Nigeria is a funny country, I tell you. Every time I become depressed about the state of this country, something always comes up that makes me burst into laughter.
Take for instance, this recent bill to tie down medical doctors for five years in Nigeria after medical school. I swear, I laughed for two minutes straight after watching the video clip of Hon. Ganiyu Abiodun Johnson, online.
So, the solution to stop the brain drain in Nigeria is to enslave young Nigerian-trained doctors for five years before giving them their full medical licence?
Really? Is this the best we can do?
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If you are just hearing about this hogwash, let me bring you up to par.
On the 6th of April, a bill for an Act to amend the Medical Doctors and Dental Practitioners Act, Cap. M379, 2004 to mandate any Nigeria-trained medical or dental practitioner to practice in Nigeria for a minimum of five (5) years before being granted a full license by the Council to make quality health services available to Nigeria; and for related matters (HB.2130), was sponsored by the House of Representatives member representing Oshodi Isolo II Federal Constituency of Lagos State, Hon. Ganiyu Abiodun Johnson.
In plain English, this bill, which has passed its second reading at the plenaries, aims to make it mandatory for doctors not to be given full practising license until five years after graduation.
While discussing the bill, Honourable Johnson kept emphasizing that the bill was to ensure ‘Nigerian doctors give back to the society’. I am not exaggerating when I say that he mentioned the phrase ‘giving back to society’ more than three times.
So, the way to give back to society is to enslave doctors? Wonders shall never end.
I will not mince words: the bill is disrespectful, amateurish, and very poorly constructed. However, before I give you the reasons why, let us briefly dissect the problem.
The problem is that Nigeria is haemorrhaging health workers. Simple. Doctors, Nurses, Pharmacists, Physiotherapists, Lab scientists, Radiologists and every specialty in the medical profession are leaving the country to seek greener pastures elsewhere. This is a problem that has been in existence for a very long time in Nigeria but has exponentially increased over the last decade. To be fair, many associations including NMA have been singing about this looming disaster for a very long time, but as is our culture, the government waited until it was too late before running from pillar to post looking for a solution.
By now, we all know the WHO recommended ratio of one doctor to six thousand patients; this statistic has been over-flogged, so much so that it gives me a headache. Yet, in Nigeria, Hon. Sununu said our current ratio is one doctor to thirty-three thousand patients. He rightly called the brain-drain pandemic ‘a storm’ and described a situation where a single doctor in a rural hospital would oversee the clinic, theatre and wards while being on call for 24 hours every day!
So yes, there is a severe lack of health workers in the country. And yet, instead of the health workers to stay back and ‘give back to the society’, we are leaving.
Why?
The factors responsible for brain drain are multifaceted but like many surveys have shown, the reasons are chiefly: poor renumeration, unemployment (or underemployment) insecurity and a general dissatisfaction with the working environment. We are poorly paid, overworked, and disgruntled.
So, what is the solution? It should be glaring, shouldn’t it? Better renumeration, employment and better working environment. But no, Nigeria would rather close eye and entertain poorly thought bills than address the root cause. God forbid that Nigerian government improves its health care system; it would be better (and cheaper) to enslave the bloody doctors!
Now, back to why this bill is quite frankly, ridiculous.
First and foremost, what the bill wants to do, is criminal. Fifteen years ago, when I graduated, I was given a provisional licence with which to practice. We were to complete a mandatory one-year housemanship/Internship, after which we would do a full registration and then given a practicing licence which would be renewed annually. Currently, this is what is still obtainable. A person who is qualified as a doctor cannot be denied a license to practise having been certified qualified, except if he is found wanting in the ethics of the profession. Doctors wishing to ‘Japa’ usually wait till they have done their full registration (as this is evidence that you have trained and can practice in Nigeria) with the Medical and Dental Council of Nigeria before seeking greener pastures elsewhere.
The idea behind this proposed bill is that if Nigeria denies young graduates their full registration for five years, they will have no choice but to stay. Therefore, in essence, doctors will practice for five years with a provisional licence in this country.
Have the lawmakers thought of the legal implications of this?
As a house officer working with a provisional licence, you are exonerated from any medical negligence you commit as it is assumed that you are under apprenticeship. One year later, after thorough training in a government owned facility, supervised and signed by senior consultants, you are then certified as fully trained and liable to be fully registered. Imagine if we have doctors roaming the street for five years with provisional licence?
Lawyers, manna has come from heaven!
Never mind that the proposed legislation at a minimum violates the right to the Freedom of Movement (section 41) and that “no person shall be held in slavery or servitude” (section 34 1b) or that “no one shall be required to perform forced or compulsory labour”. (Section 341c)
As MDCAN’s (Medical and Dental Consultants’ Association of Nigeria) press release rightly stated, “this is therefore an excellent example of modern-day slavery”.
How can a country think that the solution to stopping doctors from emigrating is by denying them their right to movement?
Secondly, the bill inaccurately assumes that only young doctors or fresh graduates are leaving the country. That is simply not true. A 2022 survey by MDCAN revealed that over 500 consultants were estimated to have left Nigeria over the preceding two years. The MDCAN along with sister Associations in the health sector, provided this information to the appropriate agencies of Government both with useful and practical suggestions on how to remedy the situation. A recent press release by MDCAN in response to this bill stated these facts.
All over the world, junior doctors work under supervision of the more senior ones. So, if the senior doctors or consultants/specialists are leaving as well, then who is going to supervise the young doctors that you want to enslave? Or will the solution be to enslave the older doctors as well?
Thirdly, the bill wrongly assumes the capacity of the federal government to employ all the doctors for the next 5years post qualification. I laugh in Fulfulde! Do the Nigerian public know how doctors are looking for work in this country? Gone are the days of studying medicine because of its marketability. Doctors don full everywhere.
Lastly, one of the major issues this government keeps throwing in our faces is that Nigeria’s education is ‘subsidised’, that we were trained ‘for free’. The idea that Nigerian trained medical doctors received heavily subsidized education is a misleading notion. My family paid for my tuition out-of-pocket. Tuition has remained part of the fees paid by every medical student, and it is usually higher than that of non-medical students in most universities in Nigeria. The fact it is cheaper relative to other countries does make it ‘subsidised’, as every graduate who is lucky to get gainfully employed afterwards will pay back by earning salaries far lower than their peers in developed countries.
I want to believe that the honourable members of the green chamber know better. That maybe, just maybe, they are mistaking this enslavement with the popular ‘bonding’ of civil servants in training who receive scholarships from various state governments. Because like Hon (Dr) Oloriegbe said: ‘how will this law advance the quality of clinical services, education, and research in any system, let alone, a crippled one like ours?’
