THE EFFECT OF RELOCATION OF HEALTH WORKERS ON HEALTH CARE SERVICES DELIVERY IN NIGERIA.

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Health workers relocation has emerged as a high-level international concern, particularly in the last two decades, owing to the observed negative effects of medical brain drain from developing countries, as well as the implications for achieving the Millennium Development Goals, and Africa is no exception. According to Najib, Abdullah, and Narresh S, et al.(2019), one of the major impediments to African growth is the emigration of talented African workers to wealthy nations. Emigration of trained people from underdeveloped and developing countries to developed or industrialized countries is not a new phenomenon; however, the magnitude of the problem in Africa soil is growing and requires immediate action, as the result of emigration poses a major challenge to Africa's overall development. According to Fagite (2018), relocation of health professionals is described as the migration of health staff throughout the world in quest of a higher standard of living and life quality, greater income, access to sophisticated technologies, and more stable political situations. Brain drain can occur within countries (internal brain drain), although it most typically refers to cross-border or international migration, especially from underdeveloped to industrialised countries.

Historically, in the 1940s, when many European health professionals immigrated to the United Kingdom and the United States, international relocation of highly qualified professionals became a serious public health concern. By the mid-1960s, the losses had become significant. According to Poppe, Wojczewski, and Taylor K. (2016), the World Health Organization published a detailed 40-country study on the importance and flow of health professionals in 1979, and the findings suggested that nearly 90% of all migrating nurses were moving to just five countries: Australia, Canada, the Federal Republic of Germany, the United Kingdom, and the United States. Policymakers in both sending and receiving nations have paid close attention to the global high demand for nurses, which has resulted in migration from low-income to high-income countries. [

The effects of massive relocation of health-care personnel were startling for a country like Nigeria, which is heavily reliant on international help and has a shaky health-care system. to strengthen further According to Simplice (2015), Nigeria, like most other African nations, is experiencing a human resource crisis in the public health sector, with many of its health professionals, such as physicians and nurses, relocating to industrialised countries in search of better work opportunities. [ Despite the fact that the government's 2007 economic assessment shows significantly increased spending on public health, the sector remains critically underfunded, and migration to metropolitan regions in Nigeria and elsewhere continues unabated. Yuksekdag (2018) stated that the migration of health professionals has a significant impact on the public health sector in Africa since the bulk of the continent's population relies on the health-care services provided by its governments. Furthermore, HIV/AIDS, malaria, coronavirus, and other serious illnesses place a significant strain on systems and need the expertise of these same individuals.

1.2 Statement of the Problem

In recent years, the health-care system in developing nations has faced several challenges, one of which is a lack of human resources. Over the last five years, developing-country governments have lost substantial numbers of health managers, nurses, and physicians to international NonGovernmental Organizations, who can easily outbid the public sectors for the services of local health expertise. In Africa, the physician-to-population ratio is reported to be 13/100,000, compared to 280/100,000 in the United States (Efendi et al., 2017). Despite these skewed numbers, around 23,000 competent academics leave Africa alone each year. A Manila-based newspaper stated in 2001 that 13,536 Filipino nurses had fled the nation, while only 4780 had graduated. 6According to a 2002 assessment of Ghana's health-care facilities, 72% of all clinics and hospitals were unable to deliver the full range of planned services due to a lack of employees. 43% were unable to give complete child vaccines, and 77% were unable to provide 24-hour emergency assistance and round-the-clock safe deliveries for women in delivery.  According to Najib et al. (2019), Zimbabwe trained 1200 doctors in the 1990s, but only 360 remained in the nation by the year 2000. Eight years ago, there was one nurse for every 700 inhabitants in Kadoma; now, there is one for every 7,500. In 1980, the country was able to fill 90% of its nurse posts countrywide; now, just 30% are filled. In addition to a lack of workers, the International Labor Organization estimates that 18-41% of Africa's health-care labour force is HIV-positive .In 2006, more than 25% of doctors in the United States were foreign-trained, and the country had an estimated ratio of 25.6 doctors per 10,000 people. In instance, the small southern African country of Lesotho has 0.5 doctors per 10,000 people and an adult HIV prevalence rate of 28.9%, in addition to TB, malaria, and a slew of other lower respiratory and gastrointestinal ailments that afflict that region. V Uganda has just one doctor for per 24,700 people, and Zambia requires 15,000 doctors for its health-care system to function efficiently, but only about 800 are registered (Benera Diana, & Kabeer 2020) and the list goes on.

