Nigeria’s Pathology crisis deepens as fewer than 200 specialists remain

By Doris Obinna

Nigeria’s pathology profession, the diagnostic foundation of modern medicine, is facing a deepening crisis, with fewer than 200 pathologists reportedly practicing in a country of more than 200 million people.

Experts at the 16th Annual Conference and General Meeting of the West African Division of the International Academy of Pathology (WADIAP), held in Lagos Nigeria, warned that brain drain, poor incentives, inadequate infrastructure and declining interest among young doctors could further weaken pathology services.

The conference, themed “Future-Proofing Pathology in West Africa: Integrating Quality, Innovation and Regional Synergy,” also highlighted the urgent need for artificial intelligence, digital pathology, molecular diagnostics and stronger regional collaboration.

Stakeholders and members of WADIAP at the 16th Annual Conference and General Meeting of the Academy, held recently in Lagos.

Pathologist and politician, Prof. Francis Faduyile, said the starting point was recognising pathology as the bedrock of healthcare. “Pathology is the bedrock of medicine,” Faduyile said, stressing that accurate diagnosis was essential to effective treatment and disease management.

He said West African countries must collaborate to improve diagnostic quality, strengthen external quality assessment and embrace innovations capable of bringing pathology practice closer to global standards.

President, WADIAP, Prof. Fatimah Abdulkareem, said fewer than 200 pathologists were currently practising in Nigeria, although the actual number could be lower.

Abdulkareem, who is also a consultant histopathologist at Lagos University Teaching Hospital (LUTH), said Nigeria had trained hundreds of pathologists over the years, but many had migrated, while fewer young doctors were choosing the specialty.

She recalled that when residency positions were advertised, only a handful of doctors showed interest, with some of those who expressed interest eventually failing to resume. “The young ones, many of them are not coming,” she said, noting that specialists who complete their training can readily secure jobs abroad.

Professor of Pathology, University of Ghana and immediate past President, WADIAP, Prof. Edwin Wiredu, described the situation as unsustainable.

According to him, Nigeria could have roughly one pathologist serving up to one million people, an “impossible task.”

Specialist shortage deepens
Abdulkareem cited an even more disturbing estimate of about one pathologist to five million people. She said the implications were enormous because pathology specialists could not be replenished quickly.
“Training a specialist takes years, while acquiring the experience required to interpret complex cases takes considerably longer,” she said.
Echoing similar concerns, Wiredu said the loss of trained specialists to migration was particularly damaging because of the time and resources invested in their training.
“When you train somebody for five or six years, and the person works for five years and leaves, it is not only the knowledge that he has taken away; he has taken all the input and everything that you have given, the experience and so on,” he said.
He said the loss meant another lengthy training cycle was required before a replacement could acquire comparable expertise.
While Faduyile stressed that the migration of health professionals, popularly known as “Japa,” had therefore become a major concern for pathology.
According to him, the problem should not be viewed simply as a healthcare-sector issue but as a national challenge driven by powerful push and pull factors.
“Poor remuneration, economic pressures, insecurity and difficult working conditions push professionals out, while better salaries, security and professional opportunities attract them abroad,” he said.
“The push factors are so much that we really need to find a way of halting those push factors. The impact is particularly severe in pathology because the specialty requires sustained investment in laboratories, equipment, reagents and highly trained personnel.”
Wiredu said many West African health systems also struggled to recover the real cost of pathology services, making it difficult to provide the remuneration and resources necessary to retain specialists.
He urged Nigeria not to regard every professional who leaves as permanently lost, advocating what he described as “brain circulation.”
Nigerian specialists abroad, he added, could continue contributing through teaching, research, mentoring, training, technology transfer and professional collaboration.
Professor of Anatomical Pathology at the University of Lagos, Prof. Adekunbiola Banjo, said government must create incentives to retain healthcare professionals and encourage specialists to work outside major urban centres.
Banjo, who is also a consultant pathologist, LUTH, noted that the crisis was not only about the number of pathologists but also their distribution.
“With specialists concentrated largely in major cities, millions of Nigerians in underserved communities face additional barriers to accessing specialist diagnostic services,” she said.

Pathology in digital age
Experts at the conference said Nigeria must not only train more pathologists but also prepare them for a rapidly changing profession in which artificial intelligence, digital pathology and molecular diagnostics are becoming increasingly important.

Chief Consultant Pathologist at LUTH and Chairman, Local Organising Committee (LOC), Dr. Martins Momoh, said the conference was designed to build systems capable of adapting to technological change.
“If you don’t build systems that can move with the times, when new technology comes, you have to dismantle everything that you’ve done in order to fit into the new system,” he said.

Momoh said digital pathology allows tissue slides to be scanned and viewed remotely, making it possible for specialists in Nigeria to collaborate with colleagues abroad without physically transporting specimens.
“For a region with limited numbers of specialists, experts said the technology could significantly expand access to expertise,” he said, adding that the pathologist of the future must be AI-compliant and proficient in molecular diagnostics.”

Banjo emphasised that the role of the pathologist had already moved beyond simply determining whether a lump was cancerous.

“Today, pathologists may have to identify the precise cancer subtype, determine biomarkers, assess prognosis and provide information that helps oncologists select the most appropriate treatment,” she said.
“Two patients with the same cancer may not respond to the same treatment, making precision and personalised medicine increasingly dependent on pathology.”

Banjo said pathology was central to this transformation because treatment decisions increasingly depend on identifying the biological characteristics of individual tumours.

She also stressed that tissue removed from a patient’s body should be sent for pathological examination to determine whether it is cancerous or benign.
“Pathology, however, extends beyond cancer. It helps distinguish infections, inflammation, benign tumours and malignant disease and contributes to public health through autopsies, which can help determine causes of death, including maternal deaths,” she said.

Diagnosis, heart of cancer care
Director General, National Institute for Cancer Research and Treatment (NICRAT), Prof. Usman Aliyu, described pathologists as the gateway to cancer treatment.

Before surgery, chemotherapy or radiotherapy can be appropriately deployed, he said, there must first be a reliable diagnosis.

A wrong diagnosis, he warned, could lead to inappropriate treatment, deterioration and potentially death.

Aliyu said NICRAT had been supporting capacity building for pathologists and other healthcare professionals while upgrading some pathology laboratories with modern equipment.

He said Nigeria must train more pathologists, retain those already in the system, improve remuneration and working conditions, strengthen laboratories, expand quality assurance, invest in digital infrastructure and extend specialist services beyond major cities.

There is also an urgent need to strengthen cancer screening and early detection, Banjo added, stressing that cancers including cervical, breast and colorectal cancers could be detected earlier through appropriate screening programmes, improving patients’ chances of survival.

Experts at the conference reiterated that a healthcare system could not be stronger than its ability to accurately diagnose disease.

As cancer becomes more complex and medicine moves increasingly towards personalised treatment, the pathologist is no longer simply the doctor behind the microscope. The specialist is becoming central to determining what disease a patient has, how aggressive it is and which treatment is most likely to work.

The race to future-proof pathology has begun. Whether Nigeria can keep pace could ultimately determine not only the future of the profession but also the quality of diagnosis and treatment available to millions of Nigerians.

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