At 8:15 am on weekdays, the waiting areas of most public hospitals in Nigeria are already bustling with activity. Plastic chairs are soon filled up. Some patients remain standing silently by the wall; others hold laboratory requisition slips or appointment cards. In some cases, some may wait till afternoon before they can be attended to, while others are told to return the next day, or even days later.
This is due to several factors, but primarily the shortage of medical personnel to handle the many patients seeking attention for one condition or another.
Maryama Idris, a Journalist with Media Trust Group, in one of those mornings recalls having an altercation with a health worker at the Garki General Hospital in Abuja, after she left her position in the waiting queue to help her sick daughter use the restroom. In her words, ‘’the people (health workers) are constantly angry because they are overwhelmed by the number of people they have to attend to; so, any opportunity to reduce the number is always a welcome development for them’’. ‘They need more hands if they must succeed in their work and also offer the best care within their limits to Nigerians’, she said.
This scenario has become all too familiar. It is not merely the case that hospitals are busy; they always have been. But nowadays, more people are reporting delays in seeing a doctor, difficulty getting an appointment with a specialist, and having to travel further to obtain care. Behind such reports lies a broader issue facing the Nigerian healthcare sector: What will happen if there are not enough trained health professionals to meet the increasing demand for medical care?
Recent comments by Nigerian doctor Chukwuebuka Francis Okoye about working long hours and about some of his classmates practicing abroad have again brought the issue of healthcare worker migration in Nigeria to national attention.
He repeated longstanding concerns held by professional organizations, academics, and hospital managers about ongoing shortages in the country as doctors seek their fortunes abroad.
Former President of the Nigerian Medical Association, Uche Rowland, announced in October 2022 that in 2015, 233 Nigerian doctors moved to the UK; in 2016 the number increased to 279; in 2017 the figure was 475, in 2018, the figure rose to 852, in 2019 it jumped to 1,347; in 2020, the figure was 833 and in 2021 was put at 932’’
The migration of healthcare workers within the healthcare industry in Nigeria has not only existed for some time but was informed by several professional, economic and personal reasons.
Better pay, better working conditions, the chance for more specialized training, use of modern technology, and the issue of workplace safety have been cited among others as the reasons why many Nigerian-trained professionals opt to practice outside of their country.
On the poor pay doctors earn, Dr Musa Abdullahi, who works with one of the few teaching hospitals in the North Central region of the country, says, “I am supposed to be the one lifting my family now. But I still depend on them. I still call my mother at the end of the month to ask for small help, like N5,000 here and N10,000 there. It breaks me.
Dr. Rowland also confirmed when he said ‘’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. He added…. “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.”
Rising Populations and the Rural Impact
On the other hand, Nigeria continues to see an increase in its population which leads to increased demand for healthcare provision in both public and private healthcare facilities. However, numbers can never completely give a picture of how this situation affects patients.
According to the Nigeria Health Watch, ‘annual graduation rates, of 4,399 doctors and 274 dentists in 2024 remain insufficient’. The doctor-to-patient ratio stands at just 2.9 per 10,000, which is about one doctor per 3,474 people, far below the WHO recommendation of 17 per 10,000.
In terms of doctor-distribution differences across states, the majority of doctors are concentrated in a handful of states. Specifically, Lagos leads the pack with 7,385, followed by the Federal Capital Territory with 4,453, Rivers with 2,194, Enugu with 2,070, and Oyo with 1996 to make up the top five.
The most recent Medical and Dental Council of Nigeria (MDCN) state counts of doctors by the six geopolitical zones revealed that the South West has 32%, North Central 22%, South-South 19%, South East 14%, North West 11%, and North East 5%. With a population exceeding 230 million, Nigeria needs nearly 400,000 doctors to meet international standards but has only around 66,000.
In Cross River State, South-South Nigeria, a petty trader, Mrs. Rose Ikem Friday, who lives at 8th Mile in Calabar, recalls her struggle to see a doctor at the University of Calabar Teaching Hospital. In her words, you can be waiting outside to see a doctor, only to discover that after the last person, the doctor dozed off because he is too tired, and we are still like fifteen or more, waiting outside the outpatient ward’.
