State of nursing in Nigeria’s healthcare system: Unlocking the economic power of care

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IN Nigeria, nursing plays a crucial role in delivering healthcare services and improving health outcomes. However, the profession faces significant challenges, including inadequate resources, limited professional development opportunities, and infrastructure deficiencies.

This article sheds light on these practical issues, their implications on health outcomes, and advocates for increased investment in nursing to drive positive change. By addressing these challenges and investing in nursing, Nigeria can strengthen its healthcare system and improve the well-being of its population. This year, the International Nurses Day (IND) theme unveils the economic power of nursing, providing a comprehensive analysis of how enhancing the nursing profession can trigger transformative enhancements in healthcare delivery, economic advancement, peace, and societal welfare (ICN,2024).

Numerous global studies underscore the economic impact of nursing care, revealing that every dollar invested in nursing yields substantial returns in terms of improved health outcomes and cost savings. The World Health Organization (WHO) estimates that increasing nursing investment could lead to a nine-fold return on investment.

This economic leverage highlights the indispensable role nurses play in healthcare systems worldwide (WHO, 2023). However, in Nigeria, the potential of nursing to drive economic and health improvements is stifled by a myriad of practical challenges. Let me talk about some key healthcare challenges in Nigeria and how investing in the nursing workforce can help to address them.

The menace of malaria

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Malaria remains a leading cause of morbidity and mortality in Nigeria, with approximately 53 million cases and 81,640 deaths reported annually (World Health Organization, 2020). Nurses play a pivotal role in malaria control efforts, contributing to prevention, diagnosis, treatment, and community education. Studies have shown that community-based malaria interventions led by nurses can significantly reduce malaria incidence and improve treatment outcomes (Adeloye et al., 2019; Okeke et al., 2020).

Malaria imposes a substantial economic burden on Nigeria, affecting individuals, families, and healthcare systems. The direct costs of treatment, coupled with indirect costs like lost productivity, weigh heavily on low-income households and strain healthcare budgets. Moreover, malaria’s impact extends to national productivity, particularly in sectors reliant on manual labor, hindering agricultural output and perpetuating poverty. The disease’s presence also deters tourism and foreign investment, limiting economic growth and development in Nigeria. Also, by examining the knowledge, acceptance, utilization, and acceptability of the malaria vaccine in Nigeria, the publication can provide insights into the opportunities and challenges associated with this groundbreaking intervention. Ultimately, the successful introduction and integration of the malaria vaccine have the potential to revolutionize malaria control efforts, reduce disease burden, and improve health outcomes for millions of Nigerians.

Maternal and child health

Nigeria has one of the highest maternal mortality rates globally, with an estimated 512 maternal deaths per 100,000 live births (World Bank, 2019). Additionally, child mortality rates remain high, with approximately 132 deaths per 1,000 live births (Federal Ministry of Health Nigeria, 2016). Nigeria’s high maternal and child mortality rates are a pressing public health issue, with a need for urgent intervention (Mojekwu, 2012; Okonofua, 2010). The role of nursing in improving these outcomes is crucial, as it can strengthen the healthcare workforce, expand access to skilled birth attendance, and provide comprehensive maternal and child healthcare services (World Bank, 2019). Studies have shown that increasing the number of skilled birth attendants, including nurses, significantly reduces maternal and neonatal mortality rates (Federal Ministry of Health Nigeria, 2016). However, the utilization of maternal health services, particularly in rural areas, is also a key factor in reducing neonatal mortality (Adeoye, 2017). Nurses and midwives in Nigeria have significantly contributed to improving maternal and child health outcomes through their expertise and dedication. They provide skilled birth attendance, antenatal, postnatal, and emergency obstetric care, ensuring safe childbirth experiences and reducing maternal and neonatal mortality. Additionally, they offer family planning services, promote healthy behaviors, and engage in community health promotion activities. Their efforts empower individuals to make informed choices about their reproductive health, leading to healthier pregnancies and improved health outcomes for women and children across Nigeria. Therefore, investing in nursing and improving access to maternal health services are essential strategies for addressing Nigeria’s high maternal and child mortality rates.

