The Doctors We Produce And The Doctors We Lose: Why Nigeria’s Medical Brain Drain Is Not Simply A Numbers Problem
By
Nze David N. Ugwu
Nigeria’s decision to dramatically expand the number of medical students admitted into its universities has been presented as part of the solution to the country’s growing shortage of medical doctors and the alarming migration of health professionals popularly described as “Japa.” The thinking appears straightforward. If Nigeria is losing doctors to Britain, America, Canada, Australia and other countries, then the country should simply train more doctors. If thousands are leaving every year, produce many more. If the doctor-to-patient ratio is unacceptable, increase the number of doctors. If the health system needs more physicians, expand medical education.
On the surface, this is a reasonable proposition. A country of Nigeria’s population, demographic growth and healthcare needs cannot afford to have an inadequate supply of medical professionals. There is unquestionably a need to expand the country’s health workforce. Recent evidence indicates that Nigeria has only about 55,000 licensed doctors, while the distribution of doctors is highly unequal across states. The doctor-to-population density remains below international benchmarks, and thousands of Nigerian doctors have emigrated in recent years.
Yet there is a profound danger in assuming that increasing the number of medical students will automatically solve Nigeria’s healthcare crisis. The problem is that Nigeria does not merely have a shortage of doctors. Nigeria has a shortage of doctors who are willing and able to remain in Nigeria, work under difficult conditions, build careers, raise families and practice medicine in an environment that gives them professional dignity, economic security and the tools necessary to save lives.
That distinction is fundamental.
A country can produce thousands of doctors and still remain desperately short of doctors if the environment continually drives those doctors away. It can build more medical schools while simultaneously exporting the graduates of those schools to foreign health systems. It can increase the number of admission spaces, expand university faculties and graduate more physicians, yet discover several years later that many of those physicians have followed the same path as their predecessors.
The real question, therefore, should not be merely how many doctors Nigeria can produce. The more important question is how many doctors Nigeria can retain, properly deploy, adequately remunerate and provide with the institutional environment required to practice medicine effectively.
This is where the debate about Nigeria’s medical workforce becomes much deeper than the issue of admission quotas.
Medical education is not the same thing as healthcare delivery. Producing a doctor is only the beginning of the process. A doctor requires a functional hospital, diagnostic equipment, medicines, electricity, water, laboratory services, nursing support, medical records, emergency transportation, specialist referral systems and a functioning health financing structure. The doctor must also receive appropriate remuneration and have access to continuing professional development, postgraduate training and a credible career progression system.
Without these conditions, increasing the number of doctors may simply increase the number of frustrated professionals searching for opportunities elsewhere.
The irony is that Nigeria may eventually find itself spending more public and private resources to produce doctors who will ultimately strengthen the healthcare systems of other countries.
This is the central paradox of Nigeria’s medical brain drain.
Nigeria invests in the education and training of medical professionals. Medical schools consume enormous public resources. Teaching hospitals provide clinical training. Families make enormous sacrifices to educate their children. Young doctors spend years studying, undergoing housemanship and residency training. Yet, after acquiring the skills that Nigeria desperately needs, many of them leave.
The receiving countries then benefit from a workforce that Nigeria has helped to educate.
This is not necessarily because Nigerian doctors lack patriotism. Nor should migration automatically be interpreted as betrayal. Doctors are professionals, but they are also human beings. They have families, ambitions, financial responsibilities and legitimate expectations about their careers and quality of life.
A young doctor who works extremely long hours in an overcrowded hospital, receives inadequate remuneration, struggles to obtain professional opportunities, works with obsolete equipment and faces uncertain career prospects cannot reasonably be expected to ignore the possibility of a better professional environment elsewhere.
The attraction of foreign countries is therefore not simply the size of the salary. It is the entire operating environment.
A doctor who earns more money abroad but, more importantly, works in a hospital where essential equipment functions, medicines are available, electricity is reliable, professional responsibilities are clearly defined, workloads are regulated, training opportunities are available and institutional processes are predictable is experiencing something much larger than an improved salary.
The doctor is experiencing a functioning professional system.
This is what Nigeria must understand.
The “Japa” phenomenon among doctors is not simply an immigration problem. It is a symptom of institutional failure.
