Why Nigeria's doctors are leaving, and how the problem can be fixed

Nigerian doctors are among the least paid worldwide. Doctors in 45 other African countries are better paid than their Nigerian counterparts.

The Guardian investigation revealed that, of all 55 African countries, Nigerian doctors (lowest salary of $320) are better paid than their counterparts only in Sudan ($66), Cameroon ($300), Egypt ($157), Guinea Conakry ($102), Zimbabwe ($83), Uganda ($300), Algeria ($265), Burundi ($100), Ethiopia ($300).

Immediate past president of the National Association of Resident Doctors (NARD), Dr. Segun Olaopa, noted that the comparison might not be fairly contextualised in absolute terms, because “a very senior doctor who gets about $1,200 cannot, for instance, (cannot) be compared with another who, perhaps, trained in Nigeria and earns more than $10,000 monthly or whose currency devaluation of equal pay puts him at a cataclysmic disadvantage.

For instance, $500 dollars in Nigeria earned by doctors cannot be equivalent in pay to the same amount in a country like Ghana. Even when we look in absolute terms, the Nigerian doctor’s pay is very terrible, irrespective of the calculating index.”

Olaopa explained that, in the outline of public doctors’ salaries, those in central hospitals were paid by the Federal Government. “Any doctor in this category can have a salary range of N195, 000 and N220, 000. Notably, this salary is exclusive of several reductions in taxes and others.

For entry-level doctors, who are in state-owned hospitals, the salaries vary from one state to another. Medical doctors in a few Nigerian states are paid the minimum of N150, 000 on a monthly basis.

Meanwhile, the maximum salary an entry-level doctor in a state-owned hospital may receive is N240, 000. This is low when compared to what senior medical consultants and senior doctors are paid as monthly salary. In fact, some of these medical professionals are paid as high as N800, 000 on a monthly basis.”

With the statistics, according to Olopa, “salaries of public doctors are subject to increment and, as a medical doctor working in a government-owned hospital, your salary increases based on your qualifications, specialty, experience, professionalism, and event duration.”

A breakdown of doctors’ salary scale in all 55 African countries published by Nigerian Health Blog on October 27, 2019, noted that “at entry-level, a doctor (house officer) earns an average of N170,000 ($470), an average middle-level medical doctor (junior resident) earns N270,000 ($746) per month. A senior registrar earns up to N400,000 ($1,106) as monthly wages, while a consultant/specialist rakes in N650,000 ($1,800) and above, depending on the level.

Some consultants in Nigeria may earn up to N1.2 million monthly ($3,100 monthly). These salaries are at the whims and caprices of the Chief Medical Directors (CMDs), who may decide to slash it as they wish. This is very common, and they go unchecked. Also, junior doctors in the private hospital sector earn between N80, 000, and N130,000 monthly ($221 – $360).”

According to Nigeria’s Consolidated Medical Salary Structure (CONMESS) dated April 2019, the highest-paid medical doctor on CONMESS 7, Level 9 earns N8,517,892 ($22,062.86) per annum.

This means that the highest-paid medical doctor in Nigeria on CONMESS 7, Level 9 earns N709,824.33 ($1,838.57) per month.

Meanwhile, Emigration of Nigerian Medical Doctors Survey Report, published by NOI Polls and Nigeria Health Watch has provided reasons why Nigerian doctors are some of the least paid and most migrated in the world.

According to the report, “It is on record that doctors in America and Europe are paid better than their counterparts in Africa. An outpatient and emergency physician in Ghana earn an annual gross salary of GH¢40,000, equivalent to N2,863,163.

The figure in naira equals to approximately N240,000 monthly salary. Similarly, there are also reports of medical doctors in Sierra-Leone who earn up to $2,000 per month, translating to roughly N700,000. In contrast, while doctors under federal government employment in Nigeria can earn a gross monthly salary of between N195,000 and N220,000, their colleagues in state government employees earn between N150,000 and N240,000. However, doctors employed by private hospitals in Nigeria earn as low as N80,000 (GH¢1,118) monthly.”

A breakdown of the findings of the report showed that only 3,000 to 3,500 doctors graduate from medical schools yearly. Nigeria has about 72,000 registered doctors but only 35,000 practise in the country. Nigeria needs 303,333 medical doctors at present, and at least 10,605 new ones yearly, to meet the World Health Organisation’s (WHO’s) recommendation on the doctor-to-patient ratio of 1:600.

