The waiting rooms at the Ifako Ijaiye hospital in Lagos are overcrowded with patients waiting to see doctors. Often people have to stand outside.
“It is now like this every day. We have to come early and pick numbers before we can meet the doctors. Even though the doctors try to see everybody, it has got worse,” says Oluchi Ezegbo, a market trader from Okearo, in nearby Ogun state.
Ezegbo came here as it is the closest government-owned doctor’s surgery to her home. Even though the distance is only 4.3km (2.7 miles), the roads are in very poor condition and the journey takes more than an hour.
When she was here for an appointment in October, the power went out. “I was not connected to a machine that needs electricity to function, but what if it was in the middle of surgery?” Ezegbo asks.
Power cuts, low pay and challenging work conditions for medical professionals are compounded by Nigeria’s larger problems of economic instability, insecurity and nepotism in recruitment processes, resulting in many doctors leaving the country.
“I left to work in a system that worked and also to have a better quality of life,” says Dr Olufunmilayo Harvey, a Nigerian doctor now working in the UK.
“There were situations where doctors were performing surgeries and carrying out deliveries using torchlight. There is a serious systemic problem with the medical system in the country that worsens the mortality rate.”
According to the Nigerian Medical Association, of the 75,000 doctors registered in the country, about 40,000 practice outside Nigeria. In the UK alone, it is estimated that 12 doctors from Nigeria are registered every week, with more than 5,250 Nigerian doctors already working there.
Nigeria faces a host of healthcare problems, from budget limitations, lack of support infrastructure, mismanagement and poor governance. The proposed 2020 budget of the Federal Ministry of Health is 427bn Nigerian naira (£0.9bn), which amounts to about 4% of the budget. This is despite a 2001 pledge of 15% of the national budget towards healthcare by member nations of the African Union.
The lack of allocation of funds to the health sector has led to understaffed and underfunded medical centres. In some states in Nigeria, doctors are owed salaries, leading to strikes that often last for months. Patients are forced to sleep on bare floors and battle mosquitoes in teaching hospitals across the country.
The frequent trips of the president, Muhammadu Buhari, to Britain to seek medical help for an undisclosed illness are noted with irony by Nigeria’s poorest.
A general state of mismanagement accounts for a lack of electricity in Africa’s most populated country. Despite continuous huge investments in power, Nigeria has suffered over 206 grid collapses in nine years with as many as 12 in 2019. This problem has resulted in doctors performing surgeries using candles, lamps and mobile phones.
Even in the better-funded private sector doctors are leaving, due to shortages of equipment and drugs. One told The Guardian that doctors often earn just N450 Naira (90p) per hour even in private hospitals.
Victims of gunshot wounds could previously not be treated in Nigerian hospitals without presenting a police report, a policy that led to several deaths. The Compulsory Treatment and Care for Victims of Gunshot Act, introduced by Buhari in 2017, was intended to end this practice, but some doctors claim the legislation is not always enforced and that police might still extort them if they treat patients with gunshot wounds.
Last month, a 28-year-old podcast host who had been stabbed in the neck by armed robbers in the Gbagada area of Lagos died after being rushed to a hospital. According to her fiance, she was allegedly rejected at the gate because a police report was not presented. The hospital denied the claim, saying she had been referred to a another hospital.
A few Nigerian startups are looking to improve the medical skills shortage. After practising for more than seven years in Nigeria, Dr Debo Odulana started a company to connect patients and professionals.
“I was interested in becoming a neonatal surgeon, but I could not find any consultant to train me in the country, so my company Doctoora is an aggregation of medical experts that are generally absent in the country,” Odulana says.
Despite evidence of growing numbers of doctors looking outside the country for residency programmes, the Nigerian minister of labour and employment, Dr Chris Ngige, has said there are enough medical personnel in Nigeria. The Nigerian minister of health, Prof Isaac Folorunso Adewole, also claims that the ratio of one doctor to 5,000 people in Nigeria is better than other African countries.
The World Health Organization regards countries with less than 10 doctors per 10,000 people to have an “insufficient” number of medical personnel.
Ifeanyi Nsofor, director of policy and advocacy at Nigeria Health Watch and Atlantic fellow for health equity at George Washington University in the US, believes that there is a solution. “Mandatory state health insurance schemes are gaining speed in the country and I believe that if people have health insurance, there will be money available to hospitals for their development and to hire more staff.”
Currently, less than 5% of Nigerians are covered by the Nigerian national health insurance scheme.
Ezegbo is not covered by health insurance, but says she is lucky to be able to get some services for free.
“I have not had to pay for any surgeries and it is mostly the drugs that are expensive. I don’t have the money to pay for any extra medical bills. School fees and rent already eat up my money.”