The Nigerian government’s own policy response recognizes that migration is connected to broader workforce issues. In 2024, Nigeria approved a National Policy on Health Workforce Migration, with emphasis on retention incentives, ethical recruitment, rural deployment, diaspora engagement and better workforce planning.
That policy recognition is important because it shifts the discussion from “How do we stop doctors from travelling?” to the much more intelligent question: “Why do doctors want to leave in the first place?”
The answer cannot be reduced to money.
Money matters enormously, but it is not the only factor.
Doctors leave because of poor working conditions. They leave because of excessive workloads. They leave because of inadequate infrastructure. They leave because of limited opportunities for professional development. They leave because of insecurity. They leave because of uncertainty.
They leave because of frustrations with bureaucracy. They leave because of industrial disputes. They leave because they want their professional expertise to be respected and properly rewarded.
Recent government interventions themselves demonstrate the depth of the problem. In January 2026, the Federal Ministry of Health acknowledged structural issues surrounding resident doctors and highlighted an annual increase of nearly N90 billion in professional allowances following government approval of revised health-worker allowances. The government also established committees to address excessive work hours, locum arrangements and residency-related disputes.
These developments reveal something important. The crisis cannot be solved by producing more doctors alone because the existing doctors are already working within a system experiencing structural stress.
The problem is therefore partly a production problem, but it is even more significantly a retention and system-capacity problem.
Consider the consequences of excessive workloads. When too few doctors are available to serve large populations, the doctors who remain are forced to carry heavier workloads. Exhaustion increases. Burnout becomes more likely. Patient waiting times increase. Errors become more difficult to avoid. Professional satisfaction declines.
The doctor begins to ask a very rational question: “Why should I remain in an environment where my workload is unsustainable when another country is willing to pay me better and give me a more functional environment?”
That question cannot be answered by opening more medical-school admission spaces.
If Nigeria produces 20,000 new doctors but loses 10,000, the net gain is 10,000.
If it produces 30,000 and loses 20,000, the net gain is again only 10,000.
If it produces 50,000 and the health system is incapable of absorbing, employing and retaining them, the country could create a different problem: an expanding pool of highly trained professionals whose ambitions remain incompatible with the conditions of the domestic labor market.
This is why workforce planning must be much more sophisticated than simply counting doctors.
The World Health Organization has repeatedly emphasized that health workforce planning must take account of the characteristics and needs of individual health systems rather than relying mechanically on a single doctor-to-population ratio.
The question is not merely how many doctors exist. The question is where they are, what specialties they possess, whether they are practicing, what facilities they have access to, what population they serve, what hours they work and whether the system can effectively utilize their skills.
Nigeria’s problem is therefore also one of distribution.
A doctor in Lagos is not equivalent, from a national health-planning perspective, to a doctor in a remote community where there may be virtually no specialist services. A concentration of doctors in major urban centres does not automatically translate into national healthcare access.
Recent data illustrate the disparity. Lagos and the Federal Capital Territory account for thousands of doctors, while states such as Taraba, Jigawa, Zamfara, Kebbi and Yobe have dramatically smaller numbers.
This means that even if Nigeria succeeds in producing more doctors, the country must confront the problem of deployment.
Who will work in rural communities?
Who will serve remote primary healthcare centres?
Who will provide specialist services outside the major cities?
Who will remain in communities where electricity is unreliable, accommodation is poor, schools are inadequate and insecurity is growing?
These are not questions that a medical-school admission policy can answer.
The Nigerian doctor is not merely a professional requiring a stethoscope and a certificate. The doctor is part of an ecosystem.
A surgeon cannot perform surgery without an operating theatre.
An anaesthetist cannot work effectively without functioning anaesthesia equipment.
A radiologist cannot diagnose properly without reliable imaging technology.
A physician cannot treat effectively when essential medicines are unavailable.
An emergency physician cannot save lives when ambulances are unavailable or roads are impassable.
A doctor cannot provide modern healthcare in a hospital without reliable electricity.
This is why Nigeria’s healthcare challenge is fundamentally an infrastructure challenge as much as it is a manpower challenge.
There is little value in producing a highly trained cardiologist if the hospital lacks the equipment required for sophisticated cardiac care.
There is little value in producing more oncologists if cancer diagnosis and treatment facilities remain inadequate.
