Brain Drain Among Nigerian Health Workers, Consequences On Health Personnel And Healthcare System

Project and Seminar Material for Public Health

Brain Drain Among Nigerian Health Workers, Consequences On Health Personnel And Healthcare System


Abstract


This study was carried out to examine brain drain among Nigerian health workers, consequences on health personnel and healthcare system. The study was specifically carried out to identify perceived reasons why health workers migrate, identify the perceived effect of migration in healthcare personnel, and assess the perceived effect of brain drain on healthcare system in Nigeria/ Sokoto. The survey design was adopted and the simple random sampling techniques were employed in this study. The population size comprise of healthcare workers in Federal Medical Centre, Sokoto. In determining the sample size, the researcher conveniently selected 120 respondents and 100 were validated. Self-constructed and validated questionnaire was used for data collection. The collected and validated questionnaires were analyzed using frequency tables. While the hypotheses were tested using Chi-square statistical tool. The result of the findings reveals that the reasons why health workers migrate include: under-funding of the healthcare system, dilapidated structures and outdated medical equipment, lack of trust in the health care system, poor remuneration, distance from home, novelty seeking, and positive body language. The study also revealed that migration has a positive effect on healthcare personnel(s). Therefore, it is recommended that the government may not be able to fully stop migration, but it can be controlled. Health workers who have migrated for several reasons are recoverable assets to their home country (Nigeria), they can play a part in developing opportunities back at home. To mention but few.


Table of Content


  • Title Page
  • Certification
  • Dedication
  • Acknowledgement
  • Table of Content
  • List of Tables
  • Abstract

Chapter One:

Introduction

  • 1.1 Background of the Study
  • 1.2 Statement of the Problem
  • 1.3 Objective of the Study
  • 1.4 Research Questions
  • 1.5 Research Hypothesis
  • 1.6 Significance of the Study
  • 1.7 Scope of the Study
  • 1.8 Limitation of the Study
  • 1.9 Definition of Terms
  • 1.10 Organisations of the Study

Chapter Two:

Review of Literature

  • 2.1 Conceptual Framework
  • 2.2 Theoretical Framework
  • 2.3 Empirical Review

Chapter Three:

Research Methodology

  • 3.1 Research Design
  • 3.2 Population of the Study
  • 3.3 Sample Size Determination
  • 3.4 Sample Size Selection Technique and Procedure
  • 3.5 Research Instrument and Administration
  • 3.6 Method of Data Collection
  • 3.7 Method of Data Analysis
  • 3.8 Validity of the Study
  • 3.9 Reliability of the Study
  • 3.10 Ethical Consideration

Chapter Four:

Data Presentation and Analysis

  • 4.1 Data Presentation
  • 4.2 Analysis of Data
  • 4.3 Answering Research Questions
  • 4.4 Test of Hypotheses

Chapter Five:

Summary, Conclusion and Recommendation

  • 5.1 Summary
  • 5.2 Conclusion
  • 5.3 Recommendation
  • References
  • APPENDIX
  • QUESTIONNAIRE

Chapter One


Introduction

1.1 Background of the Study

One of the paramount hurdles to Africa’s development is the relocation of African skilled workers to developed countries. The trained people from underdeveloped and developing nations to developed or industrialized countries are not a new occurrence; however, the enormousness of the problem in Africa soil is on the increase and calls for immediate action, as the result of emigration pose a major challenge to the overall development of Africa (Abumere, 2018). The relocation of health workers is the act of leaving one’s own country to settle permanently in another country in search of a better standard of living and life quality, higher salaries, access to advanced technology, and more stable political conditions in different places worldwide. Migration in most cases, refers to cross-border or international migration and often from the developing countries to the developed ones.

