By Chioma Obinna
Statistics from the Medical and Dental Council of Nigeria, MDCN, showed that in 2024, Nigeria registered about 4,900 new medical doctors and dental surgeons, while 4,200 requested certificates of good standing, a clear sign that many are preparing to practice abroad.
Against this backdrop, Good Health Weekly, spoke to Professor Peter Ndidi Ebeigbe, immediate past President of the National Postgraduate Medical College of Nigeria, NPMCN, Ijanikin, Lagos.
The Professor of Obstetrics and Gynaecology at Delta State University, Abraka, explains why economic reforms, stronger health financing and improved medical infrastructure are critical to stabilising Nigeria’s healthcare system.
Excerpts:
How would you assess the standard of postgraduate medical training in Nigeria today?
The quality of postgraduate medical training in Nigeria is comparable to global best standards. From inception, the National Postgraduate Medical College of Nigeria put mechanisms in place to ensure that specialist training aligns continuously with international best practices.
The College was established more than fifty years ago by Nigerian specialists who trained in the United Kingdom and the United States. Their vision was to build an institution capable of producing world-class specialists committed to excellence in clinical practice and research. That vision still guides the College today.
The first step in maintaining quality is defining the type of specialist you intend to produce. The College therefore adopted the principles of competency-based medical education, which is the prevailing model globally. Under this system, physicians and surgeons are trained according to clearly defined competencies and outcome expectations that must be demonstrated at the point of graduation.
Once the competencies are defined, a detailed curriculum is developed to guide the training process. Importantly, this curriculum is not static. It is reviewed every four to five years to incorporate new developments in medicine, global trends and evolving local realities.
Another important pillar is accreditation. Training institutions across the country must meet strict standards regarding personnel, equipment, facilities and opportunities for trainees to acquire practical medical and surgical skills. Institutions that satisfy these conditions are accredited and are reassessed periodically—usually every two to five years depending on their performance.
There is also a rigorous system of continuous assessment. Trainees are evaluated at various stages of their training to ensure they have acquired the required knowledge, professional attitude and technical competence before progressing further. Certification as a specialist is based on cumulative evidence obtained from both formative and final assessments.
This system ensures that training, accreditation and evaluation processes remain aligned with contemporary international standards. It also explains why Nigerian specialists continue to perform very well when they practise in Europe, North America and other parts of the world.
What major challenges are resident doctors currently facing in Nigeria?
Compared with resident doctors who trained three or four decades ago, the most serious challenge today is the erosion of the value of their remuneration. This is largely a consequence of the weakening value of the naira relative to the dollar and the wider effects of inflation.
Because of this economic reality, many young doctors feel undervalued within the Nigerian health system and are increasingly considering relocation abroad—what is popularly referred to as the “Japa” phenomenon. This situation has significantly affected morale within residency programmes and has reduced the number of doctors available within the system.
Beyond remuneration, there are other challenges. Many training hospitals lack cutting-edge equipment required for modern specialist training, including advanced simulation tools and training mannequins used for high-fidelity medical simulations. These pieces of equipment are mostly imported, and the weak value of the naira makes them extremely expensive to procure with limited government budgets and internally generated revenue.
Security is another concern. In recent years, several resident doctors across the country have fallen victim to kidnappers. This creates an atmosphere of anxiety that further discourages young professionals from remaining in the system.
While the College cannot directly address issues such as exchange rates, remuneration or national security, we have taken steps within our mandate to improve training opportunities. One approach has been encouraging joint accreditation arrangements between well-equipped institutions and hospitals with large patient loads but fewer facilities. This allows trainees to benefit from both environments.
We have also encouraged greater participation by the organised private health sector in specialist training. Many private hospitals possess modern equipment in various subspecialties and can collaborate with government facilities to expand training opportunities. The goal is to maximise the use of available resources within the country.
Why is the migration of Nigerian doctors accelerating?
The migration of doctors from Nigeria is fundamentally an economic issue. It is not unique to the medical profession; similar patterns are observed across other sectors of the economy.
Globally, skilled professionals tend to move to environments where their expertise is better rewarded and appreciated. In Nigeria’s case, the major pull factors include significantly higher remuneration and better working conditions in the Middle East, Europe and North America.
At the same time, several push factors encourage migration. These include poor remuneration, inadequate working facilities, insecurity and limited career prospects in some areas of practice.
