RESUMO
The emigration of doctors from Nigeria has been on the increase in recent years, with no obvious efforts to manage or mitigate the negative impacts of this growing trend on the already weak health system. This study assessed the emigration intentions of doctors undergoing residency training at the premier tertiary healthcare center in Nigeria and the factors that influence these intentions. This mixed-method study was cross-sectional in design. A semi-structured questionnaire was used to identify the factors that influence the emigration intentions of resident doctors at the University College Hospital, Ibadan, Southwest Nigeria. In-depth interviews (IDIs) were also conducted to further explore the push and pull factors identified from the survey and their migration preferences. A total of 244 resident doctors completed the questionnaires and 10 participated in the IDIs. Overall, 57.4% of the respondents had emigration intentions and 34.8% had made various attempts at emigrating. Major factors that encouraged resident doctors to emigrate to developed countries included better working and living conditions, good salary and the opportunity for career advancement in destination countries. Family ties was the single most important factor that deterred resident doctors from emigrating. The UK was found to be the top preferred destination. Strategic approaches and multisectoral collaborations will be required to address doctors' emigration from Nigeria. These efforts should be targeted at not just the health sector but should also include the social and economic aspects of the lives of resident doctors, to improve their living conditions.
RESUMO
Pandemics can result in significantly high rates of morbidity and mortality with higher impact in Lower- and Middle-Income Countries like Nigeria. Health systems have an important role in a multi-sector response to pandemics, as there are already concerns that COVID-19 will significantly divert limited health care resources. This study appraised the readiness and resilience of the Nigerian health system to the COVID-19 pandemic, using Oyo State, southwest Nigeria, as a case study. This study was a cross-sectional qualitative study involving key informant and in-depth interviews. Purposive sampling was used in recruiting participants who were members of the Task Force on COVID-19 in the state and Emergency Operations Centre (EOC) members (physicians, nurses, laboratory scientists, "contact tracers", logistic managers) and other partners. The state's health system response to COVID 19 was assessed using the WHO health systems framework. Audio recordings of the interviews done in English were transcribed and thematic analysis of these transcripts was carried out using NVIVO software. Results show that the state government responded promptly by putting in place measures to address the COVID-19 pandemic. However, the response was not adequate owing to the fact that the health system has already been weakened by various challenges like poor funding of the health system, shortage of human resources and inadequate infrastructure. These contributed to the health system's sub-optimal response to the pandemic. In order to arm the health system for adequate and appropriate response during major health disasters like pandemics, fundamental pillars of the health system-finance, human resources, information and technology, medical equipment and leadership - need to be addressed in order to have a resilient health system.
