Since completing her midwifery training three years ago, Aisha*, a 27-year-old midwife and mother of three children under the age of five, has been working in a thriving primary health care center in Kano State, northern Nigeria. Masu.
She loves her job, but said life has become more difficult since the recent devaluation of Nigeria’s currency, the naira.
“I haven’t been paid for two months,” Aisha says. “Even though I have more responsibilities at the health center, I receive 76,540 naira (about $48) a month. I often do not receive my salary on time.”
This situation sparked Aisha’s interest in finding a better paying job in an urban area in Nigeria or in the UK.
Aisha’s situation is not unique. About 80% of nurses and midwives in Nigeria say they would be willing to quit, or japa (‘escape’ in Yoruba), if they had a better job opportunity in another country. Between 2017 and 2022, more than 57,000 nurses and midwives left Nigeria, or about 30% of the country’s nurses and midwives. England was their top destination.
80%
About 80% of nurses and midwives in Nigeria say they intend to quit for better job opportunities
To address the challenges driving this migration, health consultancy firm Sidani Group has announced that from November 2023 to June 2024, nurses and midwives in primary health facilities in 36 states of Nigeria and the Federal Capital Territory of Abuja will be A nationwide survey was conducted targeting 197 people. The study was part of a larger research initiative that included interviews with policy makers and a review of projects undertaken to improve the country’s health workforce.
Of the 197 healthcare workers surveyed, 50% were between 36 and 60 years old, and 89% were women. The average age was 38 years for women and 34 years for men. Both had an average of 13 years of work experience. Healthcare providers surveyed cited higher remuneration (34%), better career development paths (31%), and availability of good infrastructure and basic amenities (16%) as the main motivations for considering relocation. ) and other factors.
Salary and financial support
There is an urgent need to increase salaries for nurses and midwives and ensure these essential health workers are paid on time. The primary care facilities surveyed earned just $20, and 79% made between $20 and $150. Many reported frequent delays in the arrival of their paychecks. To address immigration, the central government should review the pay structure for health workers and healthcare workers and force state governments to implement federally mandated pay.
State governments control about half of Nigeria’s overall health budget and most of the funds available for primary health care. Therefore, there is a need for state governments to take an active role in improving the social welfare of nurses and midwives by paying salaries on time and providing hazard pay to health workers working in rural and more precarious areas. It is essential to take appropriate measures.
Other incentive packages addressing credit insurance and access to health insurance need to be developed and implemented to encourage nurses and midwives to work in rural areas. Some states have begun offering incentive programs for rural midwives, including access to health insurance and hazard pay. Several midwives we interviewed said that having access to small loans was a motivating factor.
A mother carries her baby in a strapped carrier bag outside the Usse General Hospital on January 26, 2022 in Abuja, Nigeria. Reuters/Afolabi Sotunde
Medical facilities: aging due to lack of staff
80% of midwives reported experiencing extreme overwork in their facilities, primarily due to staffing shortages.
You need up-to-date information on non-accredited educational institutions, training programs, production capacity, and quality of learning. Nigeria has approximately 350 nursing and midwifery training institutions, including approximately 100 institutes established since 2018, enrolling nearly 30,000 graduates each year, up from 14,000 in 2018. are. As of 2022, 218 (62%) of these training institutions were fully accredited.
In addition, the federal and state governments have taken steps to help renovate aging health training schools and ensure that they have sufficient training equipment (such as medical equipment and modern computer systems) to improve the quality of education. We should be prepared.
Frontline health workers have expressed concern not only about their salaries but also about the “demoralizing” conditions in primary health care facilities. More than half (52%) of nurses and midwives surveyed said a lack of essential medicines and equipment in their facilities, such as antibiotics, anti-malarial drugs and oxytocin, was a problem. Many facilities are small, cramped, and outdated and need new roofs and equipment. Solar energy systems are also a priority, as power outages and brownouts occur frequently. Almost a fifth (19%) of those surveyed have general concerns about their safety.
Although many nurses and midwives view their work and their chosen profession as noble, they feel demotivated and demoralized. Low salaries, coupled with poorly equipped primary health care facilities, make them feel undervalued.
The way forward: funding the health sector
In line with Nigeria’s new health sector-wide approach, the government should ensure that financial and technical support is provided to increase the number of primary health facilities from about 9,000 to more than 17,000 by 2027. Funding should also be provided to secure existing health facilities. The facility has been renovated and equipped with necessary amenities such as water, electricity and a more conducive working environment.
Maternal mortality rates have plateaued in recent years, particularly in sub-Saharan Africa.
The Basic Healthcare Delivery Fund was established in 2014 to improve access to primary healthcare by supporting the operating costs of primary healthcare facilities, and is funded by an annual grant from the Federal Government of Nigeria, donations from the private sector, and international funding. We receive grants from donors. partner. The fund has been plagued by problems, primarily a lack of funding from the federal government and mismanagement at various levels. While the federal government develops and coordinates national policy and health worker training, the management and financing of health facilities is the responsibility of state-level ministries of health and local authorities.
Existing accountability and monitoring systems need to be strengthened to promote effective and judicious use of allocated resources by local government and facility-level stakeholders.
midwives save lives
Although maternal mortality rates have declined globally over the past two decades, rates have plateaued in recent years, particularly in sub-Saharan Africa. Most causes of maternal death can be prevented if women have access to quality obstetric care from qualified health professionals such as nurses, midwives, and other skilled midwives. According to The State of the World’s Midwifery Report (2021), trained midwives can provide 90% of maternal and newborn health services, but Nigeria needs more midwives.
As of March 2023, the country’s maternal mortality rate was 1,047 per 100,000 live births, making it the third highest in Africa and one of the highest in the world. The country is suffering from a shortage of medical professionals, with fewer than 200,000 midwives currently in the country for a population of 217 million. To meet the World Health Organization’s recommendation of 44.5 midwives per 10,000 people, Nigeria needs to train and deploy nearly 700,000 more nurses and midwives.
Stopping the exodus of midwives in Nigeria will require a collaborative effort by the government, local and international development partners, and health workers.
Recommendations to the nation’s federal, state, and local governments include the 2020 National Health Policy Workforce Plan and Health Workforce Development Plan to fully implement the national health workforce strategic plan and policies already in place. Includes structure and funding. Health Strategic Plan, 2021-2025. These policies are often underfunded and poorly implemented at national and local levels.
Our research demonstrated the critical value of listening to the voices and stories of healthcare professionals. Nurses and midwives said they wanted better pay and incentive packages and better working conditions. Governments at all levels can gain important insights by ensuring the voices of healthcare workers are heard, with mechanisms to regularly collect input from nurses, midwives and other frontline healthcare workers. must be introduced.
To stem the brain drain and ensure that midwives are there to save lives, donors are funding the basic primary health care delivery, implementing existing strategies and policies, developing innovative health services, and more. , needs to support national and state-level priorities. Solutions to Nigeria’s health workforce and primary health care challenges.
*Aisha’s name has been changed to protect her privacy.
A nurse weighs a baby at Maitama District Hospital in Abuja, Nigeria, May 22, 2011. Reuters/Akitunde Akinleye
Hilda Ebinim is a Senior Program Associate at Sidani Group. She holds an MPH from Liverpool John Moores University.
Oluwadamilare Olatunji is a Senior Program Analyst at Sidani Group. He holds a Bachelor’s degree in Child Development and Family Studies from the Federal University of Agriculture, Abeokuta, Nigeria.
Laura Homeke is a global health consultant and adjunct professor at the University of North Carolina Gillings School of Global Public Health.
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