Doctors Without Borders

Nigeria is producing something cheaply and exporting it. So what's the problem?

Let us start with a simple blank chart:

The chart is created from data taken from the UK’s General Medical Council website which describes it as follows:

This shows the number of doctors holding registration as of 31 December each year, by their country of primary medical qualification (PMQ).

The chart above is showing the number of doctors in the UK who obtained their first medical degree from a Nigerian university. Between 2006 and 2018, the numbers increased by 10% or lower every year. Then in 2019 there was a 16% jump followed by a 22% increase the following year. In short, there has been a double digit increase in the number of Nigerian qualified doctors registered in the UK every year after 2018.

Here is what the picture looks like for all of Africa:

The post 2018 profile of data looks the same as Nigeria’s until you look at the underlying data. Between 2018 and 2019, there was an increase of 1,948 doctors from Africa but Nigeria alone supplied 1,311 of that number i.e. 67% of the total increase. In fact in some years such as 2014, the African increase (72) was much lower than the Nigerian increase (117) because numbers from other African countries reduced to offset the total. In 2022, Nigerian doctors made up 81% (1,472 out of 1,814) of the African increase.

Exit Wave

There is another angle to further contextualise this data. An average of 1,300 Nigerian qualified medical doctors have made their way to the UK each year over the last 5 years. But how many doctors is Nigeria producing anyway? Here’s a report from earlier this year:

In a bid to address the critical shortage of healthcare workers in Nigeria arising from mass exodus of professionals, the federal government has increased the quota of admission into the Medical Schools in Nigeria by 100 percent.

This means accredited medical schools will henceforth admit double the number of students it hitherto admits in 2024 in order to increase the number of medical and dental graduates in the country.

This was contained in a letter from the Medical and Dental Council of Nigeria (MDCN) and addressed to the Secretary General , Committee of Vice Chancellors of Nigerian Univeristies. The letter with the reference number MDCN/1018/vol.1 and dated January 22, 2024 was signed by T.A.B Sanusi, the Registrar, MDCN and seen by BusinessDay.

The approval is for 41 fully accredited medical schools and 7 partially accredited medical schools. This means 9610 students will now be admitted against 4805 across the schools.

If we assume that the annual quota of 4,805 has been the same over the last 5 years and is fully exhausted by each school (each school is given a range), of the 24,025 doctors qualified in Nigeria between 2019 and 2023, about 6,448 of them - 27% - have found their way to the UK alone. I say ‘alone’ because as the article above goes on to say:

The mass exodus of doctors and health workers in other specialties has left Nigeria grappling with a shortage of manpower. Over 5,000 medical doctors in Nigeria have migrated to the UK, the US, United Arab Emirates and other African countries in five years ,the Nigerian Association of Resident Doctors revealed in 2023.

The NARD seems to be quite behind the data but the key thing to note is that the UK is not the only country Nigerian doctors are leaving to.

Doctors Do Cost

There’s more. The University of Lagos College of Medicine has an allocation of 150 to 300 medical students per year. Here’s what the fee profile looks like:

On current exchange rates, the fees for the medical school come to about £100 per year.

Any reader of this website will know that Tobi and I are constantly talking about exports. What we advocate can be summarised as follows - Nigeria needs to be able to produce stuff to export to the rest of the world in exchange for foreign exchange. In the bargain, Nigeria also gets human capital development and quality employment. It is difficult to constantly make that argument and then complain about what is going on here with doctors - Nigeria is ‘cheaply’ producing doctors and exporting them in large numbers to the rest of the world. Perhaps these doctors are sending foreign exchange back home from their earnings.

Subsidised Doctors

After that, however, the argument breaks down. It obviously does not cost £100 per year to educate someone as a doctor. Someone somewhere is paying a massive subsidy. What is the real annual cost of educating a doctor in Nigeria? We can take the fees of a private university like Babcock as a guide:

Almost 30 times the cost of a government owned university (the fees for the privately owned Afe Babalola medical school are similar). Babcock only has an allocation of 120 to 240 students a year so the vast majority of medical doctors in Nigeria are educated in government owned schools which are heavily subsidised.

The other problem with the argument is that even though you might say a Nigerian trained doctor has a far better chance of developing their skills abroad given the superiority of facilities and general environment, Nigeria currently has no plan in place to benefit from that i.e. there is no coordinated plan to bring back doctors from abroad to transfer their accumulated expertise to Nigeria. There is always the possibility of this, of course, so everyday a Nigerian doctor spends abroad is additional experience that could potentially benefit Nigeria one day. But anyone who grew up in Nigeria in the 1980s and 1990s would remember very well the stories of the exodus of Nigerian doctors to Saudi Arabia. Was there ever any benefit to Nigerian medicine from that wave? It is hard to say there was. If anything, doctors in Nigeria are constantly distracted by seeing how well their colleagues are doing abroad and with social media and easy messaging now, knowledge of how to leave is a lot more diffuse and readily available. A large number of doctors in Nigeria are currently in a holding pattern waiting to leave.

Finally, it is palpably obvious that Nigeria has a severe shortage of doctors. Indeed, it was the motivation for the Nigerian authorities doubling the number of doctors educated in Nigeria earlier this year. In such a scenario, exporting a large number of heavily subsidised doctors yearly does not seem wise.

If I keep typing, I am going to talk myself into trouble and risk accusations of hypocrisy. I am typing this from the UK where I emigrated to 20 years ago so it would be rich of me to make an argument that might imply stopping doctors from leaving Nigeria for a better life.

So, thank you for reading.