Medical Brain Drain in Nigeria and its impact on Sustainable Development Goal 3

The Nigerian health system has suffered several setbacks. It is vastly under-resourced in terms of personnel and medical infrastructure. While this is a widespread problem, conditions in rural areas are often far worse compared to urban ones. Nigeria’s poor health system has resulted in penurious outcomes, prompting stakeholders to call for immediate government intervention. Yet, the government’s health expenditure is still significantly lower than the World Health Organization’s (WHO) recommendation of 15% of the annual budget.

Over the decades, the migration of medical doctors from Nigeria has increased. The NOI Poll in 2018 revealed that 88% of doctors in Nigeria were seeking employment abroad. Furthermore, between 2015 and 2021, about 4,528 Nigerian-trained doctors have migrated to the United Kingdom (UK). Even with the pandemic and existing health burdens in Nigeria, doctor’s migration has increased. This worrying trend exacerbates an already deteriorating health system. And it is unlikely to stop, as Nigerian doctors continue to seek better working conditions abroad.

Health Personnel Shortage and Migration

A WHO report revealed that Nigeria has a Doctor-Patient ratio of 4 doctors per 10,000 patients and five hospital beds per 10,000 patients.

With over 200 million people, it would take about 25 years to produce enough doctors to cater to the population, asserts the Nigerian Medical Association (NMA). This dire situation can only lead to poor health outcomes. High child and maternal mortality rates are preventable if doctors are readily available. The link between the number of physicians and mortality rates has been documented in the literature, reflecting the negative consequences of doctor shortages in Nigeria.

The primary reason for the large number of medical doctors emigrating each year is the lack of adequate funding in the sector. The 2021 health expenditure accounted for only 7% of the total budget. It is less than the 15% agreed on by African leaders and the WHO in 2001.

According to the NMA, approximately 2000 doctors leave the country each year. The average number of doctors trained in Nigeria and currently practising in the United Kingdom (UK) increased significantly between July 2020 and May 2021 – ranking Nigerian doctors the third highest in the UK.

In 2020 the highest monthly earnings of a Nigerian doctor were about USD 1,365. In Sierra Leone, a doctor earns up to USD 2,000, while doctors in the UK, United States, and Saudi Arabia earn up to ten times what doctors earn in Nigeria. It automatically increases the appeal of emigrating to these countries. Further, the lack of equipment in hospitals in Nigeria and poor working conditions mean that the opportunity cost of emigration is significantly low.

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Nigeria’s Electrification Roadmap: After Two Years, Where Does It Stand?

The Nigerian government and German energy company Siemens AG signed the Nigerian Electrification Roadmap (NER) partnership, also known as the Presidential Power Initiative (PPI) in 2019. The Roadmap contains technical and commercial proposals for financing, implementing, and executing projects to revive the Nigerian power sector and manage Nigeria’s future electricity requirements.
The NER is structured in three phases, executed over six years, up to 2025.

  • Phase 1 (by 2021): Conducting quick impact projects to enhance the capacity of the existing grid system to utilize stranded generated power capacity, leading to an overall increase in operational power capacity from its current 5GW to 7GW.
  • Phase 2 (by 2023): Tackling distribution network constraints, and expanding the grid to further maximize the use of current generation capacities, in order to achieve a combined capacity of 11GW.
  • Phase 3 (by 2025): Building out new generation systems, while further modernizing and growing the national transmission and distribution (T&D) systems, in order to reach an overall full operational capacity of 25GW.

FIGURE 1: The NER target by 2025

The NER has made good progress so far…

Determined a financial structure. The Nigerian Electrification Roadmap deal will cost an estimated total of about N1.15 trillion (€3.11 billion).1 In 2020, all shareholders agreed that:

  • 85% of this finance will come from a consortium of banks, guaranteed by the German government through credit insurance firm Euler Hermes.
  • 15% will come from the Nigerian government in counterpart funding with a 2–3 year moratorium and 10–12 year repayment period at concessionary interest rates.
    • To enable counterpart funding, the government approved initial offshore and onshore payments of N6.940 billion (€15.21 million) and N1.708 billion (€3.74 million), respectively.2

Ensured political durability. The Nigerian government set up a special purpose vehicle and Project Management Office to ensure the Roadmap’s sustainability through political transitions. These structures intentionally limit the government’s role in policy guidelines and supervision to minimize possible government interference.

Negotiated design. In early 2021, the Nigerian government and Siemens signed a contract for the pre-engineering aspects of the Roadmap, which determined the design, project specifications, commissioning works for T&D systems, network development studies, power simulation and training support services.3

…but there are some looming challenges

Information and institutional bottlenecks. Bureaucratic bottlenecks within T&D companies making it difficult to provide data and access to networks may be a challenge in Phase 1.

