1.0 INTRODUCTION

“I am not worried about doctors leaving the country. We have a surplus. If you have a surplus, you export.” This was the shocking statement made in 2019 by the former Minister of Labour and Employment, Dr. Chris Ngige, when asked about the rising migration of Nigerian doctors (1).

 

In 2022, Dr. Osagie Ehanire, the then Minister of Health, repeated a similar statement. He said Nigeria produced 2,000 to 3,000 doctors annually, so there was no reason to worry since those leaving were around 1,000 only (2).

 

What the ministers called “surplus” was in reality, a national emergency. At the time of Dr. Ehanire’s statement, Nigeria had only about 24,000 practising doctors and 125,000 nurses serving over 200 million people (3, 4). If this is considered a surplus, then Nigeria must be drowning in scarcity, especially as the current Minister of Health, Professor Muhammad Pate, confirmed that Nigeria still urgently needs about 400,000 health workers to adequately care for its people (5).

 

This critical shortage of health workers is a symptom of ingrained systemic failures that can no longer be ignored. It has swept Nigeria into the global health workforce crisis—a situation where developing nations lose their skilled health professionals to countries offering better opportunities. In this essay, we will look at where Nigeria stands in this global trend, dig into the root causes of health workforce migration, its impacts, past failed efforts, and most importantly, propose new strategies to help stop this crisis.

 

2.0 NIGERIA’S POSITION IN THE GLOBAL HEALTH WORKFORCE CRISIS

Health workforce migration is a global crisis, but in Nigeria’s case, it is particularly critical. Within just 2021 and 2022, Nigeria became the leading health workforce exporter in Africa and second after India globally (6). This mass exodus, plus Nigeria’s already fragile healthcare system, has pushed the country to rank 11th out of 12 countries with the worst healthcare system in the world (7).

 

More troubling is that Nigeria was named among the 37 countries with critical health workforce shortages, and the World Health Organisation (WHO) warned developed countries to stop recruiting from these countries (8). Despite that, within just six months in 2024, over 1,100 Nigerian-trained nurses and midwives relocated to the UK (9). Similarly, over 16,000 doctors have left the country between 2018 and 2025 (10). Now, the question is, why are they leaving? And how is it affecting our healthcare system?

 

3.0 WHY HEALTH WORKERS ARE LEAVING NIGERIA: PUSH VS PULL FACTORS

Twenty-four years ago, African Union countries pledged to allocate at least 15% of their annual budgets to the health sector (11). However, to date, Nigeria has not even met half of this target. Out of the ₦54.9 trillion approved budget for 2025, only ₦2.38 trillion (4.33%) was allocated to the health sector (12). This poor investment in the healthcare system creates harsh working conditions that push many Nigerian health workers to seek better opportunities elsewhere.

 

Along the same line with inadequate funding, health workers are leaving Nigeria because they are not well paid. They work long hours, but their salaries don’t reflect their workload or even meet the standard of living. Some workers even go months without salaries in Nigeria. Unlike Nigeria, countries like the UK and Canada pay their health workers higher salaries without delays. For these reasons, many health workers leave for better financial opportunities abroad.

 

In addition to poor infrastructure and remuneration, Nigeria is facing a serious level of insecurity, such as Boko Haram, banditry, kidnapping, and Fulani herdsmen conflicts. Health workers in rural areas are the major victims of these social vices. These security challenges drive many health professionals to leave Nigeria for a place where they can focus solely on caring for their patients without fear for their own safety.

 

Besides safety concerns, many Nigerian health workers don’t have access to career development opportunities such as research funding, postgraduate training, specialized fields, and leadership roles (13). Unlike developed countries that provide well-organized, merit-based pathways allowing workers to specialize, pursue research, and advance their careers to their fullest potential.

 

4.0 IMPACTS OF THE MIGRATION ON THE NIGERIAN HEALTH SECTOR

One of the impacts of the health workforce migration in Nigeria is worsening the health workers-to-population ratio. According to WHO, for a country to meet basic health service demands, it needs at least 4.45 skilled health workers per 1,000 people. But as of 2024, Nigeria had only 1.83 health workers per 1,000 people, which is not even up to half of the recommended ratio (14). This means health workers in Nigeria are overburdened, and as a result, there are increased rates of burnout, avoidable medical errors, and long waiting hours.

 

Additionally, the shortage of health workers in Nigeria weakens the country’s ability to respond to health emergencies. A clear example was the recent meningitis outbreak that spread to over 23 states in the country and claimed the lives of over 150 people, especially in northern regions (15). It was crystal clear that the high fatality rate was caused by delayed response or lack of access to medical care.

 

This also extends to basic healthcare services. Many skilled birth attendants and paediatricians are leaving the country, and it is putting the lives of many mothers and babies at risk. In 2023, WHO reported that Nigeria has the second-highest maternal mortality rate in the world, with a ratio of 1,047 per 100,000 live births (16). So, it is safe to say that the ongoing health workforce migration has a hand in the increasing maternal and child mortality rate in Nigeria.

 

Furthermore, the migration of health workers contributes to the increasing morbidity and mortality rates from treatable diseases in rural Nigeria. This is largely because the few available health workers are unwilling to work in rural communities, preferring cities where facilities are better and the environment is safer. This, in turn, plays a role in the poor health outcomes of rural dwellers.

 

Lastly, perhaps the most long-lasting impact of the health workforce migration is the loss of experienced specialists and mentors in healthcare institutions. The truth is, when these professionals leave, they take with them years of experience and knowledge to train the next generations. Earlier this year, Prof. Muhammad, the president of the Medical and Dental Consultants Association of Nigeria, confirmed that about 1,300 consultants have left Nigeria in the past five years (17). But wait, what has the government done to stop this crisis, and why haven’t their efforts worked?