There is little value in training more surgeons if patients cannot afford surgery.
There is little value in producing more doctors if millions of Nigerians delay treatment because they cannot afford healthcare.
The healthcare system must therefore be understood as a chain. A doctor is only one link in that chain. If other links are weak, the doctor’s effectiveness is compromised.
Nigeria must consequently stop approaching healthcare as though the solution lies principally in producing more medical graduates.
The country needs to build a healthcare system capable of giving those graduates a reason to stay.
That means addressing remuneration.
There is no escaping this issue.
Doctors should not be treated as though professional commitment eliminates their economic needs. A medical degree does not make a person immune to inflation, housing costs, transportation expenses, family responsibilities, children’s education or the general cost of living.
When a doctor’s real income declines dramatically while the cost of living increases, migration becomes economically rational.
The government cannot continuously appeal to patriotism while ignoring the economic realities facing professionals.
Patriotism is important, but patriotism cannot substitute for a functional employment relationship.
A country that wants to retain its doctors must make staying professionally and economically viable.
This does not necessarily mean attempting to match the salaries of Britain, America or Canada naira-for-naira. That may be unrealistic. It means designing a competitive package that combines remuneration, working conditions, career progression, professional autonomy, training opportunities, housing support, insurance, security and institutional respect.
Retention is therefore an investment.
Nigeria should stop thinking about doctors merely as recurrent expenditure.
A doctor is human capital.
When a trained Nigerian doctor emigrates, the country loses not only the doctor’s labor but also the public and private investment made in training that doctor.
The receiving country acquires a ready-made professional.
This is one reason why the international migration of Nigerian doctors should be understood within the broader economics of human capital.
Nigeria trains.
Foreign countries recruit.
Nigeria loses.
Foreign health systems gain.
This cycle cannot continue indefinitely without consequences for national development.
But there is another dimension that is often ignored.
Medical migration does not affect only doctors. It affects the entire health system.
When experienced doctors leave, junior doctors lose mentors.
When specialists leave, complicated cases become harder to manage.
When consultants leave teaching hospitals, postgraduate training can suffer.
When experienced professionals migrate, institutional knowledge disappears.
The effect is therefore cumulative.
The departure of one doctor may create a vacancy. The departure of hundreds of specialists can weaken entire departments. The departure of thousands can destabilize a health system.
This is why the Nigerian government should not regard medical migration simply as an individual career decision. It is also a national capacity issue.
The irony is that many Nigerian doctors who leave are not fleeing medicine. They are fleeing the conditions under which medicine is practiced in Nigeria.
That distinction matters.
A Nigerian doctor who migrates to Britain is still a doctor.
The expertise has not disappeared.
The training has not disappeared.
The talent has not disappeared.
What has disappeared is Nigeria’s ability to capture the value of that talent domestically.
This is why the phrase “brain drain” is so powerful.
The country is not merely losing bodies. It is losing expertise, experience, institutional memory and future leadership.
The response must therefore be broader than restricting migration.
Trying to prevent doctors from leaving Nigeria through administrative barriers would be misguided. In a globalized labor market, professionals will continue to move across borders. Doctors have internationally transferable skills, and countries with ageing populations and healthcare shortages will continue to recruit them.
Nigeria cannot realistically build a sustainable strategy around preventing its citizens from travelling.
The smarter strategy is to make staying attractive.
Nigeria must compete for its own talent.
That competition begins with the workplace.
The Nigerian hospital must become a place where doctors can practice medicine rather than spend excessive time battling the weaknesses of the system.
This requires reliable electricity, functional equipment, modern laboratories, adequate drugs, digital records, safe working environments and effective administrative systems.
It requires hospital management that understands that healthcare workers are not machines.
It requires proper staffing.
It requires predictable payment of salaries and allowances.
It requires mechanisms for resolving professional disputes before they become strikes.
It requires regulation of working hours.
The fact that the Federal Government has had to address excessive work hours through a ministerial committee demonstrates how fundamental the issue has become.
A healthcare system cannot sustainably depend on exhaustion.
The heroic doctor who works continuously for extraordinarily long hours may appear admirable, but a health system built around heroic sacrifice is ultimately a dysfunctional system.
Modern healthcare is designed around teams, protocols, technology and systems.
Nigeria must move away from the culture of improvisation.