Slow progress in metering schemes. The nationwide metering scheme’s slow progress to date could stall plans to deploy a central computing environment for smart meters for both operators and customers

Facilitating capital recovery. The Nigerian Electricity Supply Industry’s efficiency in recovering invested capital ultimately depends on successful implementation of the cost- and service-reflective Multi-Year Tariff Order (MYTO).

Maintaining a fair and transparent procurement process. Committing to a fair and open procurement policy and processes is crucial to local content integration, reduce costs, and target the actual needs of the sector.

Conclusion

The NER’s ambitious plan to address the critical infrastructure deficits in the Nigerian power sector evokes hopes of vitalization across all socio-economic sectors and levels in the country. The NER aims to help eliminate technical and commercial inefficiencies along the electricity value chain, saving over $1bn in annual losses.4 The NER could also develop new technical skills and facilitate knowledge transfer that could help revitalize several other sectors, due to the local content inclusion policy mandating opportunities for Nigerian companies to contribute through conducting surveys, modeling, and supplying meters.

Siemens AG’s accomplishment of a similar Roadmap in Egypt, as well as its international reputation in power sector development provides some assurance that the NER is realizable. However, it is unclear whether Nigeria will achieve the Roadmap in the planned time frame, especially given the many possible complications of the COVID-19 pandemic.


Endnotes

  1. https://nairametrics.com/2020/02/22/nigeria-denies-plan-to-hand-over-electricity-distribution-to-siemens/
  2. http://apanews.net/en/news/nigerian-press-focuses-on-approval-of-payments-for-power-deal-with-siemens-others
  3. https://www.esi-africa.com/industry-sectors/transmission-and-distribution/pre-engineering-contract-signed-for-nigerias-presidential-power-initiative/
  4. https://nairametrics.com/2021/02/23/fg-siemens-ag-sign-contract-for-pre-engineering-phase-of-presidential-power-initiative-ppi/

This Article was first published at Energy for growth hub

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AfCFTA: Investments in Africa’s Transport, Logistics Infrastructure Crucial For Regional Connectivity

Of all the countries on the coast of the Mediterranean sea, Egypt seems to have been the first in which either agriculture or manufactures were cultivated and improved to any considerable degree. Upper Egypt extends itself nowhere above a few miles from the Nile and in Lower Egypt that great river breaks itself into many different canals, which, with the assistance of a little art, seem to have afforded a communication by water-carriage, not only between all the great towns, but between all the considerable villages, and even to many farm-houses in the country... The extent and easiness of this inland navigation was probably one of the principal causes of the early improvement of Egypt.

--- Adam Smith, Book 1, Chapter 3. The Wealth of Nations

After months of delays caused by the global coronavirus pandemic, African countries began trading officially under the African Continental Free Trade Area (AfCFTA) on New Year's Day 2021. Every African country - apart from Eritrea - has signed on to the framework agreement and 34 have ratified it. Although the launch is largely symbolic with full implementation of the deal expected to take several years.

The new continent-wide free trade area (FTA) aims to create a single market of 1.3 billion people, facilitate the cross-border movement of people, goods and services, and investments, and establish a $3.4 trillion economic bloc, which will be the largest FTA since the founding of the World Trade Organisation.

In order to boost the trade within the continent, member countries plan to remove 90% of tariff lines. Compared to other regions, the intra-trade level in Africa is significantly lower. Between 2015 and 2017, intra-African exports and imports averaged around 2 percent compared to 47 percent in America, 61 percent in Asia, 67 percent in Europe, and 7 percent in Oceania [the East Asia/Pacific region], according to the United Nations Conference on Trade  and Development (UNCTAD).

Unlocking intra-regional trade is central to African economic growth. According to World Bank estimates, the free trade agreement will boost intracontinental exports by over 81%, exports with non-African countries by 19%, and could lift tens of millions of Africans out of poverty by 2035.

While the AfCFTA holds much promise for boosting socio-economic development in African countries, several historic challenges must be overcome if the bloc is to reach its full potential. One of such obstacles is Africa’s lack of regional connectivity due to poor transport and logistics infrastructure, which is sure to hinder the free flow of goods, services and people across neighbouring countries on the continent.

Infrastructure deficits and fragmented supply chains

The challenge of moving goods around Africa is not a problem new to the continent and now represents a major factor hindering the prospects of the AfCFTA, particularly in forming regional manufacturing supply chain clusters. Africa’s huge infrastructure gap, particularly for transport, as well as the fragmentation of supply chains have significantly hampered regional trade and economic integration for decades.

Although some parts of the continent - neighbouring countries in the East African region to be precise - are doing far better with cross-border trade and movement, the majority of African countries have ranked low on indicators such as cross-border clearance processes; quality of trade; infrastructure; inconsistent tax regimes; and consignments’ track and trace mechanisms, according to the World Bank’s Logistics Performance Index. Only South Africa ranks among the top 50 (33rd) globally as of 2018.

