Japa Wave; The Looming Dearth of Medical Education

Japa is a colloquial term used amongst Nigerians to describe the act of fleeing from or escaping uncomfortable situations. Derived from Yoruba language, it is often used in reference to a departure from challenging or undesirable circumstances. More popularly, it has been adapted as an informal reference to the continued exodus of hordes of highly skilled Nigerians to other countries in search of better opportunities, i.e., Brain Drain.

Brain Drain is not an unfamiliar occurrence in Nigeria. The country has experienced several cycles of brain drain since its independence in the 60s. The first of these occurred in the mid to late 80s propelled by an economic downturn following the preceding period of economic boom when crude oil was discovered in the Southern part of the country. This period saw a mass exodus of healthcare workers and their teachers in search of better opportunities outside the shores of the country. In the wake of terrible electoral decisions, worsening economic realities and the total breakdown of the state as we know it, the newest cycle of brain drain has been activated. A 2023 survey by the Africa Polling Institute found that 69% of Nigerians would relocate if given the chance, up from 40% which was the figure obtained at a similar survey back in 2019. Currently, the net migration rate of Nigeria stands at -0.273 per 1000 population.

A 2022 study concerning emigration intentions among skilled health workers revealed doctors (55%) as the second highest group likely to migrate, second only to nurses (72%). Between December, 2021 and May 2022, at least 700 doctors Nigerian trained doctors migrated to the UK. The UK is not the only recipient of these doctors; other popular destinations are the US, Canada, Australia and Saudi Arabia amongst others with some of these countries going as far as to hold recruitment processes within the country. A statement put out by the NARD (National Association of Resident Doctors consisting Medical Officers, Registrars, Senior Registrars and House Officers) in 2022 puts the departure of doctors at a weekly estimate of over 40. A statement released by the NMA (Nigerian Medical Association) in 2022 estimates a doctor to patient ratio of 1:9000 up from 1:7000 in less than a decade and a disappointing cry from the 1:600 proposed by the WHO (World Health Organisation). Push and pull factors include the deplorable working conditions of doctors in the country, poor and often delayed remuneration, higher prospects for career development and overall improved quality of life.

Recurrent strike actions by the NARD (National Association of Resident Doctors) in protest of unpaid salary arrears spanning 8 years and untenable working conditions have yielded little to no change and have been accompanied with censure from the country’s governing medical council through a circular released implementing continued working conditions during ongoing strikes. All of this has fuelled a departure from the normal route of career progression evidenced by the declining numbers of post-NYSC doctors willing to begin residency training. For so many others, another option is a complete withdrawal from clinical practice to other lucrative job sectors. The reality now is that many medical students are primed to leave the country even from medical school. Highly sought-after webinars are held yearly detailing steps on how to register for and pass foreign exams. The sustained exodus of doctors has not only signalled a decline in the quality of healthcare available to citizens; it will also significantly affect the quality of training available to Nigerian trained medical graduates in the coming years.

The most recent effort by the government to combat these issues is a 100% increase in the training quota allotted to fully accredited medical schools. But we should not fetch water with leaking baskets. Allotting these increments without addressing the root causes of physician migration is akin to running in circles. The federal government has disclosed that it spends 5bn for every medical student trained in the country therefore churning out more doctors who will still leave should current circumstances persist is a waste of human and economic resources. This directive will also exacerbate the deplorable learning conditions currently existent in many training centres. For instance, certain metrics exist for a medical school to be fully functional. The MDCN’s statutes concerning the basic requirements for medical accreditation of an institution take into cognizance factors such as proximity & transportation, housing, lecture room size and several others. In the clinical setting, these factors are; number of residents and consultants per department with the minimum ranging between 3-10, no of students per bed, number of students at clinics and the academic qualifications of lecturers.

It goes without saying that necessary arrangements haven’t been made to accommodate the increase in medical undergraduates as directed by the federal government. The increasing patient burden and persisting paucity of manpower means that the lecturers who remain in the system will be left with little time and resources for them to effectively carry out their teaching obligations. Add that to the lack of adequate infrastructure, the unavoidable consequence of poor doctor to student ratio and crowded learning spaces and we have what makes for a most uncomfortable academic environment. Additionally, systemic factors still exist in the wider academic world such as inadequate government funding, poor infrastructure, and nationwide university strikes protesting unpaid salaries, and delayed payment of bonuses. This has led to the obvious neglect and rot that permeates many institutions of higher learning creating inexcusable learning conditions.

Fortunately, the Nigerian medical education has continuously been applauded both here and outside the shores of the country where Nigerian trained doctors continue to make their mark. This is attributable to the dedication of many of their lecturers and the resilient spirit of the Nigerian determined to succeed no matter how dire the circumstance. How long though before this standard drops? What happens then? It may seem that it will prevent further departure of trained doctors but it also means that the ones left behind are ill-equipped to handle the harsh realities of medical practice in our part of the world. It further leaves a helpless population at the mercy of poorly trained healthcare workers whilst those in government seek relief outside the country.

A house divided amongst itself will not stand. For too long the MDCN and NMA has remained in collusion with the FG ignoring and simply refusing to empathize with the plight of the average Nigerian doctor. If these institutions do not stand up for the doctors and medical students in its care, then who will? It could be argued that it is not late to forestall the stark future that stares us in the face if things remain as status quo. And that with the right strategies and effective implementations, things can change. However, if nothing is done then we may be doomed as a country. A word is enough for the wise.