Physician emigration from Nigeria and the associated factors: The implication to safeguarding the Nigeria Health System

Abstract

Background: Adequate Human Resources for Health is indispensable to achieving Universal Health Coverage and physicians play a leading role. Nigeria, with low physician-population ratio, is experiencing massive exodus of physicians. This study investigated emigration intention of physicians, the factors influencing it and discussed the implications to guide policy formulation and reforms to curtail the trend and safeguard the country’s health system.Methods: Through cross-sectional survey, 913 physicians from 37 States were interviewed with semi-structured questionnaire using online Google form with link shared via WhatsApp and Telegram forums of Nigeria Medical Association and her affiliate bodies. Data was analyzed with IBM-SPSS version-25 and charts were created with Microsoft Excel Spread Sheet version 2019. Chi-square and binary logistic regression tests were done with p-value set at 0.05 for statistical significance. Results: The mean age of respondents is 37.6±7.9 years; majority of them are males (63.2%), married (75.5%) with postgraduate qualifications (54.1%) and working in public health facilities (85.4%) located in urban areas (64.2%). Whereas only 13% and 19.3% of the physicians are respectively satisfied with their work and willing to continue practice in Nigeria, 43.9% want to emigrate and 36.8% are undecided about future location of their practice. The commonest reasons for emigration are poor remuneration (91.3%), rising insecurity (79.8%) and inadequate diagnostic facilities (61.8%). Physicians working in public health facilities are 2.5 times less satisfied than their counterparts in non-public sector and those in their thirties, forties and fifties are 3.5, 5.5 and 13.8 times respectively more willing to retain practice in Nigeria than those younger.Conclusion: Majority of Nigerian physicians want to emigrate for professional practice and top among the push factors are poor remuneration, rising insecurity and inadequate diagnostic facilities. The observed trend portends danger to the country’s health system due to the foreseeable negative consequences of physician deficit to the health system. We recommend upward review of physician remuneration, a root cause analysis of insecurity to determine workable preventive measures and increased funding of the health sector to improve the diagnostic infrastructure in order to retain physicians and save the health system from imminent collapse.