The World Health Organization prioritizes professionals in the field of medicine as fundamental in delivering health care in health systems, and further groups them according to their performance with reference to memorandum of performance that guide workers for an efficient health system (WHO, 2000). Although it has been common for health workers to migrate in search for greener pastures, it has significantly sky-rocketed at an alarming rate since 1990s. In the last few decades, a considerable fraction of physicians and nurses in Nigeria and other middle income countries were working outside their mother countries, a majority of them seeking employment in abroad countries such as United Kingdom, United States of America, Canada, Germany and Australia (Potts, 1995)
Today, migration has become a major problem in Nigeria to an extent that the country is experiencing a great loss of locally trained health professionals as a result of out-migration. This has impacted on the county’s capability to offer basic health services. An estimation made by the World Health Organization claims that, there is a great possibility that the country will be experiencing a critical inadequacy for health professional in the next five years (WHO, 2006).
Even though there is a desire to migrate from one’s country to another in search of greener pastures, there are some frequent patterns that help evaluate and comprehend the central issue around the pull and push factors behind migration. Structural factors at local, national level, regional and international height also contributes a lot to migration of health skills’ holders (Adams & Hicks, 2000).Escalated cultural diversification through the current process of globalization in the form of upcoming and increased access to global communication through new technologies such as the internet as well as adequate access to international means of travelling which allows people to easily travel as well as access global labor markets.
The desire for better income has made many health workers to search for better paying jobs abroad that will increase their chances to rise up the social ladder, work in countries with better management and governance structures as well as good living standards. In addition, the migrant communities’ networks with the recipient countries have also facilitated to not only the individual’s migration to a specific country, but also the assimilation process after they arrive. There is a connection between the desire for health professionals to move from their mother countries to other countries and frustrating factors in the home countries such as poor management structures and governance, poor salaries, lack of opportunities to mention a few. Migration trends are also connected to such factors as political/social unrest, war with a considerable number of health system professionals migrating to developed countries via refuge process (ICN, 2001).
Increased migration from Nigeria to developed countries such as United States of America, Australia, Germany and United Kingdom has been positively influenced systematic trials. Recruitment agencies have played a major role to actively recruit from Nigeria to the first world countries due to their countries inadequacy for health workers. It is then easy to comprehend factors contributing to recruitment of foreign trained staff from an economical point of view. The cost of training a professional doctor, according to NHS, ranges between 200.000 pounds to 250,000 pounds (ICN, 2001).
The issue of health professionals being trained to levels beyond realities of local health has resulted to them seeking for better chances abroad where medical infrastructure is sophisticated to justify their complaints of being brain wasted at the local level. Poor stipend is also a problem. In terms of negotiating uniformity in power, doctors and other health professionals in Nigeria are typically remunerated about 25% of what they could get if they were based in other countries in Europe, Middle East or North America. Thus, the underpaid health professionals view emigration as the most appropriate means of communicating their grievances.
In Nigeria, there are limited enticements for health workers based overseas, but willing to relocate and offer their services at home. If granted appropriate employment opportunities, numerous overseas-based health professional are willing to go back and work in Nigeria. Unfortunately, such opportunities are not only very scarce but also, unemployment rate for registered nurses and doctors in Nigeria has rapidly been escalating. In addition, very little interest is shown by the locally based health staff to create openings for overseas professional (Ratto, 2002).
There has been identified some two forms of economic effects in Nigeria. First, there is investment loss in the training of professionals, immigrating to abroad countries and secondly, the loss of the required contribution of national GDP by the professionals who depart from the country. There is a suggestion, for instance, that about $60 million was lost in training health service providers who later came to be realized to have moved out the country. In the same way, analogous impacts may be ascribed to migration of nurses. An example of a positive economic effect concerns remittances ploughed back home, which can be considerable. Data for specific nurses remittances are however, not available. A complex impact is that the nurse migration escalation creates new earnings from issuing verifications, nursing councils, but results to weakening of nursing associations via membership loss.
Recruitment of health professionals from Nigeria by foreign recruiting agencies has resulted to worsening of the situation in the local health facilities, with the country facing an extreme shortage of human resource talents in the health sector. In addition, there is a weak health system in Nigeria making it very hard for the country to avoid loosing its health professionals. In Nigeria today, the impact of migration is manifesting itself in different ways, with its system losing a lot from this because, its health systems are not conventional enough to diffuse the human resource loss. A large percentage of nurses registered in the United Kingdom are from developed countries with Nigeria contributing to a considerable fraction which only represents a cut from the small percentage of professionally trained nurses in Nigeria (Barnum, Kutzin and Saxexian, 1995).
The present deficit in the health care systems has detrimentally affected the Nigeria’s system of health, where workforce has not been able to offer health care service delivery effectively. The achievement of Millennium Development goals have been raised as a major concern, and the migration effects experience on their attainment, in specific concern for Nigerian society.