Gerontology care

Nigeria’s population is aging rapidly, with projections indicating that older adults aged 60 years and above will constitute 7.6 percent of the population by 2030 (United Nations, 2019).

This demographic shift is occurring in the context of extreme poverty, unsolved development problems, and a decline in traditional care and support for older adults (Mbam, 2022). The macroeconomic implications of this demographic shift, including increased health and long-term care needs, pose significant challenges for the country’s economy (Bloom, 2015). It was only until 2017 that the National Senior Citizens Centre was established pursuant to the National Citizens Center Act 2017 with a mandate to identify the needs of senior citizens and to cater for them. It is the first distinct national corporate body with focus on social inclusion of senior citizens in sustainable development and the improvement of the quality of living and well-being for self fulfilment (NSCC, 2023) . Nurses play a vital role in providing holistic care to older adults, addressing their unique health and social needs. Studies have highlighted the importance of gerontological nursing education and training programs in improving the quality of care for older adults and promoting healthy aging practices (Awosolu et al., 2021; Adebayo et al., 2018). To enhance geriatrics-focused care in Nigeria, it’s crucial to prioritize training and education for healthcare professionals, promote interdisciplinary collaboration, and create age-friendly healthcare facilities. Routine geriatric assessments, community-based care initiatives, and advocacy for age-friendly policies are also essential. By implementing these recommendations, Nigeria can improve the quality of care for older adults and address the increasing demand for geriatric healthcare services nationwide.

Responding to the WHO’s Global Strategy and Action Plan for Ageing and Health, I am leading efforts to establish integrated care for older adults in Nigeria called RespoHealth Integrated Care Hub (RICH). Recognizing the unique needs of our elderly population, I am passionate about promoting person-centered care and raising awareness about the importance of addressing their healthcare needs. By supporting and strengthening the care of older persons, I am working towards improving health outcomes and enhancing their quality of life. RICH was established as a centralised platform to address fragmented care, cost barriers, and limited access to specialised services for the elderly.

RICH’s marketplace model has the potential to promote competition among healthcare providers, potentially reducing elderly patient costs. The project will be rolled out 2025.

Climate Change and Health Impact

Climate change poses a significant threat to public health in Nigeria, exacerbating the incidence of infectious diseases, heat-related illnesses, and natural disasters (Lawal, 2018; Anabaraonye, 2020). Nurses can play a crucial role in mitigating these health impacts through advocacy, education, and adaptation strategies. However, the issue of climate change in Nigeria is complex, with implications for the country’s economy, agriculture, and security (Lawal, 2018). The impacts of climate change on Nigeria’s health sector necessitate the development of innovative solutions for environmental sustainability (Anabaraonye, 2020). The need for adaptation strategies is further emphasized, given the increasing degree of these impacts (Ezegwu, 2014). Nurses in Nigeria are pivotal in mitigating the health impacts of climate change through advocacy, education, adaptation strategies, and research. By advocating for policies, educating communities, implementing adaptation measures, and conducting research, nurses can protect public health, enhance healthcare preparedness, and promote sustainable development in the face of climate change challenges.

Lack of quality and patient safety standards and regulations in Nigeria healthcare

The lack of quality and patient safety standards in Nigerian healthcare presents significant challenges, including inadequate regulatory frameworks, limited resources, accountability gaps, and workforce challenges. This leads to patient harm, diminished trust, and economic burdens. Solutions involve strengthening regulatory oversight, investing in infrastructure and resources, promoting professional development, fostering a culture of safety, and engaging stakeholders. Nurses play a crucial role in improving quality and patient safety through advocacy, education, adherence to standards, and collaboration in healthcare delivery. Investment in nurses enhances their capacity to deliver safe, effective care, thereby improving health outcomes and building trust in the healthcare system. By prioritizing quality and patient safety and investing in nurses, Nigeria can create a healthcare system that provides equitable, patient-centered care to all its citizens.

Now, let’s address some of the challenges in nursing in Nigeria and discuss how investment in nursing can help to mitigate them.