Digitalisation in the logistics sector in Africa is helping to address some of these challenges and in addition, the proliferation of digital logistics startups - such as Kobo360 - have helped facilitate connectivity vital to the flow of goods within the region and across borders. But inadequate infrastructure remains a significant challenge.

Investment crucial for easy navigation across Africa under AfCFTA

Most of Africa lags global counterparts in coverage of key infrastructure classes, including road and rail transportation. For instance, a 1,000-kilometer journey reportedly takes about six days in Africa compared to 48 hours in other parts of the world.

The problem has lingered for decades and is compounded by the fact that African governments are not sufficiently investing in connectivity and infrastructure, although there have been efforts to address this in recent years. In 2012, African heads of state and government endorsed the Programme for Infrastructure Development in Africa (PIDA), an ambitious long-term plan for closing Africa’s infrastructure gap, consisting of over 400 projects, including 236 for transportation.

Furthermore, a McKinsey report notes that there has been a steady increase in infrastructure investment on the continent over the past 15 years, and international investors have both the appetite and the funds to spend much more across the continent, but Africa has had a challenge of moving projects to financial close, with 80 percent of infrastructure projects failing at the feasibility and business-plan stage.

The report further adds, on what it terms “Africa’s infrastructure paradox”, that there is need and availability of funding, together with a large pipeline of potential projects, but not enough money is being spent. According to the Infrastructure Consortium for Africa, $81.6 billion of investments were committed to infrastructure development in Africa in 2017, 41.7 percent of which went to transport projects. However, this figure is still far short of the $130-$170 billion per year to 2025 needed to close Africa’s infrastructure gap.

According to UNCTAD, one reason for this lack of adequate investment in infrastructure and connectivity in Africa is that development banks in the region remain undercapitalised. For instance, the East African Development Bank only has assets of $390 million while the largest on the continent, the Development Bank of Southern Africa, is valued at $5.3 billion. The continental African Development Bank (AfDB) has total assets valued at under $50 billion, which is significantly far off the Asian Development Bank’s over $271 billion in total assets.

With the enforcement of the AfCFTA, the urgency for infrastructure development in Africa is even more compelling. The continental trade agreement seeks to create a single market for goods and services, and thus provides an opportunity for African governments to actively confront the transportation and logistical challenges that have long plagued intra-regional trade and movement on the continent.

Making AfCFTA work requires easy intra-Africa navigation - a non-restricted flow of goods, services, and people within and across national borders. To reverse the enormous problem of infrastructure deficits and the fragmentation of supply chains, massive and strategic investments in connectivity and infrastructure are needed but without increasing the risk of  debt distress.

There is also plenty of room for the private sector to play an increased role in the funding of the continent’s infrastructure development. Of the $81.6 billion invested in 2017, the private sector accounted for just 2.8 percent compared to 42.1 percent from national governments, 23.8 percent from China, and 24.1 percent from bilateral donors, multilateral agencies and African institutions.

African governments need to urgently mobilise the continent’s financial resources to finance the regional infrastructure needed to make AfCFTA a game-changer it has been much-touted to be. Without this, the continent-wide agreement is sure to be constrained by the gap in transport infrastructure and trade integration in Africa will remain a pipe dream for the foreseeable future.

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Are African countries doing enough to ensure cybersecurity and Internet safety?

As the world continues to recover from the disruptions of the COVID-19 pandemic, coping mechanisms such as increased use of virtual workspaces, online marketplaces and e-governance have become the norm. While this presents opportunities to revamp economies and streamline public service delivery, it may also heighten exposure to cybercrime.

In Africa, many countries have seen a rise in reports of digital threats and malicious cyber activities. The results include sabotaged public infrastructure, losses from digital fraud and illicit financial flows, and national security breaches involving espionage and intelligence theft by militant groups.

Addressing these vulnerabilities requires a greater commitment to cybersecurity. This requires enforceable policy safeguards, risk prevention and management approaches, along with technologies and infrastructure that can protect each country's cyber environment, as well as individual and corporate end-user assets.

However, the latest Global Cybersecurity Index (GCI), released this June by the International Telecommunication Union (ITU), suggests Africa's levels of commitment to cybersecurity – as well as capacity for response to threats – remain low compared to other continents.

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Building Resilience Into Social Protection Systems Across Africa – Case Study on Nigeria

The dawn of the COVID-19 pandemic affected the globe with its far-reaching impacts. Even though the long-term health, economic, and social impact is still indeterminate, the immediate effects have ensued with significant loss of lives and livelihoods. Those already living in poor and vulnerable conditions have been the hardest hit, suffering extreme hardship from reduction in income and decreased consumption, since existing coping mechanisms are grossly inadequate to counter the shocks from the pandemic. This scenario is bound to threaten their chances of survival, plunge them further into extreme poverty as well as expand the inequality gap. As a result, the importance of investing in efficient social protection programmes has never been more pronounced.

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