Addressing manpower shortage in health sector

Dearth of manpower in Nigeria’s health sector is becoming worrisome, with the World Health Organisation (WHO) report revealing that 59,000 women die annually from pregnancy and childbirth in the country. The report shows that only 39 percent of births in Nigeria are carried out by skilled health professionals and the risk of a woman dying from childbirth is 1 in 18, compared to 1 in 61 for all developing countries and 1 in 800 for developed countries. The 2011 Mo Ibrahim African Governance Index rating similarly ranked the Nigerian health service 51 out of 53 countries in Africa.

The manpower shortage in health institutions in the country places undue pressure on available staff, and this is more pronounced at the primary and secondary levels of health care, thereby creating disruptive behaviour and disharmony amongst health care workers.

Recent statistics show that there is one doctor to every 6,400 patients in Nigeria. This falls far short of the WHO standard of one doctor to every 600 patients and is a grave threat to the physical and mental wellbeing of the country’s populace.

Since the inception of the Medical and Dental Council of Nigeria (MDCN), there have been 65,000 registered medical doctors, but at present only 25,000 medical doctors are practicing in the country.

One of the causes of shortage of medical doctors in Nigeria is the massive exodus of medical professionals in search of greener pastures abroad. Again, there is a disproportionate concentration of medical personnel in urban areas because they find remote areas unattractive, despite the huge disease burden – malaria, tuberculosis, typhoid fever, etc – in rural communities.

While poor geographical distribution of health care professionals also contributes to this dearth of manpower, the poor doctor-patient ratio of 1:6,400 in Nigeria as against the WHO standard of 1:600 remains a huge challenge, as medical schools in the country graduate between 2,500 and 4,000 new doctors annually.

Over 100,000 applicants show interest in studying Medicine and Surgery annually, but less than 5 percent are offered admission. Universities cannot admit more than a certain quota, based on National Universities Commission (NUC) policy. This is due to lack of infrastructure in medical schools.

Other factors responsible for this imbalance include poor human resources planning and structures, unsatisfactory working conditions, poor remuneration, and few professional development opportunities.

To meet the WHO benchmark, Nigeria needs to have 283,333 doctors, measuring by a 170 million population base. This means that the country needs 258,333 additional doctors at present. While movement of human capital affects the most highly trained professionals in whom the governments have invested so much, national health systems must build incentives for practicing health care at home if shortages of skilled health personnel are to be addressed urgently.

Reversing the current situation involves strengthening health worker motivation and incentives to retain health workers. The onus lies on the government to increase funding for education to put in place requisite facilities. This in turn would increase the number of applicants admitted to study Medicine, increase the number of medical graduates and reduce the current doctor-patient ratio.