**5.1 Global distribution of medical personnel**

In Nigeria, doctor to population ratio is 3 per 10,000 compared to US which stands at 26 per 10,000. The gap is even much wider when one considers the gastroenterologist to population ratio. Nigeria has only about 60 gastroenterologists (registered with the Society for Gastroenterology and Hepatology in Nigeria, SOGHIN). Out of this number, there are some who do not practice gastrointestinal endoscopy because they work in centres that do not have facilities for it. This number is grossly inadequate for a population of over 140 million. The anatomical pathologist plays an essential role in the diagnosis of numerous digestive disorders. The number of pathologists in Nigeria is equally abysmally low for the population and only very few of them are trained specially for gastrointestinal diseases.

Some high-income countries such as Austrialia, Canada, Saudi Arabia, the USA and the United Arab Emirates and the UK have sustained their relatively high physician – to population ratio by recruiting medical graduates from developing regions, including countries in sub-Saharan Africa (Labonte et al 2006, Mullan 2006, Pond et al 2006). In contrast, over half of the countries in sub-Saharan Africa do not meet the minimum acceptable physician to population ratio of one per 5000 (WHO 2007). Several recent reviews of health workers employed in Austrialia, Canada, the UK and the USA have shown the extent of brain drain. An estimated 13272 physicians trained in sub-Saharan Africa are practising in Australia, Canada, the UK and the USA (Mullan 2006). Around a third of medical graduates from Nigerian medical schools migrate within 10 years of graduation to Canada, the UK and the USA (Ihekweazu 2005). Nurses, who commonly bear the brunt of health-care delivery in sub-Saharan Africa are also not left out in the brain drain (Labonte 2006, Mandeville 2009)
