that we want more. The simple way government can do it , which President Bola Tinubu did when he was in government in Lagos, is the removal of tax from our call duty. They call it non-taxable call duty.
Any other allowance should be taxed. We are not saying we are not paying tax. Let’s tax everybody the way you have taxed everybody. Our call duty allowance is 40 per cent of our own. I will call it the inhuman tax law of this government.
Where are we going with this inhuman tax policy? I used the word inhuman tax law of this government in the sense that if the law goes through, it means that the senior doctors will be paying a tax of 25 percent. If their money is more than N1.5 million, that means that they will be deducting N450,000 from the N1.5 million. How much is remaining? When they start this tax, the senior doctors will also leave. They will now see what they are doing. You see, those are the things we are saying. We said to remove tax on call duty that will improve their remuneration. By the time you do that, their money will increase. They don’t have to leave.
People will stay. We have said it to them. You see, because those things are not getting money into their pockets they will not do them.
Instead, building more schools will get money into their pockets. Doing infrastructure will get money into their pockets. Those are the things they will pursue. Car loans will not get money into their pockets.
Effects on doctors
The few doctors that we have left are overworked, and suffer burnout, and their mental health is being affected.
Doctors are committing suicide, doctors are getting divorced because they are not seeing their children and spouses. They are not having time for their family.
Divorce, especially the surgeons and the nurses. I’m telling you the reality of it now. Divorce is increasing among doctors currently. They are having serious marital issues. They are not even able to pay their school fees. For example, you are not at home. You are not seeing your children. You cannot even pay for basic things. What are your family getting from you?
Many doctors are also having mental issues like depression. Female doctors are becoming single mothers because their husbands cannot cope with the situation. Doctors are having their wives or their husbands, leave them and go to other places where they have comfort because they are not there. It’s affecting doctors.
Again, you go to a hospital, you are the only person on call every day. What will your life be like? This is why doctors are dying. What are they dying of? Cardiac arrest. Doctors are suffering. They are dying because of stress.
At the end of the day, the government is not even appreciating it. The management of the hospitals does not even appreciate it. Even yesterday, one consultant was being persecuted. And this happens almost every day.
Every day I hear this. Within the system.
I can give an example in which the doctor’s wife wants to travel, and he says to the doctor that she will leave him if he refuses to go.
I will give you another example, a male doctor wants to travel, and the wife says she will stay. Those things lead to divorce. Doctors are not happy with the system.
I cannot give you figures of people who have left because as I’m talking now, some doctors are leaving. It is so bad that nobody will give you accurate statistics.
As I’m talking with you now, many are going today. By tomorrow, almost 70 are going. By the time you have your statistics, and open your eyes, in the next second or minute, that statistic is distorted. But in terms of the percentage of people now, we don’t have up to 40 per cent of doctors. As of last year, 2024, according to the MDCN, we have a total of 8,205 registered doctors in Lagos.
Attitude of doctors and emergencies
Let me tell you, I don’t believe that there is any lackadaisical attitude among doctors or health workers.
Any doctor, or health worker, is first a human being. I know. Nobody wants anybody to die.
It’s our attitude as relatives of patients. You know this completely. A dying patient, a sick patient doesn’t see what is happening but relatives.
It’s only relatives that have been talking and seeing what is not there. I’ll just give you an example of what I’m talking about. When a patient comes in, the first thing you do is to resuscitate him or her.
After that, the moment you ask for payment, people will say, we have not finished.
What the doctors have done, nobody will see it. People sometimes call me and say “They have not done anything. I say to them, please, don’t tell me that. Let me ask them.
What do you want? Do you want the doctor to sit down with you and leave the other patients? Even the fluid they are giving contains drugs. People only believe they are doing something when they see the doctor giving drugs, is that it?
No. We have to change our orientation as citizens. For a patient that has been attended to, it’s not necessary only when they give drugs.
The fluid, the antibiotics they are giving is also working. They don’t believe in that.
We have to change the orientation of our people. Our people need orientation about medical treatment.
Sometimes, I don’t blame the relatives. I blame the system.
In an emergency, there should be three stages of care. The first one is when the patient comes in, second stage is at triage where the patient is resuscitated. Either one relative or two should be there. The last stage is the time to see the doctor, when all these things are in place, nobody will complain they were not attended to. Again, nobody wants to lose his or her relative that is why I don’t blame them sometimes. It is an emotional thing. If those things are there, there won’t be a problem. Let me tell you, health workers are being beaten, some end up dying. People are not talking about it. We need the education of our people. I am not saying health workers are perfect.
Message to president
The president needs to look at the leadership of the health sector right from the minister. Number two, we should look at the welfare, we need to look at the Japa syndrome and address it tactically.
The president, the minister, the commissioners, and governors and everybody involved should be on the same page to address Japa.
Number three is to increase the budget allocation and make sure that anti-corruption is implemented to ensure the budget is met. We should look at the health insurance. We should address the informal sector which is where the majority of Nigerians fall into. The market women, road transport workers etc, are the ones at the lowest level. Look at issues regarding drug production locally.
