ASSESSMENT OF THE IMPACT OF JAPA SYNDROME ON MATERNAL HEALTHCARE DELIVERY AMONG MIDWIVES IN UNIVERSITY OF ABUJA TEACHING HOSPITAL, GWAGWALADA, FCT

ABSTRACT

Background: The mass emigration of healthcare professionals from Nigeria, popularly termed the "Japa Syndrome," has created a profound and destabilizing workforce crisis in the Nigerian health sector. University of Abuja Teaching Hospital (UATH), Gwagwalada, a major tertiary healthcare institution in the Federal Capital Territory, has not been insulated from this trend. Midwives, who are central to maternal healthcare delivery, are among the most affected cadres of professionals emigrating in search of better economic conditions and professional opportunities abroad. This study assesses the impact of this syndrome on maternal healthcare delivery among midwives at UATH.

Objective: The study aimed to evaluate the extent of midwife emigration from UATH, identify underlying push and pull factors, and determine the resultant effects on maternal healthcare indices including antenatal care coverage, skilled birth attendance, and postpartum care.

Methods: A descriptive cross-sectional survey design was adopted. Structured questionnaires and key informant interviews were used to collect data from midwives, nursing officers, and maternity ward administrators at UATH. Data were analysed using SPSS version 26.

Expected Findings: Findings are expected to reveal significant staffing shortfalls in the maternity unit, increased workload for remaining midwives, deterioration in patient-to-midwife ratios, and adverse outcomes in maternal health indicators following mass emigration of skilled midwifery personnel.

Conclusion: The Japa Syndrome poses a grave threat to maternal healthcare delivery in Nigeria. Urgent policy interventions, including improved remuneration, better working conditions, and structured retention strategies, are necessary to stem the tide of midwifery emigration and safeguard maternal health outcomes.

Keywords: Japa Syndrome, brain drain, midwives, maternal healthcare, UATH, Gwagwalada, workforce emigration, Nigeria.

CHAPTER ONE

1.0 INTRODUCTION

1.1 BACKGROUND TO THE STUDY

Nigeria is currently experiencing an unprecedented wave of skilled professional emigration across all sectors, but none more critical than healthcare. The colloquial term "Japa," derived from Yoruba and meaning "to run swiftly away," has entered common parlance to describe this mass exodus of Nigerians seeking better lives, economic stability, and professional fulfilment abroad (Abubakar et al., 2023). Within the healthcare sector, the Japa Syndrome has depleted the workforce to crisis levels, with profound implications for the delivery of essential health services, particularly maternal and child health.

Nigeria already bears one of the highest maternal mortality burdens in the world. According to the World Health Organization (2023), Nigeria accounts for approximately 28% of global maternal deaths, with a maternal mortality ratio estimated at 512 per 100,000 live births. The availability of skilled midwifery personnel is directly correlated with reductions in maternal mortality, as midwives are primary providers of antenatal, intrapartum, and postpartum care (International Confederation of Midwives [ICM], 2021). The emigration of trained midwives therefore strikes at the very core of Nigeria's capacity to reduce preventable maternal deaths.

University of Abuja Teaching Hospital (UATH), Gwagwalada, Federal Capital Territory, is a federal tertiary health institution that serves both the FCT and surrounding states including Niger, Kogi, and Nassarawa. The hospital's maternity unit is a high-volume centre managing thousands of deliveries annually. However, reports from hospital management and nursing leadership indicate that the maternity ward has lost a significant number of experienced midwives in recent years to emigration, primarily to the United Kingdom, Canada, and Saudi Arabia (Oleribe et al., 2019; Ihejirika et al., 2022).

The consequences of this workforce attrition are multifaceted. Remaining midwives face substantially increased patient loads, extended working hours, burnout, and diminished quality of care. Furthermore, the loss of senior and experienced midwives disrupts the institutional knowledge base, mentorship structures, and the overall capacity for quality maternal care delivery (Duvivier et al., 2021). New mothers and unborn children bear the ultimate cost of this crisis.

Despite the growing recognition of this problem at policy levels, there is a paucity of institution-specific studies examining the precise impact of the Japa Syndrome on maternal healthcare delivery in Nigerian teaching hospitals. This study is therefore designed to fill that gap, using UATH, Gwagwalada as a case study. The research will provide evidence-based data to inform institutional and national policy responses aimed at retaining midwifery talent and sustaining maternal healthcare quality in Nigeria.

The Japa Syndrome is not a novel phenomenon but has intensified dramatically in the post-COVID-19 era. The combination of devastating economic conditions, systemic underfunding of health infrastructure, poor remuneration, insecurity, and the heightened global demand for healthcare professionals following the pandemic has created a perfect storm that is emptying Nigeria's healthcare facilities of their most qualified personnel (Abubakar et al., 2023). The Nigerian Medical Association reported in 2022 that over 16,000 Nigerian doctors were registered with the United Kingdom's General Medical Council alone, with thousands more in Canada, the United States, and Australia.