Since her and many other women in her shoes need to see the doctor, they end up staying longer hours, repeating such hospital visits, or deciding to pay more to patronise private hospitals.
‘After that unpleasant experience at the Garki General Hospital, I decided to opt for private hospitals. I know they are more expensive, but for my mental health and quick recovery of my daughter, I would rather pay more’, Maryama said.
The above-mentioned experiences are not always similar in Nigeria; there are great differences between people living in urban and rural areas, tertiary teaching hospitals, general and primary health care centers. Sometimes private hospitals have shorter waiting lines, but the problem is that such institutions are very expensive for many families, while public ones deal with a greater number of patients.
A pattern of adaptation appears in this case: in all parts of the country, hospitals still work with a lack of staff, while healthcare workers are more and more burdened to satisfy the growing demand.
Public-Private Facilities: The Hardest Hit
Accessing quality healthcare has been a difficult thing in Nigeria generally. This is because most public hospitals are always crowded owing to their cheapness. However, quality has always been a problem for both manpower and personnel.
The problem of insufficient human resources within the Nigerian health sector occurs differently at different levels, starting with PHCs where a 122,000 professional shortage compels them to employ poorly trained community personnel. While state general hospitals suffer from critical understaffing, poor payment and lack of even basic equipment create serious problems.
At the top level, the Federal Tertiary/Teaching Hospitals suffer from severe understaffing as the outflow of resident doctors forces the remaining personnel to cope with excessive patients and long working hours.
While there are shortages in the southern part of Nigeria, the health system’s structural base operates normally. However, the rest of the territories suffer from the complete drain of skilled doctors.
The rural settings and the northern regions are places that have the absolute minimum number of physicians in the entire nation. Based on the national workforce statistics, states like Kebbi, Sokoto, Zamfara, Niger, Yobe, Borno, and Adamawa have one doctor or fewer than one doctor for every 10,000 individuals. Such patient-to-doctor ratios surpass the international standards by a very huge margin.
According to recent research findings released by the National Association of Resident Doctors (NARD), there are twelve states in Nigeria, which include Abia, Bauchi, Benue, Cross River, Kogi, and Gombe, among others, with less than 200 registered doctors in total.
The Doctors Who Stay
Despite the challenges health workers face while working in Nigeria, and the very many leaving for better offers in other countries, many remain, taking on more work for the same pay.
For instance, a physician may start off working in an outpatient department, get called to an emergency ward, review inpatients in the wards, and answer consultations before leaving work. In most hospitals, especially in tertiary healthcare facilities, the amount of work done depends not only on the number of patients but also on the low number of clinicians who could treat them.
This has led to devastating health consequences for the doctors, and in some cases, outright death.
A case in point is that of a senior consultant physician based in Kano State who died when he collapsed barely 15 minutes after arriving at a hospital to attend to patients who had been waiting several hours for his evening clinic. His sudden death was heavily attributed to extreme work overload and systemic exhaustion. Medical bodies noted that he was operating under the immense pressures of an overstretched health system.
A similar case happened when Dr. Oluwafemi Rotifa, a young resident doctor, collapsed in September 2025 and died in the call room at Rivers State University Teaching Hospital after working a grueling, non-stop 72-hour shift due to severe understaffing.
‘’The only thing still keeping me in Nigeria is the fact that I have not been able to raise the amount I need to leave this country. My colleagues abroad are already doing well and sending help back home, but here I am still struggling to feed’, says Dr. Ejike, whom this author met at a local church assembly in the Mararaba axis of Karu LGA of Nasarawa state.
Maintaining Service Delivery Amid Worker-Shortage
Amid the shortage dilemma, many hospitals, administrators, and managers have been looking at ways of adapting to stay afloat and render the much-needed care to patients. In public and private hospitals, the management changes the schedule of clinics, workload distribution, and tries different methods to ensure continuity of services.
In some facilities, the list of patients of consultants is bigger now than a decade ago; in others, the appointments have been changed to spread the patients through the week, and in some cases, multidisciplinary teams are working together to make sure there is no disruption in service.