Medical migration occurs along two major pathways. The first involves senior specialists and academics who are highly sought after in countries across the Middle East, Europe and the United States. The second involves younger professionals who are recruited by health systems in the United Kingdom, Canada, the United States and parts of Europe where there is a strong demand for doctors.
Because the root of the problem is economic, the solution must also be economic. Nigeria has experienced similar waves of migration in the past. In the mid-1980s, the government recognised that doctors and other professionals were leaving largely because remuneration in Nigeria had fallen far below international levels.
To address the problem, deliberate measures were introduced to ensure that professionals could earn salaries equivalent to a significant proportion of what they would receive abroad. Once the currency stabilised and remuneration improved, the wave of migration declined substantially.
Although the present economic challenges may make such reforms difficult, prioritising public health remains essential. Urgent salary reviews and broader economic reforms that strengthen the value of the naira will go a long way in retaining skilled health workers within the country.
Nigeria’s health sector is often criticised for relying heavily on out-of-pocket spending. How can this be addressed?
Healthcare financing is a major challenge worldwide because healthcare is inherently expensive. At the same time, access to healthcare is recognised as a fundamental human right. A functional health financing system must therefore ensure universal access to quality care while minimising inequalities.
Typically, national health systems are funded through a combination of government budgets, health insurance contributions, donations from international organisations and direct payments by individuals. Governments also provide special support for vulnerable groups such as the elderly and persons with disabilities.
The challenge in Nigeria is that contributions from other funding sources remain relatively low. As a result, the country relies heavily on out-of-pocket payments by patients. In some segments of the population, as much as 70 to 80 per cent of healthcare spending comes directly from individuals.
This places a heavy financial burden on families, especially those in the middle- and lower-income categories.
One important starting point is the commitment made by African leaders in the Abuja Declaration of 2001 to allocate at least 15 per cent of national budgets to the health sector. In Nigeria, allocations have consistently fallen far below this benchmark, sometimes below six per cent.
If Nigeria had consistently invested even close to the Abuja Declaration target over the past two decades, the country’s health system would likely look very different today.
However, government spending alone will not solve the problem. The principle of pooling resources remains central to sustainable healthcare financing. Unfortunately, health insurance coverage in Nigeria remains very low, with less than a fifth of the population currently enrolled.
Most of those covered are civil servants or employees in the organised private sector, while a large proportion of the population—particularly the self-employed and rural residents—remain outside the system.
This situation creates two major problems. First, the health system loses the opportunity to pool resources from large segments of the population. Second, individuals who are not insured must depend entirely on out-of-pocket payments whenever they fall ill.
The issue is not necessarily the design of the health insurance scheme. No system anywhere in the world is perfect. The real challenge lies in implementation.
Nigeria has successfully mobilised citizens for major national programmes in the past, such as immunisation campaigns, voter registration drives and the nationwide registration for the National Identification Number. A similar level of commitment is needed to expand health insurance coverage.
This will require aggressive public awareness campaigns, community-based enrolment initiatives and incentives that encourage people to join the scheme. At the same time, aspects of the implementation structure—including disease coverage and payment arrangements—may need to be reviewed based on evidence from experts in the field.
Medical tourism remains common among Nigerian elites. What does this say about the local health system?
Medical tourism occurs whenever patients believe they can obtain better treatment elsewhere and have the financial means to travel. People are naturally willing to go wherever they can receive effective treatment or significant improvement in their quality of life.
In Nigeria, the phenomenon is largely driven by the absence or limited availability of certain advanced medical procedures and technologies. When the required expertise or equipment is not available locally, patients who can afford it seek care abroad.
However, when similar services are available within Nigeria, they are usually cheaper and more convenient than travelling overseas. Encouragingly, more world-class hospitals are being established across the country, and this is gradually reversing the trend of medical tourism.
Nevertheless, progress needs to be faster. Another issue is equitable access. Some high-quality healthcare facilities already exist in Nigeria, but they are often beyond the reach of ordinary citizens.
Ultimately, the underlying problem is inadequate investment in the health sector. Both government and private investors must commit significantly more resources if Nigeria hopes to build a healthcare system capable of competing globally.
A useful model exists within Nigeria’s education sector. The establishment of TETFUND created a sustainable funding stream for tertiary education through a two-per-cent tax on corporate profits. The proceeds have significantly improved infrastructure in universities.
A similar intervention could be designed for the health sector.
