Dr Tunji Alausa, minister of education, made a frightening disclosure on Monday that, predictably, attracted little attention: Nigeria has a shortage of 600,000 medical doctors. Kindly read that again, this time slowly. Our attention is devoted to the 2027 presidential election, so we can be excused for missing the unhealthy piece of news. Nigerians were created for elections and politics. Nothing excites us more. Politics could be a good thing if it leads us to the road of redemption. After all, the real purpose of politics is the greater good of the society. Socrates, according to Plato in Gorgias, said the goal of politics is to make the citizens “as good as possible to live the best lives”. How I wish!

Politics and elections aside, we have an emergency in our hands but it seems we are going about our normal business. By any means, a shortage of 600,000 doctors is massive. We have the capacity to train only 10,000 doctors a year and that means it will take us the next 60 years to fill the gap. Wait. By then — that is, 2085 — our population will have exploded from the current 200 million to 741 million (according to PopulationPyramid.net). That means the doctor deficit will be in millions by the time we hope to have closed the gap, so training 10,000 doctors yearly for the next 60 years will still not solve the problem. Pardon me but there is no elegant way of saying this: we are in a hot mess.

We can use some emergency measures. Things are getting worse, what with the economic situation forcing thousands of doctors — who feel overworked and underpaid — to exit the country in search of fresh pasture. We thus have two significant problems: inadequate training capacity and exodus, known as “brain drain” in the 1980s (when many doctors migrated to Saudi Arabia) and now rebranded as “japa”. We are bleeding. The shortage is inflicting fatigue and frustration on the doctors who choose to remain in Nigeria, and the implications will continue to show in the quality of patient care. A doctor cannot be attending to a hundred patients per day and still be optimally productive.

In reality, there will be lethargy and apathy as the day progresses, and there could be loss of empathy as well. Misdiagnosis is not to be unexpected, and this may have nothing to do with the other obvious challenges, such as working conditions, inadequate facilities, obsolete equipment and unstable power supply. Many doctors also suffer depression not just from the workload but seeing avoidable deaths every day. Some things that modern technology has simplified are still being done manually. Some illnesses that could have been nipped in the bud at primary health care level have developed into chronic diseases, leading to a flood of patients at secondary and tertiary hospitals.

A visit to many public hospitals will break your heart. A country that values productivity will place, and pay, a premium on having a healthy population. Does this really bother us? In Nigeria, once you are rich enough to start checking your cholesterol levels, you no longer use public hospitals. You go to private hospitals that charge like five-star hotels or travel abroad for your medicals. It is the ordinary people — the tomato seller, the shoemaker, the truck pusher — that suffer the consequences of the inhospitable health care system. This is to say nothing about their inability to afford basic drugs, forcing many to resort to using some unproven but cheaper local alternatives.

I always ask myself: how and when are we going to get out of this mess? We can lament all we want, but lamentation cannot be a strategy. Doctor shortage is not limited to Nigeria. It is a global issue. When purpose-driven countries face this kind of crisis, they come up with a strategy to get out of jail. Some develop short-term to medium-term plans by recruiting foreign doctors from less buoyant countries. That is why Saudi Arabia and the UK have been coming for our doctors. But they are not stupid: they simultaneously pursue a long-term plan to train their own doctors. As they become more and more self-sufficient, they can start reducing the influx of foreign doctors into their system.

What are the plans for the short, medium and long terms to address this pathetic situation in Nigeria? Are we actively trying to improve the working conditions for our doctors? Are we actively encouraging students to study medicine? Are we improving training facilities? In 2015, my niece applied to study medicine at the Kaduna State University. She met all the requirements bar one: state of origin. She was told the programme was for Kaduna indigenes. Although her dad is from Ondo state, she was born in Kaduna and had lived there all her life. By the time she applied for admission, she had only been out of Kaduna thrice, all short trips. But her name meant she was not qualified.

Thereafter, my niece made several efforts to study medicine at other universities but had to settle for biochemistry because time was passing by. Her case is typical. The point I am making here is not about discrimination on the basis of state of origin. Rather, I am trying to point out the fact that we have thousands of students who want to study medicine but there are no spaces to accommodate them. We have universities bragging all over town that they had 2,000 applications for medicine but took only 200. This is a country that urgently needs more doctors! We would have to ask why it should be treated as a badge of honour that students who want to study medicine are being blocked.

I am happy that the minister of education is highlighting this issue. The minister of health, Prof Muhammad Pate, has also expressed worries over the exodus of doctors abroad. However, a crisis of this nature requires extraordinary measures. For a start, are we expanding training capability and capacity? Our first line of action until recently was to curtail the number of medical school intakes. The ceiling used to be 5,000 per year. We, thankfully, increased it to 10,000, but it is glaring that it is a drop in the ocean. I am not saying we should over-admit students or lower the standard. Medical training is delicate and we can’t turn our schools to Dugbe market. But we need to scale things up.

However, I am honestly at a loss as to what to do with doctors who “japa” after the country has spent so much money training them. It is a very complicated matter: we cannot restrict freedom of movement but how do get returns from our highly subsidised medical education? Some people have suggested a form of bond that will make the doctors who trained at public schools to work for the government for a number of years. This may make sense for the government in trying to get value for money but it may enrage the doctors, who would rather want to practise in places where they will get the kind of compensation they think they deserve. Well, there must be a solution somewhere.