It was also found that 88 per cent of doctors working in Nigerian hospitals seek work opportunities abroad because of high taxes/deductions from salary as well as low work satisfaction, and poor salary/emoluments.

INVESTIGATION showed that the Nigerian government’s expenditure on health as a proportion of its Gross Domestic Product (GDP) is relatively low in comparison to other countries’. According to 2012 data analysed by the CIA World Factbook, Nigeria ranks 109th out of 191 countries in terms of the proportion of GDP spent on health with 6.10 per cent.

The World Factbook, also known as the CIA World Factbook, is a reference resource produced by the Central Intelligence Agency (CIA) of the United States with almanac-style information about the countries of the world.

Director-General, Cross River Primary Healthcare Development Agency, Dr. Betta Edu, had in April 2019, said doctors in Nigeria are the least paid anywhere in the world. The President, NARD, Dr. Aliyu Sokomba, affirmed Edu’s assertions, last week.

Olaopa also corroborated these concerns.

Olaopa told The Guardian: “The Nigerian doctor is in the category of the least paid across Africa and the entire globe. When you compare with counterparts in North, West, and Southern Africa, the Nigerian doctor is no match in terms of welfare package, salary, and other entitlements. This has been made worse by the continuous devaluation of the Naira making the purchasing power drop drastically. Worse still, despite the abysmal pay, some State Governments still owe months of salaries.

“On the other hand, the Nigerian doctor is also one such categories of global health workforce without life insurance cover.”

How about the disparity between Federal, State, and private hospitals? Olaopa said: “Private and State Hospitals are worse in remuneration for doctors when compared to federal. However, there are few private and state hospitals that pay doctors equivalent of what the federal government pays while some even pay slightly more.”

On how much different cadre of medical doctors are paid, that is from entry-level, resident doctors and consultants, Olaopa said: “Salary packages of doctors vary from state to federal and even private, where residency takes place. It is almost impossible to put a blanket figure and generalize across cadres in different employment setups.”

He further explained: ‘‘There are irregularities in the salary structure of public doctors. With the view of phasing out these irregularities, the salaries of medical doctors (both in federal and state-owned hospitals) have been regulated, particularly with the help of CONMESS (Consolidated Medical Salary Scale). Despite the introduction of CONMESS, the formulation of this becomes difficult and as a result, the salaries of doctors in federal hospitals differ from what doctors in some state-owned hospitals earn.

“Public doctors receive higher salaries than their counterparts in private hospitals are paid. Consequently, many medical graduates prefer to secure employment in government-owned hospitals.”

Medical Director, Optimal Specialist Hospital Surulere, Lagos, Ugochukwu Celestine Chukwunenye, told The Guardian: “I have no comments other than the country can do better than it is doing presently, for all categories of workers. I feel sad each time I reflect on salaries being paid in the economy. Of course, it is one of the factors driving productivity downwards, and fueling brain drain, strikes, and insecurity in the land.”

Medical doctors in Nigeria also earn a miserable N5,000 as monthly hazard allowances. When compared with doctors’ hazard allowances in countries like Ghana, Sierra Leone, and Liberia — all in West Africa — the monthly hazard allowances earned by Nigerian doctors become insignificant.

Doctors say their condition of service becomes more worrisome as they risk their lives as front-line workers in the management of the global COVID-19 pandemic, without commensurate financial and moral incentives as enjoyed by their counterparts in some West African countries.

Health workers had called for an increase in hazard allowance from N5,000 to “a proportion” of their salaries, alleging that they were vulnerable to adverse outcomes of infections.

In some West African countries, healthcare workers are not only paid hazard allowances but also given access to other packages for being exposed to hazards that put them at risk of infection.

In Ghana, President Nana Akufo-Addo, in a recent broadcast posted by Joy News, announced an insurance package of GH₵350,000 ($603,96.62) for each health personnel and allied profession at the forefront of the fight, with a daily allowance of GH₵150 ($25.85) paid to contact trackers.

Aljazeera reported that Liberia’s Assistant Health Minister, Tolbert Nyenswah, said other health workers’ monthly hazard allowance was $435 per month during the Ebola epidemic and by comparison, doctors receive at least $825 in monthly hazard pay.

Source: The Guardian

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