The health workers in any country are the people whose responsibility it is to enhance the health of the citizens of their country and without them, quality healthcare cannot be guaranteed or efficiently delivered to the populace (Abubakar, 2021). There are many reasons people including health workers relocation from their home country to the abroad. In Nigeria and most low- and middle-income earning countries, the reason is usually economic which reflects in the sub optimal functioning of their economy. Before the 1990s, several people of African descent had migrated and settled in the abroad out of their own will, with the west topping the list of where people migrated to, this was an unprecedented trend between the 1990s and 2000s and it was made possible by a combination of factors, and we can sum these factors as push and pull factors of international migration. While the major push factors for this move are low standard of living, political instability, insecurity, and lack of opportunities to utilise skills. The pull factors for migrating are higher wages, better job opportunities, relatively good working conditions, freedom from political instability, relaxation of immigration policies and the phenomenon of new globalisation. The main destinations of most health workers are the United States, Asia, United Kingdom, Canada and Europe and this has led to a drastic reduction of health practitioners left back home, poor basic health care delivery and subpar healthcare programmes, inefficient utilisation of external assistance and low level of institutional capacity building are the main effects the loss of highly- skilled Nigerian health workers has on the country’s and Africa’s health care development (Adesote, & Osunkoya, 2019).

The observed negative effects of medical brain drain from developing countries, as well as the implications for achieving the Millennium Development Goals, have elevated the relocation of health workers to a high-level international concern, particularly in the last two decades, and Africa is no exception. According to Najib, Abdullah, and Narresh, et al. (2019), the emigration of talented African labourers to affluent nations is one of the most significant obstacles to African development. Emigration of trained people from underdeveloped and developing countries to developed or industrialised countries is not a new phenomenon; however, the magnitude of the problem in Africa is growing and immediate action is required, as the result of emigration poses a significant threat to Africa’s overall development. According to Fagite (2020), relocation of health personnel is defined as the migration of health staff across the globe in search of a higher standard of living and life quality, greater income, access to advanced technologies, and more stable political environments. Although brain outflow can occur within countries (internal brain drain), it most commonly refers to cross-border or international migration, particularly from underdeveloped to industrialised nations.
In the 1940s, when a large number of European health professionals immigrated to the United Kingdom and the United

States, international relocation of highly qualified professionals became a major public health concern. By the middle of the 1960s, the losses had become substantial. According to Poppe, Wojczewski, and Taylor . (2019), the World Health Organisation published a 40-country study on the importance and flow of health professionals in 1979, and the results indicated that nearly 90 percent of all migrating nurses were moving to just five countries: Australia, Canada, the Federal Republic of Germany, the United Kingdom, and the United States. Policymakers in both sending and receiving nations have paid close attention to the high global demand for nurses, which has led to migration from low-income to high-income nations.

For a country like Nigeria, which relies heavily on international aid and has a fragile health-care system, the effects of the widespread relocation of health-care personnel are shocking. To reinforce further, Hajian, Yazdani et al. (2020) points out that, Nigeria, like the majority of African countries, is experiencing a human resource crisis in the public health sector, with many of its health professionals, such as physicians and nurses, migrating to industrialised nations in pursuit of improved employment opportunities. Despite the fact that the government’s 2007 economic assessment indicates a significant increase in expenditure on public health, the sector remains severely underfunded, and migration to Nigeria’s and other countries’ metropolitan regions continues unabated. According to Yuksekdag (2018), the migration of health professionals has a significant impact on the public health sector in Africa because the majority of the continent’s population relies on government-provided health care services.


1.2 Statement of the Problem

Fagite, (2020), stated that the deteriorating socioeconomic conditions and deepening poverty in the late sixties and early seventies gave room for a wide variety of migration option. Immediately the excitement of national sovereignty waned and the early nationalists, who assumed the mantle of leadership with the exit of the colonisers, began to mismanage the collective resources of the nation, and military intervention became inevitable, the country was plunged into the grip and jackboot of military dictators. The situation forced many Nigerian professionals including health workers to relocate to countries that are more conducive and accommodating in their effort to increase their standard of living. But since the inception of the National Health Scheme, only about one percent of the populace have access to health insurance policy (NOIPOLLS, 2018).

