Urgent action needed to address migration of psychiatrists out of Nigeria

Despite having a population of 200 million, Nigeria – Africa’s most populous county - has only 250 psychiatrists.

According to the World Health Organisation (WHO), one in four Nigerians are experiencing a mental illness, yet fewer than ten per cent of this demographic have access to the care they need.

With a Meade Collaboration Travel Grant from the Medical Research Foundation, Dr Emmanuel Essien, from the Research Institute at the Federal Neuropsychiatric Hospital, Calabar, collaborated with Dr Mariana Pinto da Costa, based at the Institute of Psychiatry, Psychology & Neuroscience, King’s College London, to investigate the ‘brain drain’ of early career psychiatrists in Nigeria.

‘Brain drain’ describes the phenomenon of skilled professionals moving away from their home countries to take advantage of opportunities and career prospects abroad.

Since 2010, Nigeria-trained psychiatrists working outside of Nigeria have outnumbered those practising within the country itself. In 2023, a new bill to impose five years’ mandatory service on Nigeria’s medical graduates was met with resistance.

To assess migration attitudes, Dr Essien carried out a cross-sectional survey of 228 early-career psychiatrists and psychiatric trainees (over 75% of the psychiatrist population in Nigeria). His analysis was designed to uncover “push” and “pull” factors surrounding the desire to emigrate.

The results showed a strong pattern towards psychiatrists contemplating leaving Nigeria - 85 per cent had ‘considered migration’ at some point, with 70 per cent ‘considering leaving now’.

Significantly, more than 50 per cent of psychiatrists surveyed had taken practical steps towards migrating.

Part of this may be due to under-prioritisation of psychiatric care and widespread stigmatisation of mental health conditions. Psychiatry is one of the least preferred choices for post-graduate specialisation among graduating medical students in Nigeria.

The COVID-19 pandemic, which overwhelmed health systems globally, also exacerbated this problem. Over the course of the pandemic, countries labelled by the WHO as having a ‘critical health workforce shortage’ rose from 47 to 55. In Nigeria, 100 psychiatrists left the country in the last three years alone.

60 per cent of interviewees in Dr Essien’s study reported being either dissatisfied or very dissatisfied with their income, and other variables included sociopolitical unrest, insecurity, working conditions, and greater academic opportunity abroad.

"Exploring the migration tendencies of early-career psychiatrists in Nigeria was motivated by my commitment to addressing the challenges faced by our mental health care system. It's clear from our research that immediate action is needed to prevent further depletion of our valuable psychiatric workforce." - Dr Emmanuel Essien

Dr Essien’s study reveals, in detail, the complex picture of psychiatrists’ migration attitudes in Nigeria. The implications of the brain drain are broad - impacting people’s access to vital treatment and care for mental health conditions.

Dr Essien hopes that the findings from this research will help to push more effective changes to the healthcare system’s policies and practice, and perhaps even more wide-ranging interventions.

Read the study here: Workforce migration and brain drain – A nationwide cross-sectional survey of early career psychiatrists in Nigeria

The Meade Collaboration Travel Grant scheme aims to support mid-career researchers in sub-Saharan Africa, working in the field of epidemiology, who are making the transition to independence. Awardees spend up to three months in UK research organisations, aiming to learn new skills, transfer expertise, and grow research networks. Find out more about this scheme