Japa: Only 55,000 doctors left for 220m Nigerians

They raised the alarm at the Ordinary General Meeting and Scientific Conference of the Association of Resident Doctors, ARD, Federal Neuropsychiatric Hospital, FNPH, Yaba, Lagos, with the theme, “Too Few Doctors, Too Many Patients: The Consequences of Manpower Shortage on the Mental Well-being of Nigerians.”

The doctors, among whom are mental experts, also said the present situation is worsening access to psychiatric care and leaving millions of vulnerable Nigerians untreated.

The doctors also said no fewer than 16,000 Nigerian doctors have emigrated in the last five years, worsening an already dire manpower shortage in the country’s health sector.

They warned that the sustained exodus of healthcare workers under the “Japa” syndrome had severely depleted the country’s mental health workforce, widened treatment gaps, increased the cost of care and placed enormous pressure on the few specialists remaining in the system.

Confirming the situation to Vanguard yesterday,  the President of Nigerian Medical Association, NMA, Prof Omoti Ernest, said recent data showed that the Medical and Dental Council of Nigeria, MDCN, had registered over 130,000 doctors but noted only about 55,000 are actively practicing within Nigeria.

He said with a population exceeding 220 million, this translated to roughly one doctor for every 3,600 to 4,000 people.

“This ratio is far below the World Health Organisation’s recommended threshold of one doctor to about 600 people, highlighting the significant shortage of medical personnel and the strain on healthcare delivery.

“Many Nigerian-trained doctors have emigrated or are no longer engaged in active clinical practice, contributing to the country’s healthcare workforce shortage,” the NMA President said.

He said the emigration of skilled professionals in search of better opportunities abroad has had a significant impact on Nigeria’s hospitals and healthcare workforce.

He said further:  “Thousands of doctors and other healthcare professionals have left the country in recent years, leading to severe staff shortages, increased workload for those who remain with many suffering from burnout, longer waiting times for patients, and declining quality of care in many public hospitals.

“Rural and under-served communities have been particularly affected, as they already struggle with limited access to healthcare services.

‘’The reasons behind this migration include poor remuneration, inadequate working conditions, insecurity, limited opportunities for career advancement, and insufficient investment in healthcare infrastructure, among others.

“Many professionals are attracted by better pay, improved facilities, and more stable environments in countries such as the United Kingdom, Canada, and the United States.”

‘What can be done’

To address the trend, he said the Federal Government should prioritise salaries and welfare packages for healthcare workers, invest more in modern medical equipment and hospital infrastructure, expand residency and specialist training opportunities, and create clear career progression pathways.

Omoti said: “Strengthening security, ensuring timely payment of wages, and providing incentives for professionals to work in under-served areas will also help retain talent.

‘’In addition, partnerships with the private sector and diaspora engagement programmes could encourage Nigerian healthcare professionals abroad to contribute their expertise and support  development of the country’s healthcare system.”

Speaking at the parley, a Consultant Psychiatrist at the Neuropsychiatric Hospital, Aro, Dr. Yesir Kareem, said Nigeria’s doctor-to-patient ratio had fallen to about one doctor for more than 10,000 patients, far below the World Health Organisation’s recommended ratio of one doctor to 600 people.

According to him, the consequences are particularly devastating for mental healthcare.

“Only about 55,000 doctors remain to serve a population of over 220 million Nigerians. More than 40 million Nigerians suffer from mental health disorders, yet about 85 per cent of them do not have access to mental healthcare services,” Kareem said.

He noted that Nigeria’s shortage of psychiatrists and other mental health specialists has reached alarming levels, warning that untreated mental illnesses contribute to family breakdowns, substance abuse, unemployment, delayed diagnosis and premature deaths.

“The economic consequences are equally devastating, with billions of dollars lost annually due to untreated mental health conditions,” he added.

He also noted that 94,000 doctors and nurses had left Nigeria since the Japa syndrome started some years ago.

He said the doctors were leaving due to  poor remuneration and delayed salaries, competitive salaries in destination countries, overwhelming patient loads (1:10,000+), better work-life balance and conditions,  and inadequate medical equipment & facilities.

He also listed access to modern medical technology, limited career advancement opportunities, professional development and training, unsafe working conditions and long hours, unstable political and economic environment and insecurity and socioeconomic instability as factors encouraging migration of doctors from the country.

President of the Association of Psychiatrists in Nigeria, APN, Dr. Veronica Nyamali, in a chat with Vanguard, described the manpower shortage as a crisis that had forced consultants to abandon higher-level responsibilities, such as research and specialist care, in order to fill gaps left by departing doctors.

“There are gaps everywhere. Work that should be done by four psychiatrists is now being handled by one or two people. Consultants are increasingly forced to work at lower levels because the doctors they are supposed to supervise are no longer there,” she said.

Nyamali lamented that many doctors undergoing specialist training now leave the country before completing their careers in Nigeria, creating persistent vacancies across psychiatric facilities.

“Those we train are leaving. Junior registrars, senior registrars, many complete their examinations and return abroad. The result is that we have shortages at every level of care,” she stated.

Disclosing that the country currently has less than 150 psychiatrists, she warned that the dwindling number of specialists is making mental healthcare increasingly expensive and inaccessible, especially for patients in rural communities where psychiatrists are virtually non-existent.

‘Specialists now scarce’

“When specialists become scarce, services become more expensive. Access becomes difficult because patients must travel long distances to find care. This is contrary to the principle of universal health coverage, where mental health services should be available, affordable and accessible to everyone,” Nyamali said.

The APN president further linked the brain drain to a shrinking pharmaceutical landscape, saying several pharmaceutical companies had either scaled down operations or exited the country, reducing access to newer and more effective psychiatric medications.

“We now have fewer treatment options. Some of the newer drugs that offer better outcomes are no longer readily available. At the same time, the market is being flooded with fake medicines, making treatment even more challenging,” she warned.

Nyamali noted that the shortage of specialists has created room for greater reliance on traditional and faith-based healers, who are often the first point of contact for people with mental illnesses.

While acknowledging their influence within communities, she said psychiatrists are increasingly collaborating with traditional and religious healers to discourage harmful practices such as chaining, flogging and unlawful confinement of persons living with mental disorders.

“We recognise that people go to them first because they are available, accessible and affordable. Rather than confront them, we are engaging them and providing basic mental health education so that harmful practices can be eliminated and patients referred appropriately,” she explained.

Nyamali also highlighted the growing burden of mental illness in Nigeria, linking rising cases to worsening economic hardship, insecurity, unemployment, substance abuse, kidnappings and other traumatic experiences.

“People are being traumatised daily. Poverty, joblessness, violence and insecurity are all social determinants of mental illness. Those already living with mental health conditions are relapsing more frequently, while many others are developing new mental health challenges because of the pressures of daily living,” she said.

She expressed concern that mental healthcare remains largely financed through out-of-pocket spending, despite the chronic nature of many psychiatric conditions.

“Mental illness is not properly covered under health insurance. Many of the newer medications are not included in insurance drug lists, leaving families to bear enormous treatment costs. The burden on care-givers is huge,” she added.

At the conference, the President of ARD, FNPH Yaba, Dr. Okuwoga Temitope, said the shortage of doctors has become a major threat to access to quality mental healthcare in Nigeria.

“As mental health professionals, we witness first hand the widening treatment gap, the burden on already stretched healthcare workers and the impact these shortages have on access to quality mental healthcare for Nigerians,” he said.

Temitope noted that resident doctors are increasingly battling burnout, anxiety, stress and depression due to overwhelming workloads caused by the shortage of manpower.