Punch · সাধারণ

Patients stranded as specialist shortage hits public hospitals

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As Nigeria’s non-communicable disease burden grows, patients are paying the price for a critical shortage of specialists, enduring long waits, postponed appointments and restricted access to life-saving care. PUNCH Healthwise investigation exposes the widening gulf between the rising demand for specialist care and the country’s inadequate specialist workforce. JANET OGUNDEPO reports

Every day, more Nigerians are diagnosed with non-communicable diseases, including hypertension, diabetes, obesity, cancer, mental health conditions, kidney disease and cardiovascular disorders.

The persistent trickle of cases has become a growing burden, but as cases rise, the number of trained specialists to treat, manage, and care for the teeming numbers of patients who throng public secondary and tertiary hospitals on clinic days continues to dwindle.

This leaves patients and specialists on an uneven playing field, with the growing patient population tipping the balance.

Visits to hospitals in some states reveal large crowds of patients waiting to see the few available specialists.

For example, at the Federal Medical Centre, Idi-Aba, Abeokuta, Ogun State, patients described long waiting times and early daily cut-off limits for registration as challenges that made accessing specialist care stressful.

One outpatient, who identified himself simply as Ademola, told one of our correspondents on Thursday that he had been turned away when he first visited the hospital about three weeks earlier.

“I was here about three weeks ago. I got to the hospital around 8am, but I was surprised when they told me that the number of patients to be attended to had been selected. I think they said about 70 patients,” he said.

Ademola said he was advised to return the following morning and arrive earlier to secure a place. He eventually registered after arriving shortly after 7am but did not see the doctor until about 3pm.

Another patient, Mrs Adelaja, said the experience differed from the services she received at the hospital when she gave birth a decade earlier.

“I have been here since past 7am, but it is almost 12 pm and I have not been called in to do any registration, not to talk about seeing the doctor,” she said.

In the North-East, patients at the Specialist Hospital, Gombe, also raised concerns about delays, bed shortages and the cost of repeated visits.

Maryam Ahmed, who accompanied her brother for eye surgery, said they were unable to see a specialist when they arrived at the hospital and that his condition subsequently worsened.

“Unfortunately, we came at a time they considered wrong, and we couldn’t get the help, so the case worsened,” she said.

Ahmed added that the family could not afford to seek treatment elsewhere, making the experience more distressing.

In Lafia, Nasarawa State, patients at the Federal University Teaching Hospital, Lafia, said the shortage of doctors and overcrowding had pushed some of them towards private healthcare facilities.

Boniface, a patient who had been seeking answers to persistent testicular pain, said he had visited the hospital for about three months, undergoing investigations at intervals without a clear resolution of his condition.

“I have been in the hospital for over three months now with no obvious results because they have yet to attend to me,” he said.

Another patient, Ibrahim, who visited the hospital’s ear, nose and throat department, said he had spent more than N80,000 over three weeks without seeing a consultant.

“I have spent over N80,000 while visiting this hospital in the past three weeks, but I have not been able to meet with a consultant doctor at the ENT department,” he said.

Ibrahim said he was told that his condition required assessment by a senior doctor who did not live in Lafia and only visited the hospital to see patients.

He warned that he might have to seek treatment at a private facility if he could not see the consultant soon, despite the financial burden.

High burden of NCDs, fewer specialists

On Thursday, the Coordinating Minister of Health and Social Welfare, Muhammad Pate, admitted that NCDs had become “an increasingly faster-growing segment of our burden of disease.”

Last week, the death of a popular gospel singer, Olayemi Bolaji, popularly known as Toluwanisings, sparked outrage following allegations that several hospitals in Ibadan, Oyo State, failed to provide him with emergency treatment after he slumped.

Toluwanisings’ personal assistant, Babadunni Olayemi, said, “They took him to different hospitals. Some said the doctors were on strike, while others said he was rejected at the hospitals. We all tried, praying for him and taking him around to hospitals. We took him to about seven or eight different hospitals here in Ibadan, but God said it was his time.”