Despite the goodness in the proliferation of regional and national procedures as platform for health workers’ migration management, this problem should be addressed in a more precise, structured and cohesive manner. Considering the level of effects reflected by out-migration, and the manifested increase of stakeholders involved, a detailed multi-sectoral approach must be invented and employed. So there is a need for concerted effort as a crucial consideration for this problem to be effectively managed at the local, regional, national and the international level.
With the severe negative impact being manifested in the health systems in Nigeria, the approach suggested will aim its focus on the national health systems in the country, in respect to World Health Organization action framework (2006), specifically to the six major building blocks, as direction. The implementation strategic plans identified are broadly aimed at addressing the most frequent issues within the systems of health that contributes to the migration and secondly, to raise the retention rates for domestic staff, thereby mitigating the rate of emigration (Kurowski, Wyss, Abdulla, Yémadji and Mills, 2003).
For effective and practical management of migration, there is an urgent need for the government of Nigeria to evaluate the context of their country, followed by provision of feasible and suitable remedies. For maintenance and expansion of the country’s health care system, the government of Nigeria has to conduct comprehensive research on their human resource, with particular concern on the problematic areas that have potential contributors of out-migration. According to Bloom & Standing (2001), realizing the significance of information systems and creation of migration database should be considered first when addressing the issue. Even though it may not be realistic to use this method of data collection in settings where resources are poor, it is highly recommended that the government of Nigeria have at least an understanding of the methodology for reasons for their staff migration at the district and national level (Bloom and Standing, 2001).
Service provision should be the central focus, well equipped, effectively staffed, response and delivery to the needs of the population. In effect, there is an implication that international donors, both multilateral and bilateral need to recognize these issues, with assurance of appropriate and focused funding sources. The inability of health professional to effectively perform their tasks due to inadequate resources and poor fund allocation results to diminishing of their morale. There is a need for this issue to be adequately addressed so as to stimulate morale, raise maintenance rates and, ultimately, to ensure improvement in the status of health. Untimely and inadequate payments to staff workers are also critical factors that additionally need to be reiterated in studies focusing on migration (Jinadu, Olofeitime and Oribador, 2002).
In conclusion, health workers and professionals’ migration from Nigeria to the developed countries is likely to continue sky-rocketing. Even though the decision to migrate from Nigeria to developed countries in search of better incomes follows personal reasons, structural causes that escalate the percentage of health workers who chose to migrate must be acknowledged. There is intensification of unequal distribution of workers in the health systems by this process, and the consequent effect is commonly felt in developing countries such as Nigeria which has weak health systems. This has negatively affected capacity for Nigeria to realize and meet the global targets such as Millennium Development Goals (Dovlo, 1998).
The resolution lies in conceptualizing the issues for immigration, protecting against growing rates of attrition and managing present immigration patterns. This health professional migration issue is supposed to be made a worldwide priority, with analyzable targets for all participants. This will require knowledge and recognition of the crisis, and political pledge to manage it, at both the international and national levels. Finally, the health system professional should be accrued value and recognition as the basic building block of all health systems globally.
Reference List
Adams, O & Hicks, V 2000, ‘Pay and Non-pay Incentives, Performance, and Motivation’. Human Resources Development Journal. vol. 4, no. 3, pp 1-25.
Barnum, H, Kutzin, J & Saxexian, H 1995, ‘Incentives and Provider Payment Methods.’ International Journal of Health Planning and Management, vol. 10, no. 1, pp. 23–45.
Bloom, G & Standing, H 2001, ‘Human resources and health personne’l. Africa Policy
Development Review, vol. 1, no. 1, pp. 7-19.
Dovlo, DY 1999, Health Sector Reform and Deployment: Training and Motivation of HR towards Equity in Health Care: Issues and Concerns in Ghana. Web.
ICN, 2001. Nurse Migration. International Council for Nursing. Geneva: Switzerland.
Jinadu, M, Olofeitime K & Oribador, P 2002, ‘Evaluation of an Innovative Approach to Community-Based Medical Undergraduate Education in Nigeria.’ A journal on Educational Opportunities in Nigeria, vol. 15, no. 2, pp. 139–48.
Kurowski, C., Wyss, K., Abdulla, S., Yémadji, N. and Mills, A. 2003. Human Resources for Health: Requirements and Availability in the Context of Scaling-Up Priority Interventions in Low-Income Countries—Case Studies from Tanzania and Chad. London School of Hygiene and Tropical Medicine, London.
Potts, D 1995, ‘Shall we go home? Increasing poverty in African cities and migration Processes’. The Geographical Journal, vol. 161, pp. 245-264.
Ratto, M, Propper, C & Burgess, S 2002, ‘Using Financial Incentives to Promote Teamwork in Health Care’. Journal of Health Services Research Policy, vol. 7, no. 2, pp. 69–70.
World Health Organization 2000, Migration of Skilled Health Personnel in the African Region: A Case of Uganda. Unpublished.
World Health Organization. 2006. Migration of Skilled Health Personnel in the African Region: A Case of Nigeria. Unpublished.