Ongoing verification saga in Nigerian nursing

The ongoing verification saga in Nigerian nursing highlights systemic challenges within the healthcare system and the need for comprehensive reforms. Here are some key issues and recommendations:

Issues and recommendations

Delayed or Incomplete Verification Processes: Many nurses in Nigeria experience delays or difficulties in verifying their credentials with regulatory bodies due to bureaucratic inefficiencies, understaffing, and outdated verification systems. This results in delays in licensure renewal, employment, and career advancement opportunities for nurses.

Fraudulent Practices: Some individuals exploit loopholes in the verification process to engage in fraudulent activities, such as forging credentials, impersonating licensed nurses, or misrepresenting their qualifications. These fraudulent practices compromise patient safety, erode public trust in the nursing profession, and undermine the integrity of the healthcare system.Inadequate Regulation and Oversight: Weak regulatory frameworks and inadequate oversight contribute to the proliferation of unlicensed and unqualified individuals practicing nursing in Nigeria. This poses significant risks to patient safety and public health, as these individuals may lack the necessary knowledge, skills, and ethical standards required for safe and effective nursing practice.Professional Stigma and Discrimination: Nurses who encounter difficulties in verifying their credentials may face professional stigma and discrimination, both within the healthcare system and from employers. This can have negative repercussions on their career prospects, job security, and mental well-being, further exacerbating workforce challenges in the nursing profession.

To address these issues, recommendations include streamlining verification processes, strengthening regulatory oversight, enhancing professional standards, improving access to continuing education, and combating discrimination and stigma. By implementing these recommendations, stakeholders can promote regulatory compliance, safeguard patient safety, uphold professional integrity, and bolster the nursing workforce to better meet the healthcare needs of the population.

Quackery in Nursing

Quackery in nursing poses a significant threat to patient safety and undermines the integrity of the nursing profession in Nigeria. A study by Adebayo et al. (2020) revealed that approximately 40% of healthcare practitioners in Nigeria are not formally trained or licensed, leading to widespread quackery. Investment in nursing education, training, and regulation can help address this challenge by ensuring that all nurses are adequately trained, licensed, and regulated. Strengthening regulatory frameworks, increasing enforcement measures, and promoting public awareness can help combat quackery and uphold professional standards in nursing (Adebayo et al., 2020; World Health Organization, 2019).

Amongst all the several efforts to end quackery in Nigerian Nursing, I was particularly impressed by the Nursing conception initiative(NCI), a body of nurses whose vision is to promote the public profile of nursing and one of our core projects is kicking against quackery. They believe that this requires government and institutional policies to punish the quacks as well as educating the public to understand the associated dangers of quackery itself and staying clear of them. NCI embarked on a self funded and non-profit short film project titled “Alabeere (The one who wields the needle) that centers on the menaces of quacks & dangers of quackery set to be released during nurses week (May 2024). Watch here https://youtu.be/xp_dEXDUErM?si=qvbzVcx3iwF0tfSt

Limited Sponsorship Opportunities

Many aspiring nurses in Nigeria face barriers to accessing sponsorship opportunities for nursing education and training. Limited sponsorship opportunities hinder the recruitment and retention of qualified individuals into the nursing profession, exacerbating workforce shortages. Investment in nursing scholarship programs, grants, and financial aid can help address this challenge by expanding access to education and training for aspiring nurses. Scholarships can incentivize individuals to pursue nursing careers and ensure a steady supply of qualified nursing professionals (Federal Ministry of Health Nigeria, 2016; World Bank, 2019).

Through the Future Nursing Leadership Program, a CSR of my company NCO Healthcare Consulting, I am spearheading novel initiatives, two years in a role to invest in the nursing workforce and tackle nurse emigration in Nigeria. The program identifies and nurtures talented nursing students and early-career professionals, providing scholarships, leadership development, mentorship, and career advancement opportunities. We launched the Future Nursing Scholarship in Nigeria as a pivotal program of the Future Nursing Leadership Program in 2022 by providing funding for 6 students and in 2023, 10 students.

By advocating for policy reforms, engaging in community service, and promoting retention within the Nigerian healthcare system, the program aims to build a resilient and sustainable healthcare workforce that meets the needs of the population.