The country has become remarkably good at improvising around institutional failures. Doctors improvise when equipment fails. Nurses improvise when staffing is inadequate. Patients improvise when hospitals cannot provide services. Families improvise when healthcare becomes unaffordable.
But improvisation cannot be the foundation of a modern healthcare system.
The country needs systems that work before professionals arrive.
The doctor should not have to become an engineer because the generator has failed.
The doctor should not become a procurement officer because essential drugs are unavailable.
The doctor should not become an administrator because bureaucratic processes are dysfunctional.
The doctor should be allowed to concentrate on medicine.
This is where leadership becomes critical.
Nigeria needs healthcare leadership that understands the difference between increasing capacity and increasing numbers.
A medical school is a capacity-building institution. But the healthcare system is the environment in which that capacity produces value.
The government must therefore think in terms of the entire medical workforce pipeline.
The pipeline begins with admission.
It continues through medical education.
It moves into clinical training.
It proceeds into housemanship.
It continues through residency and specialist training.
It then enters professional employment.
It develops through continuing education and career progression.
It eventually produces senior specialists, consultants, medical directors, researchers, academics and health-sector leaders.
If any stage of the pipeline is dysfunctional, the entire system suffers.
Increasing admission at the beginning without fixing the later stages risks creating a bottleneck.
Nigeria should therefore ask whether it has enough teaching hospitals, clinical training spaces, qualified lecturers, residency positions, specialists, laboratories, simulation centres and other infrastructure to support a dramatic increase in medical students.
Quality must not be sacrificed for quantity.
Medicine is not a discipline in which mass production can replace professional competence.
A poorly trained doctor is not a solution to a shortage of doctors.
The expansion of medical education must therefore be accompanied by massive investment in the quality of training.
Nigeria should build more medical schools only where there is sufficient academic and clinical capacity.
It should expand teaching hospitals.
It should modernize laboratories.
It should strengthen medical simulation.
It should recruit and retain qualified medical educators.
It should strengthen postgraduate training.
It should support medical research.
It should establish clear standards for accreditation.
Otherwise, the country risks producing larger numbers of graduates without proportionately increasing the quality and effectiveness of healthcare.
The same principle applies to specialists.
Nigeria does not merely need more doctors. It needs the right mix of doctors.
The country needs family physicians, emergency physicians, anaesthetists, surgeons, paediatricians, obstetricians, psychiatrists, oncologists, cardiologists, radiologists and other specialists.
It also needs nurses, pharmacists, laboratory scientists, physiotherapists, radiographers, community health professionals and other members of the health workforce.
Healthcare is a team sport.
The doctor cannot carry the entire system.
The fixation on doctors can therefore obscure the broader workforce crisis.
Nigeria must build a balanced health workforce capable of delivering preventive, primary, secondary and tertiary care.
This is particularly important because a large proportion of healthcare problems can be addressed more efficiently at the primary-care level.
If primary healthcare facilities are functional, properly staffed and adequately equipped, many patients will not need to travel to tertiary hospitals.
Yet evidence indicates that only a fraction of Nigeria’s primary healthcare facilities are fully functional. The result is predictable: patients bypass primary facilities and concentrate in secondary and tertiary institutions, increasing pressure on already overstretched doctors and hospitals.
This creates another vicious cycle.
Weak primary healthcare produces overcrowded hospitals.
Overcrowded hospitals produce excessive workloads.
Excessive workloads contribute to professional dissatisfaction.
Professional dissatisfaction contributes to migration.
Migration reduces the workforce.
Reduced workforce increases overcrowding.
And the cycle continues.
Breaking that cycle requires more than producing doctors.
It requires strengthening the entire health system.
Nigeria also needs to confront the issue of health financing.
A doctor cannot solve a healthcare affordability crisis.
When patients cannot afford consultations, diagnostic tests, medicines or surgery, the existence of additional doctors does not automatically create access.
Healthcare must therefore become financially accessible.
The expansion of health insurance coverage is critical.
A functioning health insurance system creates predictable revenue for healthcare providers and reduces the financial burden on households.
It also allows hospitals to invest in equipment, staff and service quality.
The doctor benefits because the system has resources.
The patient benefits because treatment becomes more affordable.
The hospital benefits because revenue becomes more predictable.