Midwifery, as a profession, occupies a unique and irreplaceable role in the Nigerian maternal health system. The Nursing and Midwifery Council of Nigeria (NMCN) is the regulatory body responsible for training and certifying midwives, and the country has invested considerable resources in midwifery education through its School of Midwifery programmes. However, graduates increasingly view the local employment environment as untenable due to delayed promotions, poor salaries, inadequate equipment, and unsafe working environments (Ihejirika et al., 2022).

UATH, Gwagwalada was established as a centre of clinical excellence and academic medicine. Over the years, it has trained hundreds of midwives and nurses who have gone on to contribute significantly to healthcare delivery in the FCT and nationally. The institution is also a referral centre for high-risk obstetric cases from surrounding states. The loss of experienced midwifery staff therefore not only affects routine care but also the management of complex maternal emergencies (Oleribe et al., 2019).

Globally, health workforce shortages are acknowledged as a principal barrier to achieving the Sustainable Development Goal 3.1, which targets a maternal mortality ratio below 70 per 100,000 live births by 2030 (WHO, 2023). For Nigeria, meeting this target appears increasingly distant given the ongoing haemorrhage of skilled health workers. The International Labour Organization (ILO, 2022) estimates that by 2030, the global shortfall in healthcare workers could reach 18 million, with sub-Saharan Africa bearing the greatest burden.

Research has established clear links between healthcare worker density and maternal health outcomes. Anand and Bärnighausen (2004), in a seminal study across 117 countries, demonstrated that higher densities of doctors, nurses, and midwives were significantly associated with reduced maternal and infant mortality. More recent studies by Duvivier et al. (2021) and Rao et al. (2022) confirm that midwife emigration from low- and middle-income countries (LMICs) directly undermines skilled birth attendance rates and neonatal survival. The implications for Nigeria, and specifically for institutions like UATH, are therefore deeply concerning.

1.2 STATEMENT OF THE PROBLEM

The mass emigration of midwives from Nigerian healthcare institutions represents one of the most serious threats to the achievement of acceptable maternal health outcomes in the country. At UATH, Gwagwalada, anecdotal evidence from clinical supervisors and published hospital reports suggests that the maternity unit has experienced significant depletion of its skilled midwifery workforce over the past five years, with estimates suggesting a loss of between 30–45% of trained midwives to overseas employment (Ihejirika et al., 2022).

This staffing deficit has led to documented cases of increased patient-to-midwife ratios that far exceed internationally recommended standards. The WHO (2021) recommends a minimum midwife-to-patient ratio of 1:5 in active labour units, yet reports from Nigerian facilities consistently reflect ratios as skewed as 1:15 or higher during peak periods. Such conditions increase the probability of missed obstetric emergencies, inadequate monitoring, and adverse maternal and neonatal outcomes (Lori et al., 2020).

Despite the severity of the situation, there is a notable absence of systematic, evidence-based research specifically examining the impact of the Japa Syndrome on maternal healthcare delivery at UATH. Existing national-level studies focus on physician emigration or broad healthcare workforce trends, with limited attention to midwifery-specific impacts at the institutional level. This gap in knowledge impedes the development of targeted, context-specific interventions. The present study is therefore conducted to generate the empirical evidence needed to address this critical institutional and national healthcare challenge.

1.3 OBJECTIVES OF THE STUDY

The general objective of this study is to assess the impact of the Japa Syndrome on maternal healthcare delivery among midwives at University of Abuja Teaching Hospital, Gwagwalada, FCT.

Specific objectives include to:

1. Determine the prevalence of Japa (emigration intent and actual emigration) among midwives at UATH, Gwagwalada.
2. Identify the push and pull factors influencing midwives to emigrate from UATH.
3. Assess the effect of midwife emigration on patient-to-midwife ratios and workload distribution at UATH.
4. Evaluate the impact of midwife emigration on maternal healthcare outcomes (antenatal attendance, skilled birth attendance, maternal mortality rates) at UATH.
5. Examine institutional strategies in place to mitigate the effects of midwife emigration at UATH.

1.4 RESEARCH QUESTIONS

The following research questions guided the study:

1. What is the prevalence of emigration intent and actual emigration among midwives at UATH, Gwagwalada?
2. What are the predominant push and pull factors influencing midwife emigration from UATH?
3. How has midwife emigration affected patient-to-midwife ratios and workload at UATH?
4. What is the impact of midwife emigration on maternal healthcare delivery outcomes at UATH?
5. What institutional strategies exist to address the challenges posed by midwife emigration at UATH?

