Concerns as Nigeria Begins to Send Medical Doctors Abroad Under TMA

Nigeria, the most populous country in Africa, has a large healthcare system segmented into three levels: (Primary, Secondary, and Tertiary). These divisions intended to serve both the urban and rural population. However, the public healthcare system at all levels continues to face critical challenges due to a lack of basic medical equipment and medical personnel. Sofiyyat Lawal reports.

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Last year, a report from the Foundation for Investigative Journalism (FIJ) estimated that over two-thirds of the health facilities in Nigeria lack basic equipment and essential drugs to function. Among these, 29.9% are primary health centres and 68% secondary health facilities. Despite the Federal Government’s promise to allocate 15% of its annual budget to health sector, these problems persist due to underfunding, a report noted in June.

In fact, just last month, Nigeria’s healthcare crises deepened with doctors and nurses threatening indefinite strike. PIJAlance reported that a branch of National Association of Residents Doctors (NARD) in Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital embarked on an indefinite strike due to funding-related challenges.

Terribly, this chronic underfunding has not just made the health care centres incapacitated, but also placed immense pressure on healthcare personnel, subjecting healthcare workers to unethical workloads padded with underpayment.

As a result, health workers migrate to another country in search of greener pastures. A Premium Times report confirmed this, adding that Healthcare professionals, especially doctors and nurses, are reluctant to work due to poor infrastructure, inadequate compensation and limited professional opportunities,  most especially in rural areas.

But while this is upon Nigeria, the Federal Government is planning something else to further deepen the crisis. This plan is shrouded in what is branded an innovative foreign policy with the government of Saint Lucia.

The newly proposed deal, called the Technical Manpower Assistance (TMA) is aiming to have Nigeria’s doctors and some other healthcare professionals deployed to the Caribbean country for a two-year assignment in exchange for theirs. The aim is theoretically expected to strengthen the bilateral relationship between the two countries.

This though brings international exposure to professionals and enhances foreign relationships, many Nigerians have said the TMA initiative is “ill-timed” and “irresponsible,” given the dire state of healthcare at home.

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This is because the country has roughly 55,000 licensed doctors serving over 200 million Nigerians, with about 16,000 doctors leaving the country every year. Far from the World Health Organisation’s (WHO) recommended doctor-to-patient ratio of 1:600—in Nigeria, one doctor serves approximately 5000 patients.

Every year, Nigeria inducts about 3,000 doctors, though the Federal government aims to increase the annual inductees to 10,000 and stop immigration of doctors using the Health Policy introduced in 2024; its current action contradicts this goal.

The bilateral relationship under TMA with the government of Saint Lucia will further deepen the crisis of under-resourced health facilities in Nigeria, Rodiyah Loke, a student at LAUTECH, said, referencing long she may need to wait in line before she is granted access to a doctor should the Federal Government plan on TMA become a success.

“On average, it can take 2 to 6 hours before seeing a doctor, especially if it’s a general outpatient case”, she said. “Emergency cases may be seen faster, but for most people, the waiting period is quite long; sometimes you will have to pick a number from a roll, and that number will be the order in which you will see the doctor.” 

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Though Rodiyah was previously unaware of the TMA bilateral agreement, upon understanding it through our correspondent efforts, she expressed her concern over the deal, stating that the decision could worsen an already struggling medical system.

“Honestly, it is concerning. While it may be a good opportunity for the doctors and beneficial diplomatically, it raises serious concerns about our healthcare system. We are already struggling with a shortage of doctors, especially in rural and underserved areas. Sending our limited human resources abroad without addressing the gaps here feels like neglecting our own needs.”

Ameerah Adedeji, an educationist and a professional cobbler, echoed these concerns. Though she does not like using public hospitals, she has observed long wait times among her close relatives and friends.

“I don’t normally use public hospitals, but I can tell from people close to me how bad the situation is,” she said.

“I do not understand why doctors will be sent abroad when we do not have enough doctors for our own needs. Why would the government do that? Who will fill in for those sent out?”

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TMA: Mixed Experiences, but Unified Frustration

Not everyone had a negative experience. Contrary to the service delivery narrated by Rodiyah and Ameerah, Babatunde Dauda, a Pharmacist in Lagos, applauded the care he received at a public hospital after suffering from heat exhaustion at a public hospital.

“I recently attended a political rally where I suffered from heat exhaustion and had to go to a public hospital. The reception and management were good enough, and as a healthcare worker myself, I do not experience any delays in seeing a doctor as I have friends and colleagues across the board.”

Still, despite this Babatunde criticised the policy. 

“I feel signing the bilateral agreement is wrong of the government. Government should focus on improving wages, allowances and working conditions for healthcare workers here.”

In 2024, the Federal Government signed the National Health Workforce Policy, which aimed at curbing the migration of healthcare professionals, which has caused brain drain to the system and enhancing sustainable and resilient healthcare systems by providing professional opportunities, disbursing incentives and improving the working conditions. Doctors have been complaining and threatening an indefinite nationwide strike due to unpaid 5 months; many Nigerians viewed the government’s priority as misplaced.

“It’s a whole lot and I’m very critical of the whole sector. A lot of reforms are needed in health insurance, health infrastructure, workforce numbers, and so on. Government needs to innovate policies and attract needed funding to improve the sector,” Babatunde added.

TMA and A System in Crisis

Dr James Ilori, a medical doctor at the University of Osun Teaching Hospital and a former public relations officer of the Nigeria Medical Association (Osun State Branch), offered a stark assessment of the current situation.

“The whole TMA agreement is synonymous with a father giving out the little amount of rice meant for his family to a neighbour without an alternative. The number of Doctors in the country is not sufficient, and that’s no more news.”

He described the toll on Nigerian doctors as excruciating.

“The pain and stress subjected to it are unexplainable.  We are working with our flesh and blood. I’ve not slept since yesterday.  We kept saving lives while praying that our lives do not slip away,” he added.

While he acknowledged potential professional gains and a strong bilateral relationship from the agreement, he argued that it is an irresponsible decision given Nigeria’s current realities.

“I would not say the agreement is not beneficial, but it is happening at the worst of times. It is devastating to see patients dying in hospitals, knowing doctors are rendered incapacitated due to a lack of facilities. There are some of us, due to one reason or the other, who do not wish to leave the country, but every day, the system gives us reasons to japa.”

Dr Ilori also highlighted salary disparity.  A report by Premium Times confirmed that St Lucia doctors earn up to N131.7 million annually, the Nigerian doctors deployed there will be paid N40.8 million, and those working in the country earn a maximum amount of N11.9 million annually.

There is a large disparity between the payment in St Lucia and the Nigerian government. 

He concluded that it will soon dawn on Nigerians that some departments in Federal hospitals are being collapsed due to a lack of resources and staff.  

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