Will deterrents to migration strengthen the health workforce in Nigeria?

 

About two weeks into February, the Nursing Council in Nigeria announced a new policy to curb the migration of the nursing workforce. This policy, which will come into effect in March, will require that entry-level nurses work for a minimum of two years before applying for verification of their nursing licence for overseas work. Since the announcement of the policy, nurses have protested at the regulatory body offices in Abuja and Lagos. The protests have also gained significant traction on X.

This isn’t the first time policymakers in Nigeria have considered using such policies to deter the migration of healthcare workers. In April last year, lawmakers proposed a five-year mandatory service for entry-level doctors before applying for full licensure for practice. These lawmakers argued that the measure was a way for doctors to give back to society after enjoying the dividends of subsidised education.

The Nigerian health workforce is indeed facing an unprecedented wave of migration to the Global North. According to the Registrar of the Nursing and Midwifery Council of Nigeria (NMCN), 42,000 nurses have left Nigeria in the last three years. Unfortunately, with a nursing and midwives density of 15.6 per 10,000 population, and a doctor density of 3.9 per 10,000, the health workforce shortage in Nigeria has significantly hindered the achievement of health-related sustainable development goals.

But I can’t help but wonder, “Can deterrents effectively modify health workers’ behaviours and improve the health workforce crisis in Nigeria?” In my opinion, a resounding no, and for these reasons.

One, restricting migration violates an individual’s rights to movement for personal gain. The International Covenant on Civil and Political Rights recognises an individual’s right to leave a country, including his home country. This right is recognized by both the Universal Declaration of Human Rights and the African Charter on Human and People’s Rights.

Second, the restriction of health workers in this context is neither efficient nor equitable. From a welfarist perspective, the flow of human capital is a reflection of efficient resource allocation, and welfare is maximized globally when there is free movement of labour from countries with low productivity to countries with high productivity. Therefore, regulating international migration of skilled manpower distorts efficiency. If we consider the uniqueness of the healthcare market from an extra welfarist perspective, and value equity over efficiency, since Nigerian leaders and lawmakers are notorious for seeking personal medical care abroad, can we conclude that deterrents in this context are for the sake of equity?

Finally, substantial evidence shows that coercive policies like deterrents not only perform poorly but worsen the pressure to leave. They also reduce the chances of migrant health workers returning with their skills and expertise.

Rather than use deterrents to curb the migration of health workers, policymakers should consider non-monetary incentives. For example, mentorships from the senior health workforce may help retain entry-level nurses. Research has shown that mentorships can retain the healthcare workforce, by as much as 25%. In a study done in Northern Uganda, health workers were more likely to remain in remote public health centres if they felt valued and respected by senior colleagues. Unlike the hierarchical apprenticeship style that characterises most clinical training, the mentorship style of training encourages mutual respect and trust. It also creates a conducive environment for advocacy, career progression and job satisfaction.

Furthermore, since most of the health workforce is employed by the government, employers should optimize recruitment in such a way that spaces left by migrated workers are quickly filled by the unemployed. This is significant, in light of the menace of ghost workers that plague most public facilities in Nigeria.

Finally, the Medical and Dental Council and Nursing and Midwifery Council should strengthen advocacy efforts. They should advocate the need for better remuneration, working conditions, and smoother career progression. They should also advocate the need for employers in private practice to employ registered nurses, and not unprofessional “auxiliary nurses” in a bid to save cost.

The health workforce crisis in Nigeria is reaching a peak. Migration levels will continue to rise as the global demand for human resources for health rises.  Policymakers in Nigeria do not have the luxury of time to experiment with policies that may backfire or worsen a crisis approaching existential levels. A short-term solution to a chronic problem is hardly useful. Rather than look for quick fixes, policymakers must be ready to play the long game.

About the author: Dr. Nzube Ifediba is an early career health economist and health policy researcher. She is a volunteer health policy analyst at the Africa Health Organization. Her current project examines the evidence on the cost of health worker migration from Africa. (LinkedIn)

Competing interests: None

Handling Editor: Neha Faruqui

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