 

REFERENCES

1. Daily T. FACT CHECK: Are there enough doctors in Nigeria as the health minister, Ehanire, claimed? [Internet]. August 25th, 2022. Available from: https://dailytrust.com/fact-check-are-there-enough-doctors-in-nigeria-as-health-minister-ehanire-claimed/

 

2. Ibid

 

3. Catherine A. Nigeria has 24,000 practicing doctors – NMA. [Internet]. October 20th, 2022. Available from: https://21stcenturychronicle.com/nigeria-has-24000-practicing-doctors-nma/

 

4. Dennis A. 7,256 Nigerian Trained Nurses “Japa” to the UK, 2022 Number Highest in 5 years. [Internet]. May 25th, 2022. Available from: https://dataphyte.com/topic/7256-nigerian-trained-nurses-japa-to-the-uk-highest-number-in-5-years

 

5. Angela O. It’ll take Nigeria 20 years to produce enough doctors, pharmacists, others – Stakeholders. [Internet]. September 17th, 2023. Available from: https://www.google.com/amp/s/punchng.com/itll-take-nigeria-20-years-to-produce-enough-doctors-pharmacists-others-stakeholders/%3famp

 

6. National policy on health workforce migration. 2023. Retrieved from: https://publichealth-edu.org/assets/files/NATIONAL-POLICY-ON-HWF-MIGRATION_FINAL_COPY_PDF.pdf

 

7. TrekAfrika. Nigeria ranks 11th out of the 12 countries with the worst healthcare systems in the world. [Internet]. October 29th, 2024. Available from: https://trekafrica.net/nigeria-ranks-11th-out-of-the-12-countries-with-the-worst-healthcare-systems-in-the-world/

 

8. WHO. WHO health workforce support and safeguards list 2023. [Internet]. March 8th, 2023. Available from: https://www.who.int/publications/i/item/9789240069787

 

9. Lara A. Nigeria loses 14,815 nurses, midwives to the UK. [Internet]. April 10th, 2025. Available from: https://healthwise.punchng.com/nigeria-loses-14815-nurses-midwives-to-uk/

 

10. Annabel N. Over 16,000 doctors left Nigeria in seven years – Prof. Pate. [Internet]. (n.d). Available from: https://radionigeria.gov.ng/2025/04/08/over-16000-doctors-left-nigeria-in-seven-years-prof-pate/

 

11. Gilbert. Abuja Declaration on health – 20 years later. [Internet]. August 30th, 2024. Available from: https://gilanalytics.com/abuja-declaration-on-health-20-years-later/

 

12. Kafilat T. Is 5.18% the total allocation to the health sector in Nigeria’s 2025 budget? [Internet]. April 7th, 2025. Available from: https://www.dataphyte.com/topic/health/is-518-the-total-allocation-to-the-health-sector-in-nigeria-2025-budget#:~:text=However%2C%20by%20February%202025%2C%20when,4.33%25%20of%20the%20total%20budget.

 

13. Hillary C. The Nigerian Health sector and the brain drain syndrome. [Internet]. (n.d). Available from: https://hscgroup.org/the-nigerian-health-sector-and-the-brain-drain-syndrome/

 

14. Chukwa M. Managing exodus, shortage of skilled health workers in Nigeria. [Internet]. August 29th, 2024. Available from: https://guardian.ng/opinion/managing-exodus-shortage-of-skilled-health-workers-in-nigeria/#:~:text=According%20to%20latest%20figures%20from%20the%20Federal,1000%20patients%2C%20far%20below%20the%20WHO%20recommendation.&text=Nigeria%20has%200.363%20medical%20doctors%20per%201%2C000,per%201000%20people%20for%20adequate%20health%20coverage.

 

15. Ebere M. Meningitis Outbreak Kills 151 in Nigeria – NCDC. [Internet]. March, 2025. Available from: https://www.google.com/amp/s/www.nigeriacommunicationsweek.com.ng/meningitis-outbreak-kills-151-in-nigeria-ncdc/

 

16. Nigeria H. An Unseen Grief: Maternal Mortality’s Impact on Infants and Children. [Internet]. November, 2024. Available from: https://articles.nigeriahealthwatch.com/an-unseen-grief-maternal-mortalitys-impact-on-infants-and-children/?amp=1

 

17. Guardian N. Japa: Only 6,000 medical consultants left in Nigeria, says MDCAN. [Internet]. January 24th, 2025. Available from: https://guardian.ng/news/japa-only-6000-medical-consultants-left-in-nigeria-says-mdcan/

 

18. Basic Health Care Provision Fund. [Internet]. (n.d). Available from: https://nphcda.gov.ng/bhcpf/

 

19. Nicholas A. Gbolahan O. Addressing Nigeria’s proposed bill on the emigration of doctors. [Internet]. February 3rd, 2024. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01559-3/fulltext

 

20. Jennifer O. Health workers demand payment of salary arrears, threaten strike. [Internet]. May 14th, 2025. Available from: https://radionigeria.gov.ng/2025/05/14/health-workers-demand-payment-of-salary-arrears-threaten-strike/

 

21. Gbolahan et al. Nigeria’s new policy: solution for the health-care workforce crisis? [Internet]. October 5th, 2024. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01766-5/fulltext

 

22. Gabriel O. Interdisciplinary cross-sectoral strategies to mitigate health workforce migration in Africa. [Internet]. April, 2025. Available from: https://www.sciencedirect.com/science/article/pii/S2949916X25000039