- In an August 2021 broadcast of the Nigerian TV show Journalists’ Hangout, a public policy expert and journalists discussed problems in the country’s healthcare system.
- Three claims made on the show – about the number of doctors emigrating to the UK, doctor numbers in the country and Nigeria’s high birth rate – are correct. A claim about its limited residency programme is mostly correct.
- But a claim that the World Health Organization has a standard for the doctor to population ratio is misleading. The number of registered and practising doctors is unproven, as is the number who migrate each year. Spending on healthcare in comparison to Kenya and South Africa is understated.
“Migration is a milder term to describe their exit, they are now escaping abroad,” said Olatokunbo Otitoju, a doctor and public policy analyst.
He was speaking in August 2021 on Journalists’ Hangout, a show where journalists analyse current issues.
We took a close look at some key claims made on the day’s episode, titled “Nigerian doctors rush abroad to escape harsh situations”.
Africa Check contacted Otitoju, who made most of the claims we check in this report, for the source of his data. He sent us links to pages on the World Health Organization’s website and a March 2020 newspaper report on Nigeria's doctor population.
Show host Ayodele Ozugbakun got the ball rolling by claiming that 4,528 Nigerian doctors had left for the UK in the past six years.
“I can confirm that figure is correct and current,” Jack Bellamy, a spokesperson for the UK General Medical Council, told Africa Check.
The council keeps a register of doctors licensed to practise in the country.
Since 2015, some 4,528 doctors whose primary medical qualification was in Nigeria had joined the UK register, Bellamy said. The figure excludes Nigerians trained in the UK.
Resident doctors are medical school graduates training to become specialists. In the US, their training period came to be called a “residency” because they mostly lived in the hospital.
In Nigeria, 163 public and private hospitals are approved for the residency programme. These have 13,118 slots available for both junior and senior residents.
Getting a limited residency placement involves a highly competitive written examination.
Uyilawa Okhuaihesuyi is the president of the Nigerian Association of Resident Doctors. He told Africa Check that bottlenecks in the system meant some doctors do not get slots.
“We have a strength number of 17,000 and many of them are leaving in droves to Saudi Arabia, UK and the US,” he said. Those who left were not replaced.
One reason for this was a requirement that hospitals seek approval before employing a resident doctor, Okhuaihesuyi said.
Some 2,285 students graduated in medicine in 2019, official data shows.
A 2018 survey of Nigerian doctors also identified difficulties in getting residencies as a key obstacle.
“Most doctors interviewed indicated that securing a residency position was even more difficult than securing an internship position which is already considered quite challenging,” the survey says.
In tracking progress on health for the United Nations’ sustainable development goals, the WHO classifies countries with fewer than 10 medical doctors per 10,000 people as having insufficient health professionals.
The classification also applies to countries with fewer than 40 nursing and midwifery staff per 10,000 people.
According to the WHO’s global health workforce data, Nigeria had 3.8 doctors per 10,000 people in 2018.
(Note: The most recent local data from Nigeria is from 2017. It shows an even lower count of two doctors for every 10,000 people.)
"Global thresholds should be treated as indicative benchmarks for monitoring, not for planning at the country level."
Tarik Jasarevic, a spokesperson for the organisation, said any ratio should be determined based on countries’ individual needs, including population demographics and the burden of disease.
“However, there are some global benchmarks used for monitoring global healthworker needs,” he said.
The sustainable development goals composite index threshold recommends that 4.45 health workers – doctors, nurses and midwives – should cater to 1,000 people to reach the minimum high coverage proportion of 80% for 12 selected health indicators.
“There have also been other global thresholds. These should be treated as indicative benchmarks for global monitoring, not for planning at the country level,” Jasarevic said.
The Medical and Dental Council of Nigeria (MDCN) regulates the professions.
Data on the number of doctors practising in Nigeria differs widely.
The MDCN has not published data on those it has registered. In February 2019, in response to a freedom of information request by a national newspaper, it released data showing 39,912 were listed with it in December 2017.
It added that 91,079 medical and dental practitioners have been registered with the council from its inception in 1963 to December 2017.
Licences granted by the council have to be renewed annually.
The professional body has had this number since 2017, it told Africa Check, because getting an exact number “has been a challenge because of the flow of doctors out of the country”.
In March 2020, a health ministry official said the number of registered medical doctors in Nigeria was at 74,543 as of December 2018.
But in August 2021 we could not find any recent data about how many doctors were practising in the country.
In May 2019 former NMA president Francis Faduyile also made this claim, but did not provide supporting data.
In 2006, the first year of the data, there were 2,692 doctors. This makes for an annual average of 393 doctors over 15 years.
The US Federation of State Medical Boards supports state medical boards in licensing, disciplining and regulating healthcare professionals. It has told Africa Check that 3,895 Nigeria-educated doctors were licensed to practise medicine in the US as of 2020.
We have asked the federation for historical data.
The US, UK and Canada have been identified as top destinations for Nigerian doctors, with South Africa a popular destination for those who choose to remain in Africa.
We have not found any verifiable data to support the claim that about 2,000 doctors leave Nigeria every year.
“Women should get pregnant only when they are ready.”
Otitoju said Nigeria needs doctors to cater to its large population and high birth rate, which he said was one of the highest in the world.
The nationally representative 2018 Demographic Health Survey put the country’s crude birth rate at 38 births per 1,000 population. This was higher in rural areas, at 42 births per 1,000 people, than in urban areas, which had an average of 34 births per 1,000 residents.
The World Bank estimated Nigeria had 37.4 births per 1,000 people in 2019, against a global average of 18 births per 1,000 people.
Niger, Chad, Somalia, Congo, Mali and Angola had the highest birth rates, with more than 40 births per 1,000 people.
Nigeria’s birth rate is high because contraceptive use is low, Audu Idrisa, a professor and consultant obstetrician at the University of Maiduguri Teaching Hospital in Nigeria’s northeastern state of Borno, told Africa Check.
He said educating all people, including in schools, was important. “Women should get pregnant only when they are ready.”
According to World Bank data, Nigeria spent 3.89% – not 3.5% – of its gross domestic product (GDP) on healthcare in 2018. This is the bank’s most recent available data.
In comparison, Kenya’s healthcare spending was 5.17% of GDP, and South Africa’s 8.25%.
The World Bank’s figures come from its global health expenditure database.
Why does it matter?
The WHO says current health expenditure as a share of GDP is an important measure.
“It shows the importance of the health sector in the whole economy and indicates the societal priority which health is given, measured in monetary terms.”
In 2001, African Union members agreed to commit at least 15% of their annual budgets to health. The declaration was signed in Abuja, Nigeria’s capital city.
Nigeria’s health sector ‘underfunded’
“There is no country that can develop if the citizens are not healthy so we have to see health as a priority but that is not the case with Nigeria,” Tanimola Akande, a professor of public health at the University of Ilorin in western Nigeria, told Africa Check.
“The country where the Abuja Declaration was signed has not achieved the 15% budgetary allocation target since the agreement was signed. The funding available for health in Nigeria is horrible.”
Akande added: “We also have the national health act which says 1% of the consolidated revenue fund will be used to fund healthcare. We have started doing that but it has not gone a long way.”.
The consolidated fund is the federal government’s account.