A new bill to impose five years’ mandatory service on Nigeria’s medical graduates in an effort to stop the exodus of doctors to the UK and the US has been attacked as “obnoxious”.
The bill, which could be put to a public hearing in the next few days, passed its second reading in the Nigerian parliament’s lower house last month.
However, the plan is being met with resistance, with the doctors’ union and civil society organisations fiercely opposed. Calling it “obnoxious and outlandish”, Dr Innocent Orji, the president of the Nigerian Association of Resident Doctors, said: “We are going to resist the bill. The bill should be withdrawn immediately. It is a waste of taxpayers’ money.”
However, the government is pressing ahead, hoping to address the huge problem of brain drain among Nigeria’s medical professionals and set a timeline to recoup investment by the country’s education system.
Ganiyu Johnson, a lawmaker and leading advocate for the bill, has put out a statement on social and mainstream media, addressed to medical students and doctors.
“The government has invested so much money in training these medical doctors,” he said. “If the government subsidised your tuition, the least we expect is that … you can give back to society within the period of five years.”
In the past few years, strikes in the country’s health sector have become more frequent and prolonged. Take-home wages for doctors have remained static for more than a decade, despite a government promise to review pay every five years. Job insecurity has also grown. “These are the factors making the doctors leave. I don’t think the government understands this yet,” Chidiebere Echieh, a consultant cardiothoracic surgeon at the University of Calabar, said.
Echieh said his own career mirrored his concerns. He graduated from medical school in 2007, and his salary has remained stagnant despite further training since then. For all his experience and skills as a senior surgeon, he is paid the equivalent of about £800 a month, far less than medical graduates in most developed countries.
In 2022, Echieh visited the US for a postgraduate programme at the University of Arizona where, he said, he saw the contrast in health technology between his own country and the US. It is another factor driving Nigerian doctors abroad.
“There are so many healthcare technologies that are not available in Nigeria. For people – medical personnel – to have first-hand experience using these technologies, they have to travel outside Nigeria,” Echieh said. “No matter how long you practise in Nigeria, without hands-on experience of these technologies, your mastery will be limited.”
In public health, gaps in technology become death counts. Doctors have reported a rise in trauma and depression, which they claim is caused by too many avoidable deaths across Nigerian hospitals.
“It is painful for a doctor who knows what to do to see their patient dying because the right technology is not there to save those lives,” Orji said. “It causes depression to watch people die of easily treatable health conditions due to a lack of basic technology and equipment.”
The government and doctors now agree the situation has reached crisis point. Despite Nigeria’s population of 218 million, the country only has 24,000 licensed doctors.
The World Health Organization included Nigeria on its recent red list to discourage other countries from hunting an already depleted medical workforce. The UK is the biggest recruiter of Nigerian doctors, alongside Canada, the US and Saudi Arabia. Between 2015 and 2021, the Development Research and Projects Centre, a Nigeria-based not-for-profit, estimates that nearly 5,000 doctors relocated to the UK. Nigerian doctors say that the country’s private sector suffers even more than the state-funded system. In 2020, Hameed Adediran established Crest Care Services, which provides home care for elderly people and those with special needs. Although common in the west, the concept is novel in Nigeria.
Staff go through specialist training and retraining but rarely stay long. In Adediran’s view, the company has become a stopgap for doctors heading for the exit. “It is difficult to retain our personnel for long because the person you are hiring is either on his way out or is already out but working to save up his flight fare.”
The fear is that other private health entrepreneurs might be discouraged from investing in employee training, with knock-on effects on the quality of care.
Competition for jobs abroad is stiff, taking only the best skilled. Those who fail to make the grade might be forced to stay unwillingly in their home country. This, Adediran said, can lead to low motivation and poor standards of service.
Chima Christian, a Nigeria-based public affairs analyst, takes a different view of the brain drain. “This is a great opportunity [for graduates],” he said. “There is high demand for Nigeria’s skilled workforce. So much so that we can literally export these people and earn more foreign currencies through remittances. Today, our new oil is human beings.”
More investment was needed in universities, he said, to train more young Nigerians in in-demand fields. The country would then have enough workers to meet its needs back home, without limiting the ambitions of those who want to work abroad.
Christian has a point. In the past three years, diaspora remittances have emerged as Nigeria’s leading source of foreign earnings excluding the oil industry. In 2021, Nigerians abroad sent home $20bn – at least four times the country’s entire foreign direct investment.
Sunday Orji in Abuja/TheGuardian
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