MEDICAL DOCTORS CREATE BATTLE LINES AFTER FIVE YEARS OF MANDATORY PRACTICE

The Nigerian House of Representatives has made headlines due to a law that seeks to prevent medical physicians from exploring greener pastures less than five years after graduating from medical school.

The parliament's action was taken in response to the recent migration of medical doctors.

Brain drain has become a major issue in Nigeria's health industry, with the country losing a large number of healthcare workers to other countries.

This impending crisis has overloaded government officials, and there is no plan in place to deal with it comprehensively.

According to the World Health Organization, Nigeria has a doctor-patient ratio that is more than five times lower than the organization's recommendation.

MON DIARIES reported on the country's brain drain, with many going to the United Kingdom (UK).

According to health officials, over the previous eight years, at least 5,600 Nigerian medical doctors have migrated to the United Kingdom (UK).

The Nigerian Medical Association (NMA) stated in August 2022 that a total collapse of the health sector is likely unless immediate efforts are done to address the sector's brain drain.

The association called for an immediate solution, noting that given the current trend of medical doctors leaving the nation, there may be a need in the future to engage doctors from other countries.

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

"This statistic is as of March last year; thus it is far greater than that," Makanjuola said at an Association National Executive Committee meeting 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."

In addition, in October of last year, the Kaduna State Chapter of the Nigeria Medical Association, NMA, issued an urgent call for action to halt the continuous brain drain of medical personnel in Kaduna State.

According to the group, over 10,000 doctors have left Nigeria for greener pastures in the previous seven years, a troubling trend.

Similarly, governors from the thirty-six states represented by the Nigeria Governors' Forum, NGF, raised worry late last year about the frequency of brain drain in the health sector.

After the development, the UK added Nigeria and 53 other nations to the red list of countries where health and social care firms should not actively seek to hire.

Though complicated and multidimensional, several underlying causes have been identified as low wages, bad working conditions, a lack of career possibilities, insufficient resources and infrastructure, political instability, and insecurity.

Concerned about the imminent threat of brain drain in the nation's health-care system, the House of Representatives introduced legislation to address the situation.

The bill has cleared the second reading stage of the legislative procedure, but healthcare practitioners continue to oppose it.

It is sponsored in the House of Representatives by Ganiyu Johnson, who represents Oshodi-Isolo Federal Constituency 2 in Lagos State. It seeks to amend the Medical and Dental Practitioners Act to prevent Nigerian-trained medical or dental practitioners from being granted full licenses 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."

In addition, Mark Gbillah, a Benue senator, rejected the measure, claiming that it had provisions that violated 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 bill was opposed by the National Association of Resident Doctors (NARD).

NARD expressed its views in a statement released at the conclusion of the organization'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.

Dr Okwudili Obayi, a Consultant Psychiatrist at the Alex Ekwueme Federal University Teaching Hospital in Abakaliki and the Public Relations Officer of the Association of Psychiatrists in Nigeria, told DAILY POST in an interview that the National Assembly's bill was sad.

Obayi contended that denying young health practitioners a license unless they have worked for at least five years violates their right to freedom.

According to the health expert, the law will exacerbate the problem of brain drain rather than alleviate 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."

In order to reduce brain drain, Obayi also encouraged the government to establish an enabling atmosphere and address the issue of insecurity head on.

"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.

In addition, speaking to a reporter about the contentious bill, a health expert, Dr. Robsam Ohayi, stated, "There is no place where anybody has to wait for five years before he is given a licence to practice medicine." enabling environment and address the issue of insecurity head-on in order to reduce brain drain.

In addition, speaking to a reporter about the contentious bill, a health expert, Dr. Robsam Ohayi, stated, "There is no place where anybody has to wait for five years before he is given a licence to practice medicine." enabling environment and address the issue of insecurity head-on in order to reduce brain drain.

Ohayi, a professor who also serves as Chief Consultant Pathologist at Enugu State University Teaching Hospital and Dean of the Faculty of Basic Clinical Sciences at Enugu State University College of Medicine in Parklane, Enugu, called the proposed measure "modern-day slavery."

According to the Consultant Pathologist, labor law states that no one can be forced to do a specific job, work in a specific location, or work under a specific scenario.

"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 new bill will exacerbate the situation rather than solve it.

The health expert argued that the government should first understand the origins of the situation before proposing a viable solution.

"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.