Framing Nigeria’s medical doctors’ exodus as ‘brain drain’ over-simplifies a structural collapse – Olowokandi

Elizabeth Olowokandi, a UK-based physician, Imperial College MPH graduate, and global health advocate, in this interview with KENNETH ATHEKAME spoke on why Nigeria’s healthcare crisis is fundamentally an operational failure; how the medical exodus is affecting misdiagnosed, and why fixing primary healthcare is the country’s best economic investment. She also discussed how Nigeria can practically transform its diaspora into a net-positive economic asset rather than allowing the country to lose valuable human capital and investment opportunities. Excerpts:

You left LASUTH to practise in the UK NHS, joining thousands of Nigerian doctors practising abroad. Isn’t it hypocritical to advocate for health reform in Nigeria from the safety and comfort of the NHS?

My time at LASUTH exposed me to raw systemic scarcity- patients waiting from 5:00 AM without guaranteed care and families buying basic cotton wool out-of-pocket. Transitioning to the NHS didn’t erase that reality; it exposed the gap between structural failure and operational efficiency. Resourcefulness is not a substitute for standard infrastructure. My conviction that Nigeria can fix its system stems from knowing that the primary deficit isn’t talent or ideas, it is political will and targeted capital allocation.

Nigeria’s medical exodus is routinely called a national crisis. Is calling it “brain drain” just an excuse for the state’s failure to pay competitive wages?

Framing this purely as “brain drain” oversimplifies a structural collapse. The government relies on the uncompensated goodwill of clinicians, operating in environments defined by unpaid salaries, severe understaffing, and zero personal safety. Health workers aren’t just leaving low pay; they are fleeing an environment that actively penalises them for system-level failures.

How can Nigeria practically turn its diaspora into a net-positive economic asset rather than a lost investment?

“Brain circulation” only works if Nigeria builds intentional, formal frameworks similar to India or Ireland. They created visiting consultant programs, fellowship schemes, and structured research partnerships. Nigeria has vast networks like ABMA and ANPA, but lacks a centralized, government-backed framework to systematically plug diaspora clinical expertise and capital back into local institutions.

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The Basic Health Care Provision Fund (BHCPF) exists, yet primary health centers (PHCs) remain dilapidated. Where is the money going?

It disappears into bureaucratic black holes and overlapping mandates between federal, state, and local governments. When a PHC runs out of essential drugs or a nurse goes unpaid, no single entity takes ownership. Throwing funds at PHCs without strict, facility-level monitoring and public accountability achieves nothing.

With a severe doctor deficit, is expecting every Nigerian PHC to have a resident physician a pipe dream?

Yes, direct doctor-led primary care across every ward is mathematically unrealistic right now. Nigeria must formalize task-shifting. Properly trained, equipped, and supervised Community Health Extension Workers (CHEWs) and nurses can manage up to 80% of common conditions like malaria, hypertension, and diarrhoeal diseases. Doctors should operate strictly in supervisory and high-risk escalation roles.

Can Nigeria successfully adapt the UK’s General Practice (GP) model, or is our health architecture too fundamentally different?

The architecture must be local, but the core principle of primary care as a strict gateway to prevent tertiary hospitals from clogging is non-negotiable. Patients bypass Nigerian PHCs because they lack trust in finding medicine or basic care. If you build clinical reliability at the primary level, you protect teaching hospitals from collapse.

Digital health and AI are touted as silver bullets. Won’t these technologies simply widen the inequality gap between urban and rural patients?

Not if deployed correctly. Digital health isn’t about giving every patient an iPhone app; it’s about digitizing the back end. Unified Electronic Health Records (EHR) across PHCs eliminate paper loss and streamline decision-making. Simple AI-assisted diagnostics for tuberculosis or cervical cancer can empower rural health workers to screen accurately without a specialist on site.

Universal Health Coverage (UHC) remains a distant dream for informal workers. Should health insurance be made strictly mandatory for all citizens?

Mandating coverage without fixing service quality is selling an empty promise. The National Health Insurance Authority (NHIA) was built around formal sector payroll deductions, which excludes market traders, farmers, and artisans. We need flexible, community-based insurance schemes paired with direct government subsidies for the indigent and faster claims processing for providers.

Beyond social welfare, how does Nigeria transform its healthcare sector into a profitable engine for economic growth?

By capturing value across the supply chain instead of subsidizing the training of doctors for export. Nigeria can build a domestic health manufacturing strategy for pharmaceuticals and basic diagnostics to cut import dependence, capture regional medical tourism within West Africa, and position itself as a hub for clinical trials focused on African genetics.

If you held direct authority over the Federal Ministry of Health for the next 12 months, what three non-negotiable priorities would you enforce?

First, guarantee predictable, on-time monthly payroll for all primary healthcare workers to stem immediate frontline attrition. Second, mandate basic Electronic Health Records across high-burden PHCs to establish actual baseline data. Third, enforce the transparent release of the Basic Health Care Provision Fund with publicly trackable reporting down to individual facilities.