Bill Seeking to Prescribe Five-Year Compulsory Service Infeasible – Medics Proclaimed.

Following the April announcement of the lower chamber of the National Assembly that a bill proposing a minimum of five years’ service to Nigerian-trained medical and dental practitioners before being granted full license to practice was before the house, medics have continued to react to the development describing it as infeasible. The bill meant to be a solution to the brain drain in the Nigerian health sector is seeking to amend the Medical and Dental Practitioners Act, CAP M8, 2004. The act makes statutory provisions for the regulation of medical and dental education and practice in the country. It also makes provisions for the registration, licensing and discipline of medical and dental practitioners.

Though the sponsor of the bill, Hon Ganiyu Johnson did not return to the 10th National Assembly, analysts and stakeholders have said it is imperative that the lawmakers and the Nigerian people learn what the people who are most affected by the bills are saying so that they can be properly guided on the controversial bill going forward.

While Nigerians professionals across all disciplines continue to relocate abroad, medical and dental practitioners practitioners are not left out. Stakeholders in the health sector have expressed displeasure over bill that seek to target only medical and dental practitioners among other emigrants.

According to the Nigeria Social Cohesion Survey Report of the African Polling Institute, about 73% of Nigerians expressed willingness to relocate from the country if opportune, in 2021. There was a slight drop in this figure to 69% in 2022.

The data shows the level of dissatisfaction of citizens with the situation in the country, hence their quest to leave the country in search of greener pastures, if opportuned. If the doctors are successfully tied down, then Nigerians can be sure that similar bills would be raised against the emigration of other skilled and unskilled labour in the near future.

The bill generated a lot of reactions among Nigerians both within and outside the health sector and the health sector almost came to a standstill. The National Association of Resident Doctors (NARD), while reacting to the development, threatened to resist any attempt to enslave medical doctors in the country.

“The extended NOC observed with shock and disappointment the infuriating attempts by Ganiyu Abiodun Johnson and the House of Representatives to enslave Nigerian-trained medical doctors for five years post-graduation before they can be issued full practicing licenses or allowed to travel abroad if they so wished,” NARD’s reaction to the bill read in part.

The exact number of medical doctors registered currently in the country can not be ascertained as a result of the unavailability of data. However, about 24,640 medical doctors and 1,365 dentists were registered as of 2019 according to data from the Nigerian Bureau of Statistics.

Data from the Medical and Dental Council of Nigeria shows that the 47 accredited medical schools across the country have a cumulative quota of about 4,940 while the 11 dental schools have a carrying capacity of just 215 students as of March 2023. These data show that Nigeria does not have enough manpower to cater to the health needs of its estimated 221 million people.

The Medical and Dental Consultant Association of Nigeria while reacting to the controversial bill accused the government of paying lip service to the issue of brain drain in the country when it said none of the recommendations of the inter-ministerial committee on brain drain and bonding of health workers has been implemented.

MDCAN added that unemployment and underemployment are major factors encouraging emigration of doctors as the sponsor of the bill erroneously believed the government had the capacity to employ all medical and dental graduates after graduation. “The capacity which even the most optimistic of analysts know the government lacks. Is the bill then trying to increase the pool of unemployed and disenchanted Nigerians? The Association queried.

STUDENTS REACT

The Nigerian Medical Students Association (NiMSA), whose members are the primary target of the bill in a statement signed by her President, Ejim Egba equally “strongly opposed” the bill calling it “unpatriotic, ill-timed and a breach of the fundamental human right of doctor,” NiMSA went on to ask government seek better ways of finding solution to the problem of brain drain in the health sector.

Lawrence Temidayo, a dental surgery student at the University of Ibadan decried the special focus on medical and dental graduates by the bill while leaving out graduates of other educational programs. He also added that he didn’t believe the bill would work as it would lead to resentment among medical and dental graduates, hence wouldn’t be a sustainable solution to brain drain in the health sector.

Oluwatomisin Abaloja likened the bill to the proverbial horse that can only be forced to the stream but cannot be forced to drink from it. “Even after earning the certificate, it is not compulsory to practice, you can easily use your certificate to pursue other careers other than medical and dental practice.” He stated.

Abaloja added that he felt bad about the bill since graduates from other professions were also migrating even more than medical and dental graduates but he is concerned that only medical and dental graduates are to be tied down for enslavement.

A medical student at Obafemi Awolowo University, Ile-Ife, Abdulrahman Lawal said intending to hold down doctors in the country in the name of subsidy is wrong while pointing out that medical students pay higher than other students. “In Ife for example, medical students are already paying more than students in other departments in terms of tuition. Yet, we will start paying another Professional Fee. This brings the total training fee of health related students to about four times more money than other courses.” Abdulrahman said.