1.5 RESEARCH HYPOTHESES

H01: There is no significant relationship between the Japa Syndrome and the deterioration of maternal healthcare delivery at UATH, Gwagwalada.

H02: There is no significant association between midwife emigration and increased workload among remaining midwifery staff at UATH.

H03: There are no significant institutional mitigation strategies in place to address the impact of midwife emigration on maternal healthcare delivery at UATH.

1.6 SIGNIFICANCE OF THE STUDY

This study holds significant value for multiple stakeholders across the Nigerian healthcare landscape. For hospital administrators and management at UATH, the findings will provide a clear evidence base upon which to build workforce retention strategies, make informed staffing decisions, and advocate for improved resource allocation from the Federal Ministry of Health.

For policymakers at the national level, including the Federal Ministry of Health, the Nigeria Health Watch, and the Nursing and Midwifery Council of Nigeria, the study will contribute empirical data to the growing national discourse on healthcare worker emigration and its consequences for maternal health system performance. This can inform the development or strengthening of national retention policies such as improved salary scales, rural and hardship allowances, and structured career progression for midwives.

For the academic and research community, this study adds to the limited but growing body of literature on the Japa Syndrome's sector-specific impacts, particularly within midwifery. The findings may serve as a reference point for comparative studies across other Nigerian tertiary health institutions.

Finally, for the global health community, the study contributes to the broader understanding of health worker migration dynamics in sub-Saharan Africa and its implications for achieving the Sustainable Development Goals, particularly SDG 3.1 on maternal mortality reduction.

1.7 SCOPE OF THE STUDY

This study is delimited to University of Abuja Teaching Hospital, Gwagwalada, FCT. It focuses specifically on midwives working in the maternity unit, including those in antenatal, labour and delivery, and postnatal wards. The study covers the period from 2018 to 2024, which encompasses the intensification of the Japa Syndrome in the Nigerian health sector. The research examines the push and pull factors of emigration, workforce depletion patterns, and the consequent effects on maternal healthcare delivery outcomes. It does not extend to other cadres of healthcare workers or other hospitals, though comparisons are drawn from relevant literature.

1.8 LIMITATIONS OF THE STUDY

The study anticipates several potential limitations. First, self-reporting bias may affect the accuracy of responses, particularly from midwives who may be reluctant to disclose emigration intentions for fear of professional consequences. Second, incomplete or inconsistently maintained institutional records on staff turnover and emigration at UATH may limit the precision of workforce attrition data. Third, the cross-sectional design limits the ability to establish causal relationships between midwife emigration and changes in maternal health outcomes over time. Fourth, generalizability may be restricted to similar tertiary health institutions within the FCT and North Central Nigeria, and the findings may not fully represent the situation in rural or other geopolitical zones of the country. These limitations are, however, acknowledged and addressed through triangulation of data sources and careful methodological design.

1.9 DEFINITION OF TERMS

Japa Syndrome: A colloquial term of Yoruba origin used to describe the mass emigration of Nigerians, particularly skilled professionals, from Nigeria to developed countries in search of better living conditions, economic opportunities, and professional development (Abubakar et al., 2023).

Midwife: A trained health professional, registered and certified by the Nursing and Midwifery Council of Nigeria, who is competent to provide the necessary supervision, care, and advice to women during pregnancy, labour, and the postpartum period, as well as to care for the newborn and the infant (ICM, 2021).

Maternal Healthcare Delivery: The organised provision of health services directed at promoting, maintaining, or restoring health and preventing maternal morbidity and mortality during the prenatal, intrapartum, and postpartum periods (WHO, 2023).

Brain Drain: The emigration of highly trained or qualified individuals from a country, resulting in an intellectual and professional deficit in the country of origin (Duvivier et al., 2021).

Push Factors: Conditions in the home country that motivate healthcare workers to leave, including poor salaries, inadequate working conditions, insecurity, and limited career advancement (Oleribe et al., 2019).

Pull Factors: Attractive features of destination countries that incentivise emigration, including higher wages, advanced technology, professional development opportunities, and better quality of life (Rao et al., 2022).

Skilled Birth Attendance: Delivery care provided by a trained health professional — such as a midwife, nurse, or doctor — who has the skills to manage normal deliveries and diagnose or refer obstetric complications (WHO, 2023).

Patient-to-Midwife Ratio: The number of patients assigned to or under the care of a single midwife at any given time, used as a proxy indicator of workload and staffing adequacy (Lori et al., 2020).

Tertiary Health Institution: A hospital providing specialised consultative care, usually for inpatients referred from secondary level health facilities and serving as a training base for health professionals (Federal Ministry of Health Nigeria, 2021).

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