A new policy brief has warned that unless urgent welfare-focused reforms are implemented, the country risks a deepening crisis that could undermine access to quality healthcare nationwide.
Nigeria’s healthcare system is facing mounting pressure as the steady departure of doctors and nurses continues to erode service capacity, raising concerns about long-term system viability.
According to the policy analysis authored by health policy expert Dr Emmanuel Ejimonu, of the Athena Centre for Policy and Leadership, more than 42,000 nurses left Nigeria between 2021 and early 2024, while thousands of Nigerian-trained doctors have registered to practise abroad, particularly in the United Kingdom.
The trend shows no sign of slowing, as survey data cited in the report indicate that nearly three-quarters of medical and nursing students intend to seek employment overseas, with about one in three expressing no plans to return.
The report attributed the exodus largely to domestic welfare and governance challenges rather than professional ambition. Health workers interviewed consistently pointed to low and irregular salaries, unsafe and overstretched working environments, limited opportunities for funded specialist training and weak social protection systems.
These challenges, the brief notes, have made emigration a rational choice in the face of institutional uncertainty, especially as global demand for health professionals continues to rise.
Although the Federal Government introduced a National Policy on Health Workforce Migration in 2023 to promote ethical recruitment and retention, the brief argues that its impact has been limited. Implementation gaps, inadequate funding and uneven execution at state and facility levels have prevented the policy from delivering meaningful improvements in working conditions.
The consequences of sustained health worker losses are already visible. Teaching hospitals are reportedly struggling to maintain specialist training and mentorship programmes, while recurring strikes highlight growing mistrust between health workers and government authorities.
Economically, the country is losing returns on public investments in training, even as staff shortages compromise care delivery in both urban and rural facilities. Remaining workers also face rising burnout, further fuelling migration intentions.
Drawing on international experiences from countries such as Ghana, Kenya, the Philippines and Cuba, the policy brief stresses that health worker migration cannot be completely stopped. Instead, it recommends managing mobility through welfare-based retention strategies and credible governance structures.
Central to the recommendations is a proposed Welfare-First Retention Package, which prioritises guaranteed and timely payment of salaries, improved workplace safety, funded career progression, fair bonding arrangements and strengthened social protection. The package also calls for disciplined use of bilateral agreements and ethical recruitment frameworks to protect Nigeria’s investment in health worker training.
The brief estimates that, if properly funded and implemented, the proposed measures could reduce short-term health worker attrition by up to one-third within two years, while significantly improving retention over a five-year period.
The report stated that reversing the health workforce crisis will require treating welfare reform as a core economic and governance priority, backed by political will, fiscal discipline and strong institutional coordination. Without such action, the report warns, Nigeria risks the gradual hollowing out of its healthcare system, with far-reaching consequences for public health and national development.
