The trend of Nigerians seeking greener pastures abroad, often referred to as the "Japa" movement, has become widespread.

It is no longer news that this mass exodus has had far-reaching implications across various sectors. Unfortunately, the healthcare system appears to be the hardest hit.

The departure of skilled healthcare professionals, particularly doctors, has left a gaping hole in Nigeria’s already strained medical infrastructure.

In states like Lagos, where a doctor used to see over 100 patients daily before the rise of the "Japa" trend, the ratio has now doubled in some hospitals. Some clinics are no longer operational due to the lack of specialists to manage them.

The allure of higher salaries, better working conditions, and advanced medical facilities in developed countries has driven countless Nigerian doctors to seek opportunities abroad.

This brain drain has had a devastating impact on the nation's healthcare system.

A young pediatrician who recently left Nigeria for the United States shared that it was a difficult decision. "I love my country and my patients, but the challenges were overwhelming. The long hours, poor working conditions, and lack of resources made it nearly impossible to provide the level of care I wanted to give," she told Sunday Vanguard.

The departure of healthcare professionals like this pediatrician has had a profound emotional impact on those who remain.

A nurse at a public hospital in Lagos shared her frustrations anonymously: “We are overworked and underpaid. Many of my colleagues are leaving, and it’s taking a toll on our mental health. It’s disheartening to see patients suffer because we don’t have enough staff.”

Massive Shortage

It is widely acknowledged that there is a massive shortage of medical professionals.

The exodus of doctors has exacerbated an already critical shortage of healthcare workers in Nigeria. This shortage has led to longer waiting times for patients, overcrowded hospitals, and a decline in the quality of care.

In Lagos, for example, the state's Commissioner of Health, Prof. Akin Abayomi, noted that there is a shortage of 30,000 healthcare professionals.

Many Nigerians, particularly in rural areas, struggle to access basic healthcare services due to the lack of qualified doctors. This gap may be contributing to a rise in preventable diseases and maternal and child mortality rates.

Moreover, the departure of skilled medical professionals has hindered the development and maintenance of healthcare infrastructure. Coupled with the economic situation, including skyrocketing costs of drugs and medical supplies, some hospitals and clinics lack essential equipment, medicines, and trained staff, further compromising the quality of care.

Direct Impact on Patients

The "Japa" syndrome has had a direct and significant impact on patients.

Many Nigerians have been forced to travel long distances or seek alternative, often less reliable, healthcare options. This can lead to delayed diagnoses, improper treatment, and even preventable deaths. Additionally, the financial burden of seeking medical care abroad is overwhelming for many families, especially in the face of the current foreign exchange crisis.

For instance, while the World Health Organization recommends a ratio of one doctor for every 1,000 residents, in Lagos, the ratio is one doctor for every 4,000 patients—better than in other states across the country.

Findings reveal that apart from doctors, nurses, pharmacists, medical lab scientists, and dentists are also affected by the brain drain.

At Lagos University Teaching Hospital (LUTH), five wards comprising 150 beds were shut down due to the massive migration of doctors, as noted by the House of Representatives Committee on Health during a visit.

According to the Coordinating Minister of Health and Social Welfare, Prof. Ali Pate, the "Japa" syndrome has deprived Nigeria of its top talents in the health sector, with over 16,000 doctors having left the country in search of better opportunities abroad over the last five years.

Reasons for Leaving

According to the President of the Nigerian Medical Association (NMA), Prof. Bala Abdul, the increasing number of medical doctors leaving the country is affecting healthcare delivery, with remaining doctors overworked and stressed. He emphasized that welfare is the single most important reason doctors are leaving the country. Once their pay is improved, more than 90% of the problem will be solved.

In addition to welfare, doctors also seek job satisfaction, including proper working conditions and opportunities for young doctors to train for their postgraduate studies. Security concerns also play a significant role in the decision to leave, as healthcare professionals need a safe working environment.

Those who remain in Nigeria are experiencing burnout due to excessive workloads. The NMA is engaging with the government to address the retention of doctors and reduce the number leaving the country.

Bringing Back Retired Doctors

In Lagos, the state government has initiated a policy to bring back retired medical professionals, an initiative that has gained support among healthcare workers. The Chief Medical Director of Lagos State University Teaching Hospital (LASUTH), Prof. Adetokunbo Fabamwo, noted that while this is a positive step, the government must be selective, ensuring that only mentally and physically fit doctors return to practice.

Fabamwo emphasized that many older physicians abroad continue practicing well into their 60s. In Lagos, some retired consultants are already being offered contract appointments, extending their service for several more years.

Recruitment Efforts

LASUTH has implemented an automatic exit replacement system, allowing it to recruit staff quarterly to replace those who have left. While these new recruits may lack the experience of their predecessors, they are expected to learn on the job and gain experience over time.

However, Dr. Moruf Abdulsalam, Chairman of the Medical Guild (an association of Lagos state doctors), expressed concern that an average of two doctors resign from the state's secondary healthcare facilities each month. Many doctors who have not left the country now opt to work in private facilities due to the excessive workload in government hospitals.

Abdulsalam highlighted that doctors from other states with worse working conditions are migrating to Lagos before eventually leaving the country, turning the state into a transit hub for the "Japa" movement.

The Medical Guild has submitted a position paper to the state government with suggestions to limit migration. Some of these suggestions, such as providing housing units at a 40% discount and bridging salary disparities with federal counterparts, are already being implemented.

While the state government has increased the number of internship spaces to help address the shortage, further measures are needed to retain medical professionals.