Bizarrely, the system is too fragile and weak structurally and systematically to offer effective service where it is most needed. Relocation of healthcare workers appears to have compounded and exacerbated the problem. In many impoverished nations, hospital beds are overcrowded. Staff are overwhelmed by the apparently never-ending influx of people on the verge of death (Olorunfemi, Agbo, Olorunfemi, et al 2020).  According to Adeyemi Joel Ebenezer (2018), the detrimental impact of healthcare workers relocation might be concealed in developing nations' metropolitan regions due to a larger concentration of public and private health clinics, but such consequences are visible in rural areas.

Although  Most studies of health-worker migration have therefore tended to focus on the impact of their migration on health systems in African countries generally, ethical recruitment, and codes of practice. There is, however, renewed interest in the situation in home countries like Nigeria in recent years for several reasons.Upon this premise, the researcher seeks to examine the effect of f relocation of health workers on health care services delivery in Nigeria.

1.3 Objective of the Study

The broad objective of this study is to examine the  effect of f relocation of health workers on health care services delivery in Nigeria. Specifically, the study seeks:

i.          To examine the extent at which heath worker relocate to international countries.

ii.        To investigate the causes of relocation heath worker to international countries.

iii.      To ascertain the impact of health workers relocation in Nigeria

iv.      To establish ways Ways to reduce health workers emigration in the country.

1.4 Research Questions

The research is guided by the following research questions:

i.          What is the extent at which heath worker relocate to international countries?

ii.        What are the causes of relocation heath worker to international countries?

iii.      What is the impact of health workers relocation in Nigeria?

iv.      What are the ways to reduce health workers emigration in the country?

1.5 Significance of the Study

Knowing the impact of nurse emigration in the country will assist policymakers in implementing the proposed remedy to the problem or danger to the health-care system. The study's findings will offer a direction for training institutions on the need to enhance their training capacity and student intake. These are merely short-term actions, but they may trigger or encourage more nurses to travel overseas in the long run. The study's findings will provide hospital administrators with a permanent solution to this problem, while also recommending that hospital administrators and the government provide a conducive working environment, better remuneration, attractive retirement benefits, and other incentives to encourage nurses to return to their home countries. Finally, the findings of this study will contribute to the long-term development of human capital in Nigeria and serve as a resource for students and researchers interested in doing more research on a similar issue.

1.6 Scope of the Study

The scope of this study borders on the  effect of f relocation of health workers on health care services delivery in Nigeria. The study also discussed the level of health workers relocation, causes of the relocation, impact of the relocation and ways to reduce the emigration of health workers. The study is however delimited to selected Federal Medical center  in Abuja.

1.7  Limitation of the Study

Like in every human endeavour, the researchers encountered slight constraints while carrying out the study. The significant constraint was the scantiness of literature on comprehensive data covering number of health worker that have relocated from Nigeria to other countries for greener pasture.  Thus much time and organization  was required in sourcing for the relevant materials, literature, or information and in the process of data collection. Also the study is limited Federal Medical Center  in Abuja. .  Therefore findings of this study cannot be used for generalization for other other health facilities in the country which  creates a  gap  in scope and gives room for further studies.

1.9 Definition of Terms

Relocation: also known as Emigration,  is the act of leaving a resident country or place of residence with the intent to settle elsewhere.

Brain drain: the departure of educated or professional people from one country, economic sector, or field for another usually for better pay or living conditions

Health workers: A healthcare worker is one who delivers care and services to the sick and ailing either directly as doctors and nurses or indirectly as aides, helpers, laboratory technicians, or even medical waste handlers.

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