The government benefits because healthcare outcomes improve.
This is the kind of systems thinking Nigeria requires.
The central mistake would be to treat the medical doctor as the entire healthcare system.
The doctor is not the system.
The doctor operates inside the system.
If the system is broken, increasing the number of doctors only increases the number of people operating inside a broken system.
That is why Nigeria’s medical workforce strategy must be anchored in retention.
Retention should become as important as recruitment.
Training should be linked to retention.
Deployment should be linked to incentives.
Rural service should be supported by meaningful financial and professional benefits.
Doctors serving underserved communities should have access to housing, security, education opportunities for their families, career advancement and specialist support.
Technology can also help.
Telemedicine can allow specialists in major cities to support doctors in rural communities.
Digital health platforms can reduce geographical barriers.
Electronic medical records can improve continuity of care.
Artificial intelligence can support diagnosis and decision-making where appropriate.
But technology must complement, not replace, infrastructure and people.
Nigeria must also embrace its diaspora.
Thousands of Nigerian doctors practicing abroad represent not merely a loss but potentially an enormous national resource.
The question should be how to convert the diaspora from a symbol of brain drain into an instrument of brain circulation.
Some doctors may return permanently.
Others may return periodically.
Some may teach remotely.
Others may participate in specialist missions.
Some may support Nigerian universities and hospitals through research collaborations.
Others may provide second opinions through telemedicine.
The objective should not be to shame the diaspora into returning. It should be to create meaningful opportunities for them to contribute.
A Nigerian consultant working in London, Toronto, Houston or Melbourne can still contribute to Nigeria if the system creates mechanisms for collaboration.
The government should therefore develop structured diaspora programs involving universities, teaching hospitals and professional associations.
But even diaspora engagement will have limited impact if the domestic system remains unattractive.
People return when they believe they can make a difference without sacrificing their professional dignity.
The larger lesson is that Nigeria cannot solve a retention problem exclusively through recruitment.
The country must fix the reasons for departure.
This requires a fundamental change in policy philosophy.
For decades, Nigerian public policy has often focused on inputs rather than outcomes.
How many schools have we built?
How many people have we trained?
How many hospitals have we commissioned?
How many doctors have we produced?
These questions are important, but they are insufficient.
The more important questions are different.
How many doctors remain in the country?
How many are practicing?
Where are they practicing?
How many patients can they effectively serve?
How many hospitals have functioning equipment?
How many health facilities operate continuously?
How long do patients wait?
How many doctors leave each year?
How many return?
What is the average duration of service before migration?
What are the principal reasons for leaving?
What would make them stay?
These are the questions of a serious workforce strategy.
The government should establish a national health workforce dashboard that continuously tracks these indicators.
Policy should be based on evidence rather than assumptions.
If the objective is to increase the number of doctors, the government must calculate how many doctors Nigeria needs, where they are needed, which specialties are required and what financial resources will be necessary to employ them.
Otherwise, the country could produce doctors faster than it can employ or retain them.
The issue of employment deserves special attention.
Producing tens of thousands of doctors without corresponding expansion in hospitals and healthcare services creates another contradiction.
A doctor needs a professional position.
If government hospitals cannot absorb new doctors, private hospitals may have to do so.
But private healthcare is ultimately constrained by the purchasing power of patients.
This means that workforce expansion must occur alongside health-system expansion.
More doctors require more hospitals, more clinics, more diagnostic centres, more insurance coverage and more healthcare consumption capacity.
The medical workforce cannot be planned in isolation from the economy.
This is why the medical education policy must be integrated into national economic planning.
The same government that trains doctors must create the conditions under which those doctors can practice.
Otherwise, medical education becomes an export industry for human capital.
Nigeria must avoid becoming a country that trains doctors for other countries. Except the policy focus is to begin to export doctors as a means of foreign exchange generation.
There is nothing inherently wrong with Nigerian doctors working abroad. Indeed, the global contribution of Nigerian medical professionals is a source of pride. The problem arises when migration reaches a scale that undermines the capacity of the domestic health system.
The objective, therefore, should not be to eliminate migration.
It should be to make migration a choice rather than an escape.
A doctor should be able to say, “I want to work abroad because I want international experience,” rather than, “I must leave because I cannot build a decent professional life here.”