According to the World Health Organisation’s Noncommunicable Diseases Data Portal, NCDs, including cardiovascular diseases, cancers, diabetes and chronic respiratory diseases, account for nearly three-quarters of deaths globally.

Every year, 17 million people under the age of 70 die from NCDs, with 86 per cent of these deaths occurring in low- and middle-income countries.

In 2021, NCDs were estimated to have caused 467,800 deaths in Nigeria, compared with 194,000 deaths from malaria. This means the estimated number of deaths from NCDs was approximately 2.4 times the number attributed to malaria that year.

Despite the increasing burden of NCDs and communicable diseases, the number of licensed doctors has dropped to about 40,000, far below the estimated 300,000 needed to adequately serve a population of over 220 million.

PUNCH Healthwise previously reported that a former President of the Nigerian Medical Association, Prof. Mike Ogirima, described Nigeria’s doctor-to-patient ratio as “horrible”, noting that the country had about one doctor to 8,000 patients, far below the World Health Organisation’s recommendation of one doctor to 600 patients.

Ogirima said Nigeria produced an average of only 3,000 doctors annually, making it difficult to bridge the estimated deficit of nearly 300,000 doctors.

“If we are producing just 3,000 doctors yearly, it will take at least 10 years to catch up—and that is assuming no doctor leaves the system.

“We cannot afford to wait that long. That is why doctors are overworked, exhausted, and burned out,” he said.

In this report, PUNCH Healthwise examines the available specialists across the country.

The figures presented are estimates obtained from the specialists’ associations unless otherwise reported.

About 200 endocrinologists despite 15 million people with diabetes

With diabetes affecting six to seven per cent of Nigerians, representing about 15 million people, the Endocrine and Metabolism Society of Nigeria has said that the country has between 150 and 200 practising endocrinologists.

The EMSON President, Prof Andrew Uloko, exclusively told PUNCH Healthwise that the shortage, compounded by the migration of specialists abroad, inadequate diagnostic infrastructure and poor support for those who remain in the country, was placing an enormous burden on endocrinologists and limiting access to specialist care.

He said the situation was particularly concerning as NCDs, including diabetes, obesity, thyroid disorders and cholesterol-related conditions, continued to pose a growing health challenge.

Uloko said the number of endocrinologists in Nigeria had remained around 200 because specialists continued to leave the country in search of better remuneration, improved welfare and opportunities for professional development.

“Our figure still revolves around 200. Sometimes you come across documentation that we are somewhere between 150 and 200. That’s our number currently in the country,” he said.

Uloko said endocrinologists were concentrated in major cities, where specialist facilities and diagnostic services were more readily available, leaving rural and underserved communities.

He explained that even urban centres did not have enough endocrinologists, while primary and secondary healthcare facilities rarely had specialists in the field.

The EMSON president identified the North-East, South-West and North-Central as areas with relatively lower numbers of endocrinologists, while noting that the South-West might have the highest concentration.

He attributed the uneven distribution partly to the demands of endocrinology, which requires specialised equipment, laboratory investigations and diagnostic infrastructure that are not readily available in many parts of the country.

He said the limited availability of such facilities also encouraged specialists to move abroad, where they could access the infrastructure needed to practise their speciality.

Uloko added that the number of patients requiring specialist care was increasing, while the few facilities with endocrinologists continued to receive referrals from across their regions.

He said some patients had to travel long distances to obtain specialist consultations and investigations unavailable in their communities.

The EMSON president said the combination of high patient numbers, inadequate infrastructure and poor support services affected the practice of endocrinology and the well-being of specialists.

“Workload is stupendously heavy. You practically do not even have time for yourself,” Uloko said.

The endocrinologist said improving remuneration and welfare would be essential to retaining endocrinologists and encouraging more specialists to remain in Nigeria.

He also called for improved diagnostic and laboratory infrastructure across the country, including at secondary healthcare facilities, to reduce pressure on tertiary hospitals and limit the need for patients to travel between states for investigations and treatment.

“We hope that in the coming years, it should catch the attention of the government that Nigeria needs many more endocrinologists, and all that is required will be tailored into training and retaining endocrinologists in Nigeria,” he said.