Five years mandatory practice: Medical doctors draw battle line

Nigeria’s House of Representatives is in the news following a bill seeking to stop medical doctors from seeking greener pastures less than 5 years after medical school.

The action of the parliament came as a reaction to the exodus of medical doctors within the last few years.

Brain drain has become a serious challenge in Nigeria’s health sector, with the nation losing healthcare workers in droves to other countries.

This imminent crisis has overwhelmed government authorities, with no plan to tackle it wholesomely.

According to the World Health Organisation, WHO, Nigeria suffers from insufficient doctors and has a doctor-patient ratio over five times lower than the organisation’s recommendation.

DAILY POST reported how the country loses hundreds of doctors annually to brain drain, many of which are to the United Kingdom (UK).

Health officials say at least 5,600 Nigerian medical doctors have migrated to the United Kingdom (UK) alone in the last eight years.

In August 2022, the Nigerian Medical Association (NMA) said a total collapse of the health sector is imminent if urgent steps are not taken to address the brain drain in the sector.

The association called for an emergency solution, adding that with the trend of medical doctors leaving the country, there may be a need to hire doctors from foreign countries in the future.

Earlier this year, the National President of the Medical and Dental Consultants of Nigeria, MDCAN, Dr. Victor Makanjuola revealed that over 500 medical consultants have left the country within the last two years.

“This figure is as of March last year; so it is far more than that,” Makanjuola said during a National Executive Committee meeting of the Association in Enugu.

He added that, “we are not where we are supposed to be; we are faced with poor budgetary allocation, poor infrastructure, lack of incentives leading to brain-drain, challenge of power generation and distribution in most of our facilities.

“It has become difficult for administrators to run the facilities smoothly and provide efficient medical care for the citizens.”

Also, in October last year, the Kaduna State Chapter of the Nigeria Medical Association, NMA, raised an alarm that something urgently needed to be done to arrest the continued brain drain of medical personnel in Kaduna State.

The association observed that no fewer than 10,000 doctors left Nigeria for greener pastures in the last seven years, a situation it said had become disturbing.

Similarly, governors of the thirty-six states under the umbrella of the Nigeria Governors’ Forum, NGF, had expressed concern over the prevalence of brain drain in the health sector late last year.

Sokoto State Governor and Chairman of the Forum, Aminu Waziri Tambuwal, pointed out the forum’s fears when he visited Dr Osagie Ehanire, the Minister of Health, in Abuja.

“We are witnessing brain drain over the years. It is alarming, and I believe it has something to do with the welfare of medical personnel.

“I urge the federal government to do something about this urgently,” Tambuwal said.

In March this year, WHO identified 55 countries, including Nigeria, as having the most pressing workforce challenges related to Universal Health Coverage.

Following the development, the UK placed Nigeria and 53 other countries on the red list of countries that should not be actively targeted for recruitment by health and social care employers.

Though complex and multifaceted, some factors, including low salaries, poor working conditions, lack of career opportunities, inadequate resources and infrastructure, political instability, and insecurity, have been attributed as the underlying causes.

Worried by the imminent threat of brain drain in the nation’s health sector, the House of Representatives had proposed a bill to address the crisis.

The bill has passed the second reading stage of the law-making process and has continued to attract opposition from healthcare practitioners.

Sponsored by Ganiyu Johnson representing Oshodi-Isolo Federal Constituency 2 of Lagos State in the House of Representatives, it seeks to amend the Medical and Dental Practitioners Act to prevent Nigerian-trained medical or dental practitioners from being granted full licences until they have worked in the country for at least five years.

According to Johnson, “It was only fair for medical practitioners, who enjoyed taxpayer subsidies on their training, to give back to society”.

While opposing the bill, Uzoma Nkem-Abonta, who represents Abia State on the platform of the Peoples Democratic Party, PDP, said it would “tie down” doctors in Nigeria for five years before they can seek employment in a foreign country.

Also, Mark Gbillah, a lawmaker from Benue, opposed the bill, saying it proposed clauses that would overstep the fundamental human rights of Nigerian-trained doctors.

“A person in such a critical field as medicine — how would you give somebody a temporary licence? You would need a licence to be certified to practice.

“Do we try to restrict these people and infringe on their fundamental human rights or apportion more resources to the medical profession?” Gbillah said.

Meanwhile, the National Association of Resident Doctors (NARD) opposed the bill.

NARD made its position known in a communique issued at the end of the association’s extended National Officers’ Committee (NOC) meeting.

“The extended NOC observed with shock and disappointment the infuriating attempts by Honourable Ganiyu Abiodun Johnson and the Federal House of Representatives to enslave Nigerian-Trained Medical Doctors for five years post-graduation before they can be issued full practising licences or allowed to travel abroad if they so wished,” it said.

However, a Consultant Psychiatrist at the Alex Ekwueme Federal University Teaching Hospital, Abakaliki and a Public Relations Officer of the Association of Psychiatrists in Nigeria, Dr Okwudili Obayi, told DAILY POST in an interview that it was unfortunate that the National Assembly came up with such a bill.

Obayi argued that denying young health practitioners a licence unless they practise for at least five years infringes on people’s right to freedom.

The health expert added that the bill would not solve the problem of brain drain but instead worsen it.