One of the key answers to the problem is the increasing use of task shifting and task sharing, a strategy recommended in Nigerian health policies, which allows properly trained nurses, community health extension workers and other cadres to perform selected procedures usually performed by physicians under regulated professional frameworks.
Advocates claim that task shifting will improve access to services without loss of quality if properly done, especially in primary healthcare. Dr. Jude, who runs the Mararaba Charity Hospital at Abacha Road in Karu LGA of Nasarawa State, says the challenge of manpower has made him come up with flexible routines, few incentives, as well as increased service charges to retain talent.
‘We have to do that to stay afloat because the cost of consumables is rising by the day. Even at that, we still offer competitive services at very affordable rates. It is very challenging because everyone wants to stay healthy, so countries that offer better pay take our talents away, but you must adapt’.
A nurse at the hospital, who does not want to be named because she is not authorized to speak, says sometimes they work way beyond the routine 9-5-hour belt, before being relieved by the next person. According to Dr. Jude, the aspects of medical specialties most affected by doctors leaving Nigeria are surgical operations, emergency care, and specialized clinical training, hitting fields like surgery, anesthesiology, and oncology hardest.
Beyond the Numbers
Across Nigeria, available data reveals that workforce distribution is uneven across rural and urban areas. In rural communities, qualified health personnel are very limited in number; hence, patients are more often than not attended to by the lower cadre of health professionals. One argument is that most locals are unable to pay for highly qualified professionals, even if it were in private hospitals, while those in public hospitals remain very limited and tied to facilities in the cities. This is why referrals to city centers are common when it comes to severe health conditions.
About patients’ experience in Nigeria, there is a stark difference, with people preferring public hospitals on grounds of affordability and reliability in their treatment, while private clinics excel in terms of speed and empathic behavior towards their customers. Research consistently reveals that patients’ satisfaction in the private healthcare system is significantly higher due to individualized care provided by the clinic in such areas as:
Scheduling and Efficiency: The secondary and tertiary public health institutions struggle with overcrowding, which results in patients spending an unnecessarily large amount of time in queues because of the huge number of patients. On the contrary, private hospitals provide short waiting times and easy registration and appointment scheduling.
Attitude of Healthcare Providers and Patient Dignity: Providers in the public sector suffer from significant burnout, which is reflected in their low scores in terms of respect, courtesy, and privacy. Private clinics pay significant attention to their provider’s responsiveness and patient empathy.
Cost and Financial Access: Public health institutions are well subsidized and therefore the main accessible options for the poor and middle classes. On the other hand, private healthcare is unaffordable to the general population, thus changing the patient demographic to only the few people who can pay out of pocket or those insured through companies.
Facilities and Equipment: Public institutions often experience shortages of even the most basic diagnostic consumables and power issues. On the other hand, private institutions usually offer better conditions and facilities, although they lack specialized clinics that exist in the best public teaching institutions.
Resilience Of Nigeria’s Healthcare System
One of the greatest takeaways from the debate on Nigeria’s healthcare workforce might just be the realization that migration isn’t the whole picture. Healthcare workers have been migrating for centuries, bringing their experience and expertise all over the world. The key challenge, however, lies in strengthening the health systems of individual countries amidst the growing mobility of the global workforce.
Some of the approaches to this challenge could include developing training programs, improving working conditions, fostering primary healthcare services, providing opportunities for professional development of healthcare workers, increasing the utilization of technology, and ensuring sound workforce planning based on current and anticipated future trends.
The resilience of the healthcare system of Nigeria is manifest every single day in the efforts of doctors who work extra hours, nurses who comfort worried families, administrators who find new ways to operate medical facilities, and the patients who trust the healthcare providers in Nigeria.
But resilience shouldn’t be confused with inexhaustibility. There is a healthcare worker behind every consultation who brings valuable expertise to the table. There is a person behind every statistic waiting for proper care rather than treatment.
When doctors migrate, patients pay a price for that, and that is true, but the story behind the migration of doctors is much more than just that. It is about whether the health system can continue providing timely care when demand grows faster than available human resources, as exemplified in the dearth of professionals, especially in public health facilities across Nigeria.
