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To curb the ongoing migration of medical practitioners from rural to urban areas and improve the nation’s overall health indices, stakeholders in the health sector have advocated higher salary payments for health workers serving in hard-to-reach regions of the country.
In separate interviews with PUNCH Healthwise, the doctors asserted that medical practitioners in rural areas face significant challenges, including limited access to social amenities, outdated medical equipment, and inadequate pay, noting that these led to increasing migration of health workers.
They noted that the situation had contributed to poor health outcomes, a rise in deaths from preventable diseases and high maternal mortality rates.
The physicians called for a 30 per cent salary increase for rural healthcare professionals as an incentive to encourage them to remain and continue working in these underserved areas.
The Federal Government in the Harmonised/Consolidated Health and Medical Salary Structures, 2013 had approved a review of allowances of medical practitioners in the country.
A review of the allowances for health professionals included the payment of Rural Posting Allowance at the rate of 20 per cent of the Basic Salary per annum to all Health Professionals on rural posting.
However, findings revealed that such payment has not been implemented.
However, in August, the Borno State Governor, Prof Babagana Zulum, implemented the 30 per cent bonus allowance for health personnel working in rural areas.
The Special Adviser to President Bola Tinubu on Health, Dr Salma Annas, stated this in her visit to Maiduguri.
“I am very happy that you are very committed to health; in the areas of human resources, you have even gone ahead to put in place sustainable measures, an increment of 30 per cent to health workers in rural areas. This is a great incentive. I think this is only done in South Africa; that is why they saw progress in the health of their communities,” she said.
PUNCH Healthwise reported that the progress of the health sector has been marred by the japa syndrome, poor remuneration and obsolete equipment.
The Coordinating Minister of Health and Social Welfare, Prof Ali Pate, had in March stated that of 90,000 registered doctors, only 55,000 licensed doctors remained in the country.
Pate also said that over 75 per cent of Nigerian-trained health workers have left the country for opportunities abroad.
Speaking on the matter, the National President of the Nigeria Medical Association, Prof Bala Audu, in a recent interview with PUNCH Healthwise, identified inadequate salaries, lack of modern and functional equipment and the insecurity of lives and properties as factors driving the migration of health professionals from rural to urban areas and from urban areas abroad.
He noted that this move has caused an unequal distribution of health professionals in the country, adding that this meant that a particular number of the population would suffer, consequently affecting the health indices of the entire nation.
Audu said, “This situation is one of the driving factors that make people not want to stay or want to practice in some parts of the country. If you don’t have a good distribution of health professionals, it means a certain population will suffer and the impact of that suffering can spread and negatively affect the health indices.”
The don warned that epidemics and diseases “do not respect boundaries. One small community that is not well taken care of, anything can start from there and spread over the whole world, not just the whole country.”
The doctor further called for adequate funding and commitment to the effective utilisation of such funds to address and resolve the situation.
Also, a professor of Obstetrics and Gynaecology at the Usmanu Danfodiyo University, Sokoto State, Abubakar Panti, emphasised the need to equip and upgrade some primary health centres to comprehensive health centres, especially those in the rural areas.
He asserted that health personnel working in rural areas must be well remunerated to ensure they stay.
Panti decried the lack of payment of the rural allowance for doctors and nurses working in rural areas despite its adoption 10 years ago.
“You know, in 2009 and 2010, when we were active in the association, we proposed this CONHESS payment to the government at that time and it scaled through during former president Goodluck Jonathan’s regime.
“But the thing about this CONHESS payment, if you look into it, you’ll see what we call rural allowance for nurses and doctors that work in rural areas. But the government has not been paying this rural allowance for those that are practising in those areas,” he said.
The don stated that the rural allowance was important as healthcare professionals working in those areas had little to no access to modern and necessary social amenities.
He noted that the conditions in those areas prevented skilled medical practitioners from staying or offering skeletal services to the residents.
“So the government needs to bring in remuneration and things that can encourage people to go to the rural area. For example, if you make sure that the difference in payment of a nurse, doctor, laboratory scientist or pharmacist who is in the rural area, is about maybe 30 per cent more than somebody who is in the urban area, that will be a drive.
“In countries where they do this, they give a high remuneration for people in the rural area to encourage them. The majority of our population, if you go into population dynamics, are in the rural areas and they do not have enough health coverage because they (health practitioners) have all gone to the urban area,” Panti said.
On his part, the Niger State NMA chairman, Dr Yusuf Mohammed, stated that while much attention was given to urban populations, access to medical facilities and trained practitioners were important for those living in rural areas.
Given the challenges in these areas, he emphasised the need for increased remuneration to motivate healthcare workers to stay committed to their roles in rural communities and further reduce their migration to urban areas.
“Increased remuneration is one of the things that is needed to encourage health workers practising in the rural areas to be more committed to their work. People in the rural areas are sort of disadvantaged in that they lack access to social amenities such as electricity, internet and good infrastructure, present in urban areas.
“So the only thing that will encourage them is an improved salary, which will be used to augment other social amenities that they are lacking in their environment,” Mohammed said.
He, however, noted that increased remuneration was not a reason to neglect the provision of much-needed social amenities.
The Niger State NMA chair further noted that an improvement in the security situation in those areas was necessary to reduce the rural-urban migration of the much-needed healthcare workers.