That is the difference between healthy mobility and destructive brain drain.
Nigeria must also recognize that doctors are not the only professionals affected by the operating environment.
Nurses are leaving.
Pharmacists are leaving.
Laboratory scientists are leaving.
Other skilled health professionals are leaving.
The healthcare system therefore needs a comprehensive human-resource strategy.
Focusing exclusively on doctors could unintentionally worsen imbalances within the health workforce.
A doctor without nurses cannot provide quality care.
A surgeon without an anaesthetist cannot operate safely.
A physician without laboratory support cannot diagnose many conditions accurately.
A hospital without pharmacists cannot ensure effective medication management.
The future Nigerian health system must therefore be multidisciplinary, technology-enabled and patient-centred.
Above all, it must be functional.
Functionality is the missing word in much of the debate.
Nigeria has plans.
Nigeria has policies.
Nigeria has strategies.
Nigeria has committees.
Nigeria has conferences.
Nigeria has workshops.
Nigeria has announcements.
What the Nigerian healthcare system desperately needs is consistent implementation.
Doctors do not migrate because Nigeria lacks policy documents.
They migrate because they experience the consequences of weak implementation.
Patients do not die because Nigeria lacks committees.
They die when emergency systems fail, when hospitals lack equipment, when medicines are unavailable, when treatment is delayed and when skilled professionals are unavailable.
The solution therefore lies in execution.
Government must move from policy declaration to institutional transformation.
The medical workforce policy should be accompanied by measurable targets.
Every year, Nigeria should be able to answer how many doctors were trained, how many entered practice, how many migrated, how many returned, how many retired, where doctors are located, how many vacancies exist and what the working conditions are.
Without such data, workforce planning becomes guesswork.
The debate over the expansion of medical admissions should therefore be reframed.
The question is not whether Nigeria needs more doctors.
It does.
The question is whether producing more doctors without transforming the environment in which they practice will solve the problem.
It will not.
At best, it will provide part of the solution.
At worst, it could intensify the very problem the policy seeks to solve.
Imagine Nigeria successfully expands medical admissions dramatically. Imagine thousands more young Nigerians enter medical school. Imagine they graduate after years of intense study. Imagine they complete housemanship and begin professional practice.
Then imagine they encounter the same problems their predecessors encountered: inadequate salaries, poor infrastructure, long hours, insecurity, inadequate equipment, delayed allowances, limited postgraduate opportunities and weak career progression.
What will happen?
Many will leave.
The country will have succeeded in producing more doctors but failed to produce a more attractive environment for doctors.
That would be a policy failure of historic proportions.
The central lesson is therefore simple.
Nigeria does not merely need to produce more doctors.
Nigeria needs to build a country in which doctors want to remain doctors in Nigeria.
That requires political will.
It requires financial investment.
It requires institutional discipline.
It requires healthcare reform.
It requires better management.
It requires infrastructure.
It requires security.
It requires professional respect.
It requires competitive remuneration.
It requires credible career pathways.
It requires functional hospitals.
It requires affordable healthcare.
It requires stronger primary healthcare.
It requires better health insurance.
It requires evidence-based workforce planning.
It requires a national commitment to retaining human capital.
The debate should therefore move beyond the arithmetic of medical-school admissions.
The real arithmetic is different.
If Nigeria trains one doctor and retains that doctor for thirty years, the country receives enormous value.
If Nigeria trains one doctor and loses that doctor shortly after qualification, the country loses a substantial part of that investment.
If Nigeria trains ten thousand doctors and retains them, national healthcare capacity expands.
If Nigeria trains ten thousand doctors and half migrate, the country has not solved its workforce problem.
The difference is the operating environment.
This is why the fight against “Japa” cannot be won at the airport.
It must be won in the hospital.
It must be won in the university.
It must be won in the teaching hospital.
It must be won in the salary structure.
It must be won in the emergency room.
It must be won in the operating theatre.
It must be won in the laboratory.
It must be won in the primary healthcare centre.
It must be won in the rural community.
It must be won wherever a Nigerian doctor decides whether to stay or leave.
The doctor does not wake up one morning and suddenly decide to abandon Nigeria. Migration is usually the culmination of accumulated experiences. It is the product of frustration, calculation and comparison.
The doctor looks at what is available in Nigeria.
