On 11 April 2023, a bill to mandate medical doctors to practise in the country for at least five years before moving abroad passed the second reading in the Nigerian parliament. The bill has received backlash from some quarters of the opposition and the Nigerian medical community on the grounds that it violates the rights of medical practitioners who, according to the bill, will not receive their medical license until they have completed the mandatory period of service. Regardless of the merits of the arguments on both sides, ensuring health services for all Nigerians is possible and should be the priority. This can happen through the concerted and collaborative efforts of both the governments and a selfless, motivated health workforce. In this regard, the Cuban experience can serve as an inspiration for Nigeria in particular and Africa in general.
Although Cuba is a small, underdeveloped country, it boasts of excellent public healthcare. According to a recent report, “with about one-tenth of the GDP per capita of that of the USA, people in Cuba nevertheless enjoy longer life expectancy (79 years) than do people in the USA (78 years), in Mexico (77 years), in Latin America as a whole (75 years), and in the developing world as a whole (66 years). Also, Cuba also has a lower childhood mortality rate than the USA.
Prior to these excellent records, Cuba, like most countries in Africa today, was faced with situations where a vast majority of their population could not access quality healthcare partly due to a shortage of doctors and other healthcare workers which is similar to Nigeria’s current situation of having only 24,000 licensed medical doctors available for over 200 million people. According to reports, Cuba overcame this difficulty by banning the lucrative private practice of medicine (which made quality healthcare available only to the middle and upper class). Cuba also welcomed the vast majority of the lower class into medical training (which before then was not affordable for the poor) fully paid for by the government on the condition that these doctors promised in their graduation oath not to engage in private medical practice for profit. The country still regulates the migration of its medical doctors and health workers overseas, sending them mainly for medical missions abroad, especially to other developing countries. Thanks to all these efforts, today Cuba’s doctor-to-patient ratio (with a doctor for every 150 people) is about double that found in developed nations.
This means that for African countries like Nigeria to close the gap in their doctor-to-patient ratio, they must regulate through some form of legal and bilateral frameworks the rate and manner its health workforce migrates overseas to practise just as Nigeria is planning to do. However, this kind of regulation alone is not sufficient. Governments in Nigeria and Africa need to engage in massive training of medical doctors and other health workers by establishing specialized universities of health sciences and making it easy for the majority of citizens from poor backgrounds to gain admission with access to scholarships into such schools. In this way, Africa will be able to produce more doctors and health workers for its underserved population. Furthermore, African countries must prioritize girl child education as Cuba did: about 57 per cent of its doctors as females. And for the deployment of this workforce to be possible, there needs to be a focus on the massive development of primary healthcare facilities in rural and low- and middle-income areas who are the most vulnerable and are disproportionately impacted by diseases. Such rural health facilities are cheaper to establish when compared to the cost of building big and expensive hospitals in the cities.
On the other hand, Nigerian doctors and health workers should reflect deeply on their calling and oath of practice which is primarily about saving lives and seeing to the well-being of Nigerians especially the poor and vulnerable, and not about the commodification of medical practice. Nigeria and indeed African doctors and health workers should draw inspiration from Cuba’s extraordinary medical personnel who both at home and abroad support the radical struggle for healthcare by serving and empowering poor communities and peasants with medical care and training at little personal gain, thereby ensuring that healthcare reaches the majority of the population.
Equally important is the need for the Nigerian government to make efforts to regain the trust of Nigerian doctors and health workers by being transparent and clear enough on what it hopes to achieve with the new law with regard to improving health outcomes in Nigeria.
Most importantly, there is the need to make healthcare affordable for the vast majority of Africans, especially those in the informal sectors (who are mostly poor, indigent, and vulnerable) through the effective implementation of universal health insurance schemes across all of Africa. At the moment, only 25 out of 54 countries in Africa have schemes that ensure affordable healthcare coverage for their citizens. In this category, Rwanda remains an inspiration for other African countries with over 90% of Rwandans reported to have health insurance. Nigeria with less than 10% of its citizens on health insurance may take a cue from Rwanda on how to expand its health insurance scheme to cover the majority of Nigeria’s underserved population.
While Africa is taking steps to increase the density of its health workers on the continent and halt further brain drain of its health workforce, and also increase the affordability of healthcare for its citizens, it must immediately put stronger emphasis and investment in preventive medicine and measures as demonstrated by Cuba. This alone can drastically reduce the burden on our healthcare systems as doctors and health workers would only intervene when there is no other alternative. Preventive measures, like vaccinations, mosquito control, and provisioning of adequate and cheaper supplies of potable water and sanitation will save more lives especially those of infants than most curative steps.
By applying some of the lessons from Cuba, Nigeria will be on its way to improving its healthcare and achieving health coverage for all.