Inadequate Facilities and Support for Human Capital Development

Nigerian nurses often work in healthcare facilities with inadequate infrastructure, equipment, and resources, hindering their ability to deliver quality care. Additionally, there is limited support for human capital development, including training, continuing education, and career advancement opportunities. Investment in nursing infrastructure and human capital development is essential to address these challenges. By improving healthcare facilities, providing access to modern equipment and technology, and offering ongoing training and professional development opportunities, nurses can deliver high-quality care and advance their careers (Adeloye et al., 2019; Ojewole et al., 2020).

Poor investment in Nurses’ Welfare and Well-being

Nurses in Nigeria often face poor working conditions, low wages, and inadequate support systems, leading to job dissatisfaction, burnout, and attrition. Investing in nurses’ welfare and well-being is crucial to retain a motivated and competent nursing workforce. Measures such as improving working conditions, enhancing remuneration packages, providing psychosocial support, and implementing policies to promote work-life balance can contribute to nurses’ job satisfaction and retention (Adebayo et al., 2018; Ogundipe et al., 2021).

Disparate Entry Points, Specialization, and Career Progression

The nursing education system in Nigeria features disparate entry points, with varying program durations and qualifications. This lack of standardization can lead to inconsistencies in nursing education and competencies among graduates. Investment in nursing education reform and standardization can address this challenge by establishing clear entry requirements, curriculum standards, and pathways for specialization and career progression. By providing opportunities for continuous learning, professional development, and specialization, nurses can enhance their skills, competencies, and career prospects (Federal Ministry of Health Nigeria, 2016; Awosolu et al., 2021).

Brain Drain and the JAPA Syndrome

Nigeria experiences significant nurse emigration due to push factors such as poor working conditions, limited career prospects, and low remuneration. The “JAPA syndrome” refers to the phenomenon of Nigerian nurses leaving the profession due to job dissatisfaction. Investment in nursing workforce retention strategies is essential to address brain drain and the JAPA syndrome. Improving nurses’ working conditions, offering competitive salaries and benefits, providing opportunities for career advancement, and implementing policies to recognize and reward nurses’ contributions can help retain skilled nursing professionals and mitigate the negative effects of nurse emigration (Federal Ministry of Health Nigeria, 2016; Adeloye et al., 2019).

Lack of Healthcare Facilities and Proper Healthcare Structure

Nigeria faces challenges in healthcare infrastructure, with inadequate facilities and a hierarchical healthcare structure that may limit nurses’ involvement in decision-making processes. Investment in healthcare infrastructure development and structural reforms is essential to address this challenge. By expanding access to healthcare facilities, decentralizing decision-making processes, and promoting nurse leadership and participation in healthcare governance, Nigeria can strengthen its healthcare system and improve the delivery of quality care (Federal Ministry of Health Nigeria, 2016; World Bank, 2019).

By investing in nursing and addressing these challenges, Nigeria can strengthen its nursing workforce, improve healthcare delivery, and enhance health outcomes for its population.

Conclusion

In conclusion, the state of nursing in Nigeria presents both challenges and opportunities to unlock the economic power of care and drive positive change in the healthcare sector. Despite facing systemic issues such as inadequate resources, regulatory deficiencies, and workforce challenges, Nigerian nurses demonstrate resilience, dedication, and a commitment to delivering quality care to their patients. By addressing key practical issues affecting nursing, including facility improvement, scholarship opportunities, human capital development, and nurses’ welfare, stakeholders can improve health outcomes, enhance patient safety, and strengthen the healthcare system as a whole.

Investing in nursing is not only a moral imperative but also an economic necessity. Nurses are the backbone of the healthcare workforce and play a critical role in delivering essential services, promoting health, and addressing the diverse needs of the population. By recognizing the economic value of nursing and prioritizing investments in nursing education, training, and professional development, Nigeria can harness the full potential of its nursing workforce to drive sustainable development, economic growth, and improved health outcomes for all Nigerians.

As we celebrate International Nurses Day and reflect on the contributions of nurses to the health and well-being of individuals and communities, let us renew our commitment to supporting and empowering nurses in Nigeria. By working together to address the challenges facing the nursing profession and unlocking the economic power of care, we can build a healthier, more prosperous future for our nation.

Aremu, a doctoral researcher, is Assistant Professor in Nursing, University College Dublin, Ireland.