We need to think, think and think. It is not only about how to address the health sector challenges. We generally have a severe thinking deficiency in policymaking. It always shows up in the way we approach issues. Recently, I commented on the Lagos state house of assembly’s resolution calling for the enforcement of the tenancy law to contain astronomical increases in rent. Housing crisis is usually caused by a supply problem in mega cites. In some other climes, government will come up with incentives — such as tax waivers and accelerated approval processes — to encourage private developers. Government will embark on affordable mass housing projects to reduce the deficit.

In my dearly beloved Nigeria, it is law enforcement that will address housing shortages! Just unleash government agencies on landlords and rent will start falling! This faulty reasoning is endemic in the lawmaking and policymaking spheres. I am forced to wonder at times if we actually think before we manufacture certain laws and reel out some policies. I am sincerely interested in the thinking process that leads to the drafting of some laws and policies. We behave as if we can just decree some things into being. I would implore our leaders to always take the chill pill, take a deep breath, think logically and consult widely before pouring a torrential rain of policies on us. We need to have some insight.

In a recent article, ‘If the Foundations of Logic Be Destroyed’ (April 20, 2025), I raised the issue of logical reasoning in our policymaking. I think many policies fail at the problem definition level. If the problem is not well defined and analysed, we will come up with solutions that are superficial. If the medical schools are overloaded, we tend to define the problem as that of having “too many applicants”, so we limit the number of intakes. We do not see the big picture. If rents are high, we think it is the landlords that are to blame, so we make laws to put them in their place (and it never works). If a road is prone to vehicle accidents, we always put the blame on the “reckless” drivers.

I recently came across excerpts of a book, ‘Sequential Analysis’, written in 1972 by the late Robert Holland, a respected figure at McKinsey & Company known for developing a practical framework for tackling complex decision-making. He recommended five sequential questions: (1) Is there (or is there likely) to be a problem (or opportunity)? (2) Where does it lie? (3) Why does it exist? (4) What could we do about it? (5) What should we do about it? (Note the “could” and “should”.) They are applicable to public policies as well. Questions 1 and 2 help define the problem we are trying to solve. Question 3 allows us to structure our thinking. Questions 4 and 5 help us to find a solution.

My sense is that many Nigerian policymakers and lawmakers start from either No 4 or No 5: what could/should we do about it? They define a problem by the “solutions” they already have in their heads. They take the short-cuts by avoiding rigorous thinking. This lack of sequential thinking often gives birth to policies that worsen rather than solve the problems they are intended to address. Until something changes in the way we attend to many national issues — such as doctor shortages, housing crisis, communal conflicts, herder/farmer clashes, and even environmental sanitation — we will keep making laws and policies that will end up having little or no impact on the society.

AND FOUR OTHER THINGS…

MELE MESS

Mr Bayo Ojulari, the new group CEO of the Nigerian National Petroleum Company (NNPC) Ltd, is carrying out what looks like an extensive surgery on the leadership of the national oil company. To do an audit, he has fired the MDs of the three refineries. Mr Mele Kyari, the former GCEO, led an overhaul of the refineries running into billions of dollars, but it seems the reality on the ground is far from the claims that they have been working well and churning out products without fail. Industry experts are not surprised: “turn around” contracts have been the “oil block” of many NNPC bosses and petroleum ministers for decades. That is why we have refused to sell the refineries. Nigeria!

THE CBEX TRAP

Have you ever wondered why some people get burnt in tanker explosions while scooping petrol but that does not stop others from going for their own share? Despite all the hullaballoo over the CBEX catastrophe in which over 600,000 Nigerians lost an estimated N1.2 trillion, credible reports show that the crypto trading platform is still attracting new “investors” and taking money from the old ones. They are asking people to pay a certain fee in order to regain access to their accounts and get refunded a percentage of their “investments” in June. I can understand why old timers are vulnerable — they are still hopeful of recouping their funds — but what about their new victims? Delusion.

HEARTLESS MINISTRY?

Something is going on that should automatically trigger police investigation, but I assume they are yet to pick it up. A popular online prayer group known as Abba’s Heart Ministry suddenly went underground and there are now reports that many members might be held at a location without the knowledge or consent of their families and friends. The story is not yet clear, but the things I have read so far point to the possibility that this might be one of those religious cults that brainwash members into selling their possessions and handing them over to their leaders. We may have a real problem and I hope police are keeping a close tab before we start hearing of mass suicide. Wackos.

NO COMMENT

Governor Umo Eno of Akwa Ibom state — who is also referred to as pastor — has been speaking in tongues all because he wants to defect from the Peoples Democratic Party (PDP) to the All Progressives Congress (APC). “What Akwa Ibom people want is good governance, not the name of the party,” he said. “Whether Ibom Air or Air Peace, board the flight that is ready to take you to your destination. Board the flight and forget the name of the airline.” He doubled down days later, saying: “I see party as a vehicle to get to power. When you get there, please begin to govern everyone.” All manner of philosophy and poetry simply because of an impending defection. Just do it! Hahahaha.