In recent years, the health-care system in developing countries has faced a number of obstacles, one of which is a lack of human resources. Over the past five years, developing country governments have lost a significant number of health managers, nurses, and physicians to international Non-Governmental Organisations, which can easily outbid the public sector for local health expertise. According to Efendi et al. (2019), the physician-to-population ratio in Africa is 13/100,000, whereas it is 280/100,000 in the United States. Despite these disproportionate numbers, approximately 23,000 competent academics depart Africa annually. In 2001, a newspaper based in Manila reported that 13,536 Filipino nurses had escaped the country, while only 4,780 had graduated. 6A 2002 assessment of Ghana’s health-care facilities revealed that 72 percent of all clinics and hospitals were unable to provide the complete range of intended services due to a lack of personnel. 77% were unable to provide 24-hour emergency assistance and round-the-clock secure deliveries for women in labour, and 43% were unable to administer complete child vaccinations. According to Najib et al. (2019), Zimbabwe trained 1200 physicians in the 1990s, but by the year 2000, only 360 remained in the country. In Kadoma, there was one nurse for every 700 residents eight years ago; today, there is one for every 7,500. In 1980, the nation was able to occupy 90% of its nursing positions; today, only 30% are occupied. In addition to a dearth of employees, 18-41% of Africa’s health care workforce is HIV-positive, according to the International Labour Organisation. In 2006, more than 25 percent of U.S. physicians were trained abroad, and the country had an estimated ratio of 25.6 physicians per 10,000 persons. Lesotho, a small country in southern Africa, has 0.5 physicians per 10,000 people and an adult HIV prevalence rate of 28.9%, in addition to TB, malaria, and a multitude of other lower respiratory and gastrointestinal diseases that plague the region.

In addition, the inefficiency which is a reflection in the underinvestment as well as the poor administration in the health sector in Africa particularly in Nigeria, have to a large extent contributed to the mass exodus of healthcare workers from the country which has in turn left the country’s health system in a fragile state. It has been proven by experts that there is a direct correlation between the efficient governance of the health system and the positive output of health workers which in turn reflects in the positive health of the citizens (WHO, 2011, cited in Enabulele, 2021). The same assertion was collaborated in a journal of national Library of Medicine (Fryatt, Bennett, and Soucat, 2021). It is against this backdrop that this study will be investigating brain drain among Nigerian health workers, consequences on health personnel and healthcare system.


1.3 Objectives of the Study

The overall aim of this study is to examine brain drain among Nigerian health workers, consequences on health personnel and healthcare system. Hence, the study will be channeled to the following specific objectives;

  1. To identify perceived reasons why health workers migrate.
  2. To identify the perceived effect of migration in healthcare personnel.
  3. To asses the perceived effect of brain drain on healthcare system in Nigeria/ Sokoto.

1.4 Research Questions

The research is guided by the following research questions:

  1. What are the reasons why health workers migrate?
  2. What is the effect of migration in healthcare personnel?
  3. What is the effect of brain drain on healthcare system in Nigeria?

1.5 Research Hypothesis

  • Ho: Brain drain has no negative effect on Nigeria healthcare system
  • Ha: Brain drain has a negative effect on Nigeria healthcare system

1.6 Significance of the Study

Knowing the impact of nurse emigration in the country will assist policymakers in implementing the proposed remedy to the problem or danger to the health-care system. The study’s findings will offer a direction for training institutions on the need to enhance their training capacity and student intake. These are merely short-term actions, but they may trigger or encourage more nurses to travel overseas in the long run. The study’s findings will provide hospital administrators with a permanent solution to this problem, while also recommending that hospital administrators and the government provide a conducive working environment, better remuneration, attractive retirement benefits, and other incentives to encourage nurses to return to their home countries. Finally, the findings of this study will contribute to the long-term development of human capital in Nigeria and serve as a resource for students and researchers interested in doing more research on a similar issue.


1.7 Scope of the Study

The study focuses on brain drain among Nigerian health workers, consequences on health personnel and healthcare system. The study will be carried out in Federal Medical Centre, Sokoto.


1.8 Limitation of the Study

Like in every human endeavour, the researcher encountered slight constraints while carrying out the study. Insufficient funds tend to impede the efficiency of the researcher in sourcing for the relevant materials, literature, or information and in the process of data collection, which is why the researcher resorted to a limited choice of sample size. More so, the researcher simultaneously engaged in this study with other academic work. As a result, the amount of time spent on research will be reduced.

