The healthcare system in Nigeria is teetering on the edge of a major structural crisis as medical associations raised fresh alarm over the country’s worsening doctor-to-patient ratio, which has officially deteriorated to a staggering 1:4,000.
Driven by the wave of external migration—popularly known as the “Japa” syndrome—this brain drain has left the nation’s remaining medical practitioners severely overstretched and burned out.
This alarm on the doctor-to-patient ratio in Nigeria was raised at the Ordinary General Meeting and Scientific Conference of the Association of Resident Doctors, ARD, Federal Neuropsychiatric Hospital, FNPH, Yaba, Lagos, with the theme, “Too Few Doctors, Too Many Patients: The Consequences of Manpower Shortage on the Mental Well-being of Nigerians.”
According to data presented during the meeting, the gap between available medical professionals and the growing population of over 220 million people has widened into a chasm.
While the Medical and Dental Council of Nigeria (MDCN) has historically registered over 130,000 doctors, only about 55,000 remain actively practicing within the country.
The rest have emigrated, retired, or left clinical practice altogether.
The doctors also said no fewer than 16,000 Nigerian doctors have emigrated in the last five years, worsening an already dire doctor-to-patient ratio in Nigeria.
They warned that the sustained exodus of healthcare workers under the “Japa” syndrome had severely depleted the country’s mental health workforce, widened treatment gaps, increased the cost of care, and placed enormous pressure on the few specialists remaining in the system.
Speaking on the situation, the President of Nigerian Medical Association, NMA, Prof Omoti Ernest, said recent data showed that the Medical and Dental Council of Nigeria, MDCN, had registered over 130,000 doctors but noted only about 55,000 are actively practicing within Nigeria.
He said that with a population exceeding 220 million, this translates to roughly one doctor for every 3,600 to 4,000 people.
“This ratio is far below the World Health Organisation’s recommended threshold of one doctor to about 600 people, highlighting the significant shortage of medical personnel and the strain on healthcare delivery.
“Many Nigerian-trained doctors have emigrated or are no longer engaged in active clinical practice, contributing to the country’s healthcare workforce shortage,” the NMA President said.
He said the emigration of skilled professionals in search of better opportunities abroad has had a significant impact on Nigeria’s hospitals and healthcare workforce.
He said further: “Thousands of doctors and other healthcare professionals have left the country in recent years, leading to severe staff shortages, increased workload for those who remain with many suffering from burnout, longer waiting times for patients, and declining quality of care in many public hospitals.
“Rural and underserved communities have been particularly affected, as they already struggle with limited access to healthcare services.
‘’The reasons behind this migration include poor remuneration, inadequate working conditions, insecurity, limited opportunities for career advancement, and insufficient investment in healthcare infrastructure, among others.
“Many professionals are attracted by better pay, improved facilities, and more stable environments in countries such as the United Kingdom, Canada, and the United States.”
To address the trend on the doctor-to-patient ratio, he said the Federal Government should prioritise salaries and welfare packages for healthcare workers, invest more in modern medical equipment and hospital infrastructure, expand residency and specialist training opportunities, and create clear career progression pathways.
Omoti said: “Strengthening security, ensuring timely payment of wages, and providing incentives for professionals to work in underserved areas will also help retain talent.
‘’In addition, partnerships with the private sector and diaspora engagement programmes could encourage Nigerian healthcare professionals abroad to contribute their expertise and support development of the country’s healthcare system.”
Speaking at the parley, a Consultant Psychiatrist at the Neuropsychiatric Hospital, Aro, Dr. Yesir Kareem, said Nigeria’s doctor-to-patient ratio had fallen to about one doctor for more than 10,000 patients, far below the World Health Organisation’s recommended ratio of one doctor to 600 people.
According to him, the consequences are particularly devastating for mental healthcare.
“Only about 55,000 doctors remain to serve a population of over 220 million Nigerians. More than 40 million Nigerians suffer from mental health disorders, yet about 85 per cent of them do not have access to mental healthcare services,” Kareem said.
He noted that Nigeria’s shortage of psychiatrists and other mental health specialists has reached alarming levels, warning that untreated mental illnesses contribute to family breakdowns, substance abuse, unemployment, delayed diagnosis, and premature deaths.
“The economic consequences are equally devastating, with billions of dollars lost annually due to untreated mental health conditions,” he added.
He also noted that 94,000 doctors and nurses had left Nigeria since the Japa syndrome started some years ago.
He said the doctors were leaving due to poor remuneration and delayed salaries, competitive salaries in destination countries, overwhelming patient loads (1:10,000+), better work-life balance and conditions, and inadequate medical equipment & facilities.
He also listed access to modern medical technology, limited career advancement opportunities, professional development and training, unsafe working conditions and long hours, unstable political and economic environment, and insecurity and socioeconomic instability as factors encouraging migration of doctors from the country.
President of the Association of Psychiatrists in Nigeria, APN, Dr. Veronica Nyamali, in a chat with Vanguard, described the manpower shortage as a crisis that had forced consultants to abandon higher-level responsibilities, such as research and specialist care, to fill gaps left by departing doctors.
“There are gaps everywhere. Work that should be done by four psychiatrists is now being handled by one or two people. Consultants are increasingly forced to work at lower levels because the doctors they are supposed to supervise are no longer there,” she said.
Nyamali lamented that many doctors undergoing specialist training now leave the country before completing their careers in Nigeria, creating persistent vacancies across psychiatric facilities.
“Those we train are leaving. Junior registrars, senior registrars, and many complete their examinations and return abroad. The result is that we have shortages at every level of care,” she stated.
