Pathology crisis: Nigeria has less than 200 specialists for 200m people

…Pathologists demand urgent investment as brain-drain, poor working conditions threaten cancer care
By Chioma Obinna

Nigeria has fewer than 200 practising pathologists serving a population of more than 200 million people, a development experts say is threatening accurate diagnosis, cancer care and the wider health system.

The specialists, who described pathology as the bedrock of modern medicine, warned that the country could face a deeper diagnostic crisis unless government urgently invests in training, infrastructure, technology and incentives to retain specialists.

Speaking in Lagos at the 16th Annual General Meeting and Scientific Conference of the West African Division of the International Academy of Pathology, WADIAP, tagged EKOPATH ’26.

The three-day conference, which began on August 24 to 26th, has as its theme: “Future-Proofing Pathology in West Africa: Integrating Quality, Innovation, and Regional Synergy.”

Speaking, President of WADIAP, Prof. Fatimah AbdulKareem, said current statistics showed that fewer than 200 pathologists were practising in Nigeria, with the situation worsening as young doctors showed little interest in pathology training and qualified specialists migrated abroad.

According to her, Nigeria had at some point trained about 800 pathologists, but the number currently practising in the country was far below that figure.

“Right now in the country, the number that are in the country now, by the time we take the statistics, it may not be up to 200 pathologists that are left in the country,” she said.

AbdulKareem said the country was facing a dangerous combination of inadequate recruitment and migration.

She cited the experience of Lagos University Teaching Hospital, LUTH, where an advertisement for residency training reportedly attracted only two interested applicants, yet none eventually resumed the programme.

“Secondly, the ones that we are training, as they finish, as they qualify, they leave. Because they can easily get a job outside the country,” she said.

The WADIAP president warned that the shortage had serious implications for cancer diagnosis and treatment, particularly as modern medicine increasingly depends on molecular diagnostics, digital pathology and artificial intelligence.

She explained that pathology had moved beyond simply determining whether a tumour was cancerous.
“Two patients with the same type of cancer may require different treatments because of differences in their tumour characteristics.”

AbdulKareem said future pathologists must be proficient in AI, digital pathology and molecular diagnostics to provide precise diagnoses, guide oncologists on treatment options and predict patients’ responses to treatment.

She, however, stressed that AI would not replace pathologists.

“Even if AI comes today, AI will not take the job of a pathologist. Pathologists will continue to be relevant,” she said.

Also speaking, Anatomic and Forensic Pathologist and Senator representing Ondo South Senatorial District, Prof. Francis Faduyile, estimated that only about 150 histopathologists were available to serve Nigeria’s huge population.

He described the situation as “dismally low,” warning that the country must urgently address the factors driving medical specialists abroad.

“We really need to rally around on those that we have so that we can continue to encourage them,” Faduyile said.

He identified poor remuneration, economic hardship, insecurity and unfavourable working conditions as major push factors behind the migration of health professionals.

According to him, better pay, improved security and stronger professional support abroad constitute the “pull factors” attracting Nigerian specialists.

“We really need to find a way of halting those push factors,” he said, adding that the challenge was not limited to pathology but affected virtually every medical specialty.

Faduyile said legislators had a role to play in reversing the trend.

“We are going to see that we collaborate with fellow colleagues to see that appropriate laws are put in place. We want to continue to help in the oversight function of what the executive arm does,” he said.

He said the objective was to ensure that the concerns of Nigerians were adequately represented in legislative debates and decisions that would improve their lives.

Meanwhile, Professor of Pathology at the University of Ghana Medical School, Prof. Edwin Wiredu, said West Africa must build pathology systems capable of adapting to rapid technological changes.

Wiredu warned that countries that failed to establish resilient and futuristic systems would continue to spend heavily dismantling old structures whenever new technologies emerged.

“We don’t build structures that are resilient, that are futuristic, so that when new technologies are introduced, we just fit in,” he said.

He described pathology as a largely overlooked area of medicine despite its central role in diagnosis and treatment.

“Pathology is like a backbencher. We are not at the forefront,” Wiredu said.

According to him, the low visibility of the specialty had made it difficult to attract the investment and human resources required to develop it.

He said training a pathologist was expensive and took several years because specialists needed broad knowledge to work with virtually every other medical discipline.

Wiredu called for deliberate efforts to attract young doctors into pathology and retain those already trained.

He also advocated greater involvement of diaspora specialists in developing pathology in West Africa, describing it as a form of “brain separation” when trained professionals abroad return to contribute their expertise.

The keynote speaker, Prof. Adekunbiola Banjo, Professor of Anatomy and Pathology at the University of Lagos, said equitable healthcare could not be achieved without accessible, high-quality pathology services.

Banjo stressed that pathology was central to modern cancer management because treatment was increasingly personalised.

“The world has moved on so much that previously one treatment was for all cancers. But now we know that we can treat cancers based on some peculiar features of the patient.”

She urged Nigerians to ensure that every tissue removed during a medical procedure was submitted for pathological examination.

“Anybody that has anything removed from their body, anything at all, should be sent for examination to be able to know whether it is cancer or it is not cancer,” Banjo said.

She also called for stronger cancer screening programmes, particularly for cervical, breast and colorectal cancers, stressing that early detection could significantly improve outcomes.

Banjo noted that pathology was not restricted to cancer diagnosis, explaining that pathologists also diagnose infections and inflammatory conditions and contribute to public health planning through autopsies.

She cited cases in which what appeared clinically to be cancer was subsequently diagnosed as tuberculosis following pathological examination.

Speaking, Director-General of the Nigeria Institute for Cancer Research and Treatment, NICRAT, Prof. Usman Aliyu, described pathologists as the gateway to appropriate cancer treatment.

He said no cancer treatment could be appropriately administered without an accurate diagnosis.

According to him, NICRAT has been strengthening pathology services through capacity building and the upgrading of pathology laboratories with modern equipment.

Aliyu attributed the rising cancer burden partly to changing lifestyles and an ageing population, urging Nigerians to embrace healthier lifestyles, including proper nutrition and regular exercise, while avoiding smoking, excessive alcohol consumption and physical inactivity.

Also, Chairman, Local Organising Committee of EKOPATH ’26, Dr Martins Momoh, said future-proofing pathology required more than acquiring modern equipment.

“Most importantly, it requires regional synergy, breaking down geographic and institutional silos, so that sub-regional collaboration can drive standard setting, research, and resource sharing across West Africa,” Momoh said.

The experts agreed that without urgent action to expand the pathology workforce, modernise laboratories, introduce digital and molecular technologies, strengthen quality assurance and improve working conditions, Nigeria and other West African countries risk falling further behind in cancer diagnosis and precision medicine.

They called for stronger regional collaboration to ensure that pathology services keep pace with global advances and remain accessible to patients across the sub-region.