He added that a common fact-finding would have revealed that graduates of other courses are leaving the country at even higher rates. He also decried the non-exclusion of doctors who are not trained in government institutions. “It may interest you to know that a good percentage of doctors are being produced in private and state universities whose training are not at all subsidized. The bill made no provision for that – at least none that is known to the public yet.” He concluded.

“If you look at it critically, it affects almost every other profession in all facets of life. Poor remuneration, poor working standard, so it’s something that we have to sit down at every sector at a roundtable to discuss and agree on the way forward by symptomatically managing each condition that is present. We can increase remuneration, provide mortgages for houses, car loans. We can invest more in the health infrastructure of the hospitals, create standard operating procedures and protocols that will enable career progression for young doctors.” He said.Atunrase added that health insurance for doctors and every other person in the sector are things that must be put in place in order to effectively address the issue of brain drain in the country. “It’s a robust discussion that is going to be and it’s going to be ever-ongoing and ever-expanding.” He concluded.Lawrence Temidayo, while commenting on the way forward without disrupting industrial harmony agreed with Atunrase on the need for stakeholders to come together to holistically address the issues responsible for emigration. He added that there is a need to support the private sector to create more job opportunities for medical and dental graduates so they can be encouraged to stay back in the country

“It is a biased bill meant to witch-hunt medical and dental practitioners, the medical education is subsidized likewise other educational programs, hence medical and dental practitioners shouldn’t the only ones to pay back if that is what the bill wants to achieve,” said Dr Stephen Okogu, a House Officer at University of Uyo Teaching Hospital, Uyo. He added that the bill is ill conceived so would not work.

According to Michael Onasanya, a House Officer at Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, the bill is a poor reflection of the understanding of the problem bewildering the health system. He added that the narrative of subsidy on medical education is not really true as medical and dental students are the categories of students that paid the highest tuition fees across the country.

Dr Ayooluwa Adekoya, a resident doctor at UNIOSUN Teaching Hospital, Osogbo, while commenting on the bill condemned the target of doctors only by the bill while adding that all workers in the health sector are equally important. “The hands-on approach of doctors and dentists in consultations and surgeries may make them seem inevitable but all health workers are important and no one should singularly be a focus of the bill since we are a team.” She stated while reacting to the bill.

Dr Eyitayo Adeleke while speaking to this reporter said the bill is infeasible since no provision has been made for the postgraduate training of the medical graduate for specialization, so stopping fresh graduates will not automatically translate to improvement of service delivery in the health sector.“If you also look inward, not only fresh graduates are leaving the country, consultants are also leaving, but only fresh graduates are the target. If the bill is successful in stopping the fresh ones and the so-called medical elders leave the country, we will still be back to square one because there will be no one to train those who have been tied down by the bill for housemanship and residency training.” Adeleke stated.

WAY FORWARD

On how the brain drain can be adequately addressed in the country, Dr Adekoya said data should be collected from health workers using a non-bias sampling method that will allow them also have an input in policymaking in issues related to the healthcare sector since they are at the forefront and decisions should not be left solely in the hands of people who may not be aware of the peculiarities of the health sector.Dr Nicholas Aderinola, a medical intern at LAUTECH Teaching Hospital, Ogbomoso, advised the government not just to tackle symptoms of the brain drain in the health sector but to address the root causes of the problem. He admitted that education is indirectly subsidized in the country when compared to other countries of the world. Dr Atunrase Abiodun, a medical officer at Federal Medical Centre while suggesting possible solutions to the problems bedeviling the health said he believed the matter is beyond the National Assembly just sponsoring and passing bills. He called for a stakeholder’s roundtable discussion to address all the problems in the health sector.

“If you look at it critically, it affects almost every other profession in all facets of life. Poor remuneration, poor working standard, so it’s something that we have to sit down at every sector at a roundtable to discuss and agree on the way forward by symptomatically managing each condition that is present. We can increase remuneration, provide mortgages for houses, car loans. We can invest more in the health infrastructure of the hospitals, create standard operating procedures and protocols that will enable career progression for young doctors.” He said.

Atunrase added that health insurance for doctors and every other person in the sector are things that must be put in place in order to effectively address the issue of brain drain in the country. “It’s a robust discussion that is going to be and it’s going to be ever-ongoing and ever-expanding.” He concluded.

Lawrence Temidayo, while commenting on the way forward without disrupting industrial harmony agreed with Atunrase on the need for stakeholders to come together to holistically address the issues responsible for emigration. He added that there is a need to support the private sector to create more job opportunities for medical and dental graduates so they can be encouraged to stay back in the country.

By Taiwo Fatola

ACJ Uniosun