Then looks at what is available abroad.
The decision becomes increasingly obvious when the difference between the two environments becomes too wide.
The Nigerian government must therefore compete not only with foreign salaries but with foreign systems.
It must make the domestic professional environment sufficiently attractive that leaving becomes a preference rather than a necessity.
The greatest mistake would be to interpret the departure of Nigerian doctors as evidence that Nigerians have become unpatriotic.
The more uncomfortable interpretation is that Nigeria has not given enough of its professionals a compelling reason to stay.
People are often willing to endure hardship when they see progress.
They are willing to make sacrifices when they believe institutions are improving.
They are willing to work for less when they believe their efforts are respected and their future is secure.
What destroys commitment is not hardship alone.
It is the perception that hardship has no end.
That is the psychological foundation of the Japa phenomenon.
Nigeria must therefore offer its doctors something more powerful than appeals to patriotism.
It must offer them a future.
A future in which a young doctor can enter the profession, develop expertise, become a specialist, conduct research, earn a decent income, provide for a family, work in a safe hospital, access modern equipment, enjoy professional respect and retire with dignity.
That is the environment Nigeria must build.
The country should absolutely expand medical education. It should train more doctors. It should strengthen medical schools. It should increase clinical capacity. It should invest in teaching hospitals. It should encourage private-sector participation while maintaining rigorous standards. It should expand postgraduate training. It should strengthen primary healthcare.
But all of these efforts must be part of a larger strategy.
The strategy should be called not simply “producing more doctors” but building a health system in which doctors can thrive and Nigerians can receive quality healthcare.
That is the distinction between a manpower policy and a national healthcare policy.
Nigeria’s healthcare crisis cannot be solved by counting heads.
It must be solved by building institutions.
The doctor is important, but the doctor is not magic.
Give a doctor a functioning system and the doctor can save lives.
Give the same doctor a dysfunctional system and the doctor may spend much of the day fighting shortages, bureaucracy, broken equipment, overcrowding and exhaustion.
The solution is therefore not either more doctors or better working conditions.
Nigeria needs both.
It needs more doctors and a better environment for practicing medicine.
It needs more medical schools and better medical education.
It needs more graduates and more hospitals.
It needs more doctors and more nurses.
It needs more specialists and stronger primary healthcare.
It needs recruitment and retention.
It needs training and employment.
It needs ambition and execution.
Most importantly, it needs to understand that human capital is not retained by decree.
Doctors cannot be ordered to stay.
They must be persuaded to stay.
They must see value in staying.
They must see dignity in staying.
They must see opportunity in staying.
They must see security in staying.
They must see a future in staying.
Until that happens, Nigeria risks running endlessly on a treadmill: train more doctors, lose more doctors, complain about shortages, expand medical schools, lose more doctors again.
That is not a sustainable national health strategy.
It is a revolving door.
The ultimate test of the Federal Government’s proposed expansion of medical education will therefore not be the number of medical students admitted. It will be the number of competent doctors who are still practicing in Nigeria ten, fifteen and twenty years from now.
That is the number that matters.
Nigeria should not measure success by how many doctors it produces.
It should measure success by how many doctors it retains, where they serve, what conditions they work under and how effectively the health system enables them to serve the Nigerian people.
The country does not have the luxury of choosing between producing doctors and fixing the environment.
It must do both.
But if there is one lesson that should guide the current policy debate, it is this: Nigeria’s medical brain drain is not fundamentally a problem of producing too few doctors. It is a problem of losing too many of the doctors it produces.
And that problem cannot be solved in the classroom alone.
It must be solved in the hospital.
It must be solved in the economy.
It must be solved in governance.
It must be solved in infrastructure.
It must be solved in remuneration.
It must be solved in professional management.
It must be solved in the quality of life.
Ultimately, it must be solved in the operating environment of the Nigerian doctor.
Until that environment changes, Nigeria can produce 20,000 doctors, 50,000 doctors or even far more.
The fundamental question will remain the same:
How many will stay?
And that, more than the number admitted into medical school, is the question Nigeria must answer if it genuinely wants to end the medical dimension of the Japa syndrome.
Nze David N. Ugwu is the Managing Consultant of Knowledge Research Consult. He could be reached at [email protected] or +2348037269333.