There are also lessons to be learned from countries like India, where privately owned hospitals have grown into world-class institutions partly because they have access to low-interest government-backed loans that enable them to upgrade facilities regularly.
If Nigeria were to adopt a similar approach, it could transform selected tertiary hospitals into centres capable of attracting international patients. The resulting inflow of foreign exchange could then be used to subsidise healthcare for the local population.
Nigeria still records high maternal mortality rates. What factors drive these deaths?
Maternal mortality remains a significant challenge in Nigeria, although the medical causes are well known. They include severe bleeding after childbirth, prolonged obstructed labour, unsafe abortion and its complications, severe pre-eclampsia and eclampsia, and puerperal sepsis.
These conditions are not always preventable, but they can be treated effectively if women reach hospitals early and receive appropriate care.
Reducing maternal mortality therefore depends on several key pillars. First, women must have access to family planning services so they can decide when and how many children to have. Second, pregnant women must receive proper antenatal care from qualified health professionals. Third, deliveries should be supervised by skilled birth attendants such as midwives or doctors. Finally, women must have access to prompt emergency obstetric care whenever complications arise.
The difference between developed and developing countries is largely determined by how well these pillars function.
What delays often prevent women from receiving life-saving care?
Research and clinical experience in Nigeria show that maternal deaths are often linked to three types of delay.
The first delay occurs when a woman fails to recognise that her symptoms are life-threatening or delays the decision to seek medical help. This is common among women who did not register for antenatal care or who lack basic health education.
The second delay involves difficulties reaching a health facility. Poverty, poor transportation systems, bad roads and insecurity can all prevent women from getting to the hospital quickly. In some cases, cultural practices or economic dependence may also require women to wait for permission or financial support before seeking care.
The third delay occurs after the woman reaches the hospital. If the facility lacks skilled personnel, essential drugs, blood supplies or functioning equipment, treatment may be delayed further.
All three delays contribute significantly to maternal deaths.
What practical steps can help reduce maternal mortality?
Reducing maternal deaths requires action from individuals, families, communities and healthcare providers.
Women of reproductive age should plan pregnancies carefully and make use of contraception when necessary. After childbirth, adequate spacing between pregnancies is important to allow the body to recover. Ideally, women should limit the number of pregnancies and avoid childbirth at older ages when risks increase.
Once pregnancy occurs, early registration for antenatal care is essential. Pregnant women should attend clinics regularly, undergo recommended tests and follow medical advice.
Families and communities also play a vital role. They must ensure that pregnant women reach hospitals quickly whenever labour begins or complications arise. In some communities, collective arrangements have been established where vehicle owners or local drivers assist in transporting pregnant women to hospitals during emergencies.
Healthcare providers also have responsibilities. Hospitals must ensure that essential drugs, blood supplies and equipment are readily available. Medical staff must also respond promptly and courteously to patients, ensuring that critical care begins within minutes of arrival.
Looking back at your tenure as President of the National Postgraduate Medical College of Nigeria, what achievements stand out?
One major realisation early in my tenure was that many stakeholders across Nigeria did not fully understand the role of the College despite its more than fifty years of existence. We therefore made deliberate efforts to engage different sectors of society and increase awareness of the institution’s mandate.
Another significant initiative involved creating pathways for Nigerian specialists in the diaspora who have distinguished themselves in medical practice, research and training to become fellows of the College. In 2024, the College approved criteria for fellowship by election for qualified Nigerian specialists abroad.
We also introduced honorary fellowship categories for internationally recognised experts in medicine and related fields. During our annual scientific conference in Sokoto, the first set of twelve distinguished individuals—eleven Nigerians and one American—were honoured.
International collaboration was another priority. The College strengthened partnerships with several institutions, including the Royal College of Emergency Medicine and the Royal College of Pathologists. Discussions with other Royal Colleges were also underway at the end of my tenure. Regional partnerships with the College of Emergency Medicine of South Africa, Ghana College of Physicians and Surgeons, and the East, Central, and South African College of Obstetrics and Gynaecology (ECSACOG) were advanced, among others.
In addition, the College expanded its training programmes significantly. New specialist areas such as Interventional Radiology, Nuclear Medicine, Interventional Cardiology, Pain Medicine, Critical Care Medicine and Transplantation Medicine were introduced.
We also established the Faculty of Radiation and Clinical Oncology as the seventeenth faculty within the College.
These initiatives were designed to strengthen specialist training and ensure that Nigeria continues to produce highly competent medical professionals capable of competing globally.
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