Moreover, the case study method utilized in the study posed some challenges to the investigator including the possibility of biases and poor judgment of issues. However, the investigator relied on respect for the general principles of procedures, justice, fairness, objectivity in observation and recording, and weighing of evidence to overcome the challenges.


1.9 Definition of Terms

Relocation:

Also known as Emigration, is the act of leaving a resident country or place of residence with the intent to settle elsewhere.

Brain Drain:

The departure of educated or professional people from one country, economic sector, or field for another usually for better pay or living conditions

Health Workers:

A healthcare worker is one who delivers care and services to the sick and ailing either directly as doctors and nurses or indirectly as aides, helpers, laboratory technicians, or even medical waste handlers.


1.10 Organization of the Studies

The study is categorized into five chapters. The first chapter presents the background of the study, statement of the problem, objective of the study, research questions and hypothesis, the significance of the study, scope/limitations of the study, and definition of terms. The chapter two covers the review of literature with emphasis on conceptual framework, theoretical framework, and empirical review. Likewise, the chapter three which is the research methodology, specifically covers the research design, population of the study, sample size determination, sample size, and selection technique and procedure, research instrument and administration, method of data collection, method of data analysis, validity and reliability of the study, and ethical consideration. The second to last chapter being the chapter four presents the data presentation and analysis, while the last chapter(chapter five) contains the summary, conclusion and recommendation.


Chapter Five


Summary, Conclusions and Recommendations:

5.1 Introduction

This chapter summarizes the findings on brain drain among Nigerian health workers, consequences on health personnel and healthcare system. The chapter consists of summary of the study, conclusions, and recommendations.


5.2 Summary of the Study

In this study, our focus was to examine brain drain among Nigerian health workers, consequences on health personnel and healthcare system. The study was specifically carried out to identify perceived reasons why health workers migrate, identify the perceived effect of migration in healthcare personnel, and assess the perceived effect of brain drain on healthcare system in Nigeria/ Sokoto.

The study adopted the survey research design and randomly enrolled participants in the study. A total of 100 responses were validated from the enrolled participants where all respondent were healthcare workers in Federal Medical Centre, Sokoto.


5.3 Conclusions

Based on the findings of this study, the researcher concluded that;

  1. The reasons why health workers migrate include: under-funding of the healthcare system, dilapidated structures and outdated medical equipment, lack of trust in the health care system, poor remuneration, distance from home, novelty seeking, and positive body language.
  2. Migration has a positive effect on healthcare personnel(s).
  3. The incidence of brain drain has significant effect on Sokoto state health care delivery, which include: it affects quality healthcare delivery, dearth of healthcare practices in the state, reduction of work satisfaction, and burnout and presenteeism

5.4 Recommendations

The followings recommendations are hereby given as a result of the findings from the study:

  1. The government may not be able to fully stop migration, but it can be controlled. Health workers who have migrated for several reasons are recoverable assets to their home country (Nigeria), they can play a part in developing opportunities back at home.
  2. The health service sector in Nigeria must be supported by the government at all levels and all stakeholders to maintain their skilled personnel. Because it is only when health staff, in whatever their cadre, have the necessary tools they require to do their job, adequate and relevant training opportunities, a network of supportive colleagues, and equal recognition for the difficult job they do without nepotism, are they likely to feel motivated to stay back in their home country even when opportunity beckons from elsewhere.
  3. Those that are already foreign based professionals could with the support of the Nigerian government be used to develop innovative graduate education opportunities at home and technology to be transferred to areas of national priorities for research and development.
  4. The hospital managers and the government should provide a conducive-working environment, better remuneration, attractive retirement benefits, and other incentives as a push in factor for nurses to stay back in their home countries.
  5. It is also recommended that a stricter compliance on the WHO recommendation on acceptable global health practice and defaulters should be severely punished. This would lessen the burden of the workload most health workers especially in the public hospitals are made to bear. And there should be an up to date data of all health workers in the country to ensure accountability.

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