REASONS for health worker shortage in health facilities in Nigeria are legion, in the view of the Vice President, WAR, Commonwealth Medical Association, Dr. Osahon Enabulele.They include poor health human resource development plans; inadequate training infrastructure and health facilities to support the production of health human resource; migration of health workers (particularly medical/dental practitioners) due to insecurity and poor job satisfaction, particularly as a result of uninspiring workplace conditions, poor health infrastructure and equipment, inadequate remuneration and welfare conditions.
Enabulele who is the erstwhile President of the Nigeria Medical Association, NMA, argues that the attractive remuneration, better security guarantee, better incentive packages, conditions of service and workplace conditions in developed countries, such as United States of America, United Kingdom, Germany, Australia, etc., greatly encourages migration of health workers from developing countries, particularly countries in Africa, Nigeria inclusive.
“In terms of the appropriate numbers recommended by the World Health Organisation, a country is expected to have a minimum number of the various categories of health workers to cater for the population of the country. For instance, the recommended ideal doctor : patient ratio is 1:600, even though for developing countries the minimum is usually taken as 1:1000 (doctor-patient ratio).
In Nigeria, an average of 2, 500 medical doctors are produced annually. However, this is grossly inadequate considering the average doctor- patient ratio of 1:6300 in Nigeria.
“To address health worker shortage, there is need to address the identified factors responsible for Health worker shortage in health facilities in Nigeria, particularly by increasing the number of training infrastructure without compromising quality and standard; instituting a more efficient and effective health human resource development plan and Personnel Management System; improving the morale and job satisfaction of health workers by constantly improving their incentive package, remuneration and welfare conditions to be in tune with their professional calling, job roles and economic realities; effective resolution of conflict areas, particularly with regard to role conflict through proper designation of job roles; improved security of health workers; and institution of a transparent performance reward system,” he asserted.
No common platform for medical personnel to thrive— Dr. Olurotimi Odunnubi, MD, National Orthopaedic Hospital, Igbobi, Lagos
ADDRESSING shortage of healthcare providers requires planning and projection. For instance if the country need 12,000 doctors over the next five years there will be need to create avenue for such in terms of training.
But after training them, how to retain and distribute them so that they can cover the Nigeria population is another issue because there is freedom of movement. When you train people and they have better offer somewhere else, you can’t stop them.
In the face of this shortage, there are some states without a single specialist doctor and they are not even looking for a specialist. There are states in this country where the only specialist is at the Federal Medical Centre, FMC.
There are so many Nigerian doctors outside the country, and one way of fast tracking development and quality healthcare is to attract them back to the country. Many of them want to come back but want improved infrastructure in place first. Government can provide incentive which was what India did, like giving them land or tax relief maybe for five years because they have the skills but they are working in different environment from what exists here.
For a skilled surgeon to practice successfully, you need all those supportive services that ensure you are still providing that high level care. The diagnosis that will almost explain what the patient problem is even before going into the surgery is required and to acquire those equipment require a lot of money, they don’t really need to bring that money out of their pocket, just like government did for agriculture and industry, providing special bank for them, you can provide fund or special bank in which the interest rate will be low, the operational rate now is about 26- 30 per cent if you make special concession like maybe single digit interest rate that will encourage people to take loan from such special bank to develop healthcare.
Government should also pursue idea of encouraging various specialists to come together and provide a platform because the days of unit specialist is fading away. Gradually one man hospital which is what we have in a lot of private hospital in the country is going out of fashion. There is need for collaboration to minimise risk.
In service delivery, time is of essence, if somebody is ill, he wants to get back to his state of good health as early as possible, because for every minute he is ill, is a loss of revenue to the family and larger society. When you don’t have the right personnel to provide the specific care he needs, he wait his turn, there are some hospitals where people wait for elective surgery, and these are surgeries that are not emergency. They have to wait for upwards of six months or nine months.
The surgeon cannot do more than a certain number per day and there are not enough surgeons so they need to wait for that special care. These are basic problems that happen when you have shortage of qualified medical personnel, and in the course of waiting for service sometimes other problems may develop, for instance, anaemia.
Normally for most people is not dangerous but while you are waiting, you can develop complication, obstruction which can be life threatening.
No hospital is exempted— Prof. David Oke, CMD, LASUTH, Ikeja, Lagos
THE Chief Medical Director, LASUTH, Prof David Oke, admits that there are shortages in all cadres of healthcare professionals in all health facilities in the state. “No one will deny that it does not have enough. LASUTH is not exceptional in Lagos State. We are only hoping that the incoming government will look into it and we are now doing task sharing and task shifting with the little number that we have.
“The inadequate number is understandable because of the wage bill. And that is what we are saying that it has to be factored in by any incoming government to judiciously use the money they have.
There is no hospital anywhere in the world that is having enough health workers and Nigeria is no different. As much as possible the government is aware of it and they have mentioned to us that they will tackle it.
“Shortage of health workers is one of the priorities of the new government coming into Lagos State. Right now we have consultants, resident doctors, pharmacists, nurses and others but I cannot give you the numbers because I am out of the hospital.”
In the view of
Dr. Olufumilayo Bankole, who is the Acting Medical Director, Isolo General
Hospital, Lagos, the staff strength of the hospital dropped from 550 to 409 over the last two years, while patronage is on the increase.