He said, “It is a very unfortunate thing for anybody to think; very unfortunate in the sense that you are infringing on people’s human right to freedom.

“Even if the person was sponsored or trained free by the country, the country can not say don’t leave, unless there is a bond signed. Look at it; why select doctors? Every other person has the right to travel; why should it only be doctors that should not travel?

“Brain drain is in all aspects. In recent times, we have witnessed a wave of people leaving the health sector; doctors, nurses, pharmacists and all that; it is higher than what it used to be in the past. But then denying them a licence unless they practise for at least five years is not the answer to it.”

According to the psychiatrist, “We know the main causes of brain drain; and that they are large. Supposing one wants to look at what makes people leave the health sector, one may say services, salary, rewards, poor working conditions, general insecurity ( doctors have been kidnapped more than any other profession in the country), unemployment of young doctors even in the state of this mass exodus and many others are responsible.”

Obayi further advised the government to create an enabling environment and address the issue of insecurity head-on in order to curtail brain drain.

“Regarding the proposed bill, it is unfortunate that a normal human should think about it. It is an embarrassing bill, to say the least.

“If they would want to proffer a solution to brain drain in the health sector, they should look at the working condition, enabling environment, and take home an average worker. A doctor’s lifespan is known to be low compared to any other profession simply because of overworking.

“Burnout is high in the health profession, both among doctors, nurses and other healthcare workers. These are the major reasons people say, ‘we should leave to where our services are more appreciated and our reward better’.

“The impact is much when people leave; it is enormous. It is not good for any country that its young graduates are leaving en masse.

“The government should create an enabling environment and address the issue of insecurity head-on,” he said.

Also, speaking to DAILY POST concerning the controversial bill, a health expert, Dr Robsam Ohayi, said, “There is no place where anybody has to wait for five years before he would be given a licence to practise medicine.”

Ohayi, a professor, who doubles as the Chief Consultant Pathologist at Enugu State University Teaching Hospital and the Dean of the Faculty of Basic Clinical Sciences at Enugu State University College of Medicine, Parklane, Enugu, described the proposed bill as “modern-day slavery”.

The Consultant Pathologist stated that the labour law stipulates that one cannot be forced to do a particular work or to work in a particular place or work under a particular circumstance.

“Well, I think in the first instance, the bill smarks ignorance on the person proposing the bill. I have tried to read the bill a bit, and it does not even look like somebody who understands the dynamics of the medical profession, training and practice.

“I give one example- in the entire world, there is no place where anybody has to wait for five years before he would be given a licence to practise medicine. It supposes that there would be a kind of five years of house-manship; it does not happen in any part of the world. The maximum anywhere anybody has done is a year.

“As a matter of fact, in some countries, when they have a crisis, even as recent as the Ebola crisis, people shorten such a period. In some places, medical students were not even examined; they were brought out to help in the workforce.

“What it means is that if you say somebody would stay five years before licensing the person, you are saying that the person cannot take responsibility for managing a patient. The brain he is trying to gain, he is not actually gaining it; he is losing it because you finish training the person for another five years – a post-training, yet he is not a doctor; he is a supervisee to be supervised.

“So he cannot take responsibility for a patient. So what kind of gain is it in a human being who is only existing in name and not in activity?

“The other aspect of it is that the labour law says you cannot force somebody to do a particular work or to work in a particular place or work under a particular circumstance. This is modern-day slavery. This is subjecting and forcing people to say, ‘You must work here’. This is actually usurping their rights as human beings to move.

“The mobility of labour is known all over the world; people can choose where they want to be.”

According to him, the proposed bill will compound brain drain more than it can solve the problem.

The health expert believed that the government should identify the causes before it could proffer a good solution to the crisis.

“What is even the status of these people vis-a-vis their salaries? They won’t have any status in Nigerian medical practice where we have levels of employment. What are you calling them? Even when someone is fully employed, promotion takes place every three years.

“So when are they going to be promoted? Are you going to promote them after three years or what? Because their careers don’t really start until they have a full licence. So these are the issues.

“Talking about the bursary, saying medical students are paid with taxpayers’ money; they get bursaries from the government. Is there anybody who attended a public university who got a different treatment vis-a-vis expenses from the rest?

“Engineers, lawyers, sociologists, teachers, all of us that went to Nigerian public universities, let’s assume there is a subsidy, everybody enjoyed that subsidy. How can you single out medical doctors to say, ‘Okay, you cannot move around; you cannot choose where to go because the government funded your education. Whose education was not funded by the government?

“This is the same National Assembly that has recently thrown away a bill trying to stop them from sending their children abroad for education. This is the same National Assembly that is refusing the Medical and Dental Council of Nigeria to regulate the influx of foreign-trained doctors into this country. I mean Nigerians that trained abroad.

“Some people have gone to places where their medical education is sub-optimal. And the National Assembly refuses MDCN to re-examine these people before they can be licensed; they have refused it to happen. I cannot explain what they are thinking about healthcare delivery in our country. The reality of what they are proposing will compound brain drain more than it can solve it.

“The bill targets people who just graduated, but professors and consultants are leaving, and very senior medical doctors are leaving the country too.

“The bill did not even identify the causes of brain drain. Unless you identify the causes, you cannot proffer a good solution. And that is exactly what this bill has failed to do- to identify and properly diagnose the problem and proffer a very good solution,” he said.