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April 15, 2023

Bill to curb doctors’ brain-drain: Doctors plan court action, lawyers back them



•Bill dead on arrival – NMA
• An attempt at modern day slavery – NARD
• It’s unreasonable, can’t achieve anything —Top lawyers

By Sola Ogundipe

There is trouble in the House of Health in Nigeria. The Nigerian health scene is in turmoil. Medical doctors are angry, they are complaining loudly and are spoiling for a showdown. Their grouse is against a proposed Bill before the House of Representatives to amend the Medical and Dental Council of Nigeria (MDCN) Act.

The bill in question seeks to deny Nigeria-trained medical or dental practitioners from being granted full licences until they have worked for a minimum of five years in the country.

The doctors’ counterparts in the legal profession, the lawyers, have also condemned the bill wondering if our representatives in the House were not legislating on forced labour by the proposed Bill. The lawyers described the proposed Bill as not only contradictory but discriminatory and self-defeating which would not achieve anything.

A Lagos lawmaker, Ganiyu Johnson, representing Oshodi Isolo II Federal Constituency in the House of Representatives, sponsored the bill titled “A Bill for an Act to Amend the Medical and Dental Practitioners Act, Cap. M379, Laws of the Federation of Nigeria, 2004 to mandate any Nigeria-trained medical or dental practitioner to practice in Nigeria for a minimum of five years before being granted a full licence by the Council in order to make quality health services available to Nigerians; and for related matters (H B.2130).”

Saturday Vanguard gathered that the bill which is part of the measures to halt the increasing brain drain in the nation’s health system by doctors in search of greener pastures was met with mixed feelings even from within the Green Chamber. The argument was that the doctors who enjoyed taxpayer subsidies on their training should give back to society by working for a minimum number of years in Nigeria before exporting their skills abroad. While many lawmakers supported the bill, others opposed it and called for more flexible options. But a majority voice vote passed the bill for second reading.

This development has been met by a deluge of responses from medical doctors, their professional associations, affiliate groups, and several Nigerians at home and abroad.

These responses are not unexpected because the spate of brain drain in the health sector has been on the rise over the years. In fact, over the past eight years, an estimated 13,609 Nigerian doctors have migrated to the UK alone. The figure is third behind Pakistan and India. Worse still, the Nigerian doctor-to-patient ratio is at one doctor to 5,000 patients, which is far beyond the World Health Organisation’s recommended ratio of one doctor to 600 patients.

Bill is dead on arrival – Dr Uche Ojinmah, President, NMA

Regretting the development, the Nigerian Medical Association, the umbrella body for medical doctors in Nigeria, vowed to challenge the bill in court and warned of an imminent showdown with the government. “The bill is dead on arrival. It is a misplaced priority for lawmakers. We will go to court; we will test it in court,” the NMA President, Dr. Uche Ojinmah asserted. Urging the National Assembly to address the challenges of doctors that include poor remuneration, insecurity and lack of job satisfaction which are among the reasons doctors leave Nigeria, he said the logic being presented in support of the bill does not make sense.

His words: “I’m totally upset with what I heard. Nobody will force doctors to remain in Nigeria. It is a very wrong step and can never work. The suggested policy is discriminatory. Many qualified doctors remain unemployed in Nigeria, regardless of the brain drain in the health sector. If it requires going on industrial action to stop it, we will do it, and nothing will happen. The Federal government should not attempt to cut the head off in order to cure a headache, jobs and good remuneration should be given to the legion of doctors still seeking employment in the country.

“Even based on the fact that doctors are leaving, some are still not employed and there is a story of one-for-one policy that they will start replacing those that leave immediately. When you talk of rural areas, you may be talking about one to 9,000. When you talk of these areas where there is banditry and terrorism, it may be one in 20,000 or more.

“If everybody is being subsidised, you cannot in a discriminatory manner go down to a few people. All that we have come to realise is that doctors are important just like other healthcare workers and the solution is to make a man that is important feel that he belongs to you.

“The pull factors are those things that are outside that are making them go which is not within our control while the push factors are the things within our control that are pushing them out of Nigeria.

“The first push factor is poverty. A newly trained doctor [abroad] is earning about £40,000 (about N22 million at the official exchange rate) per annum while our own is earning about N3 million to N3.6 million per annum. A fresh doctor in Nigeria earns in a year what a fresh doctor in the UK earns in a month.”

The NMA President then complained of a number of vices militating against doctors in Nigeria saying there was no equipment for doctors to work with in most hospitals in Nigeria.

It is an attempt at modern-day enslavement —NARD

In its own reaction, the Nigerian Association of Resident Doctors, NARD, observed with “shock and disappointment”, what it described as “the infuriating attempts by the Federal 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”. At the end of an emergency meeting of the extended National Officers’ Committee, NOC, of the NARD, it admonished the Reps over what it described as its “obnoxious bill” which it said was a clear definition of modern-day slavery and not in keeping with anything civil and so should be thrown away at this point.

Although the house agreed on the palpable dangers of the current menace of brain drain in the health sector and promised to work with the Government to reverse the trend when the Government is ready to come up with genuine solutions to the problem, the NARD was emphatic that any attempt by the government or any of her agencies to enslave Nigerian medical doctors under any guise would be strongly and vehemently resisted.

Proposed bill is illegal – Prof Oladapo Ashiru, President, AMSN

The President of the Academy of Medicine Specialties of Nigeria, AMSN, Prof Oladapo Ashiru remarked that creating a law to address just one group of workers is an exercise in futility. Ashiru, who is also President, the Africa Reproductive Care Society, described the proposed bill as illegal.

“You cannot make a law that violates fundamental human rights. The law that the Reps are trying to make is illegal, and you cannot make a law to justify illegality. Nigeria cannot say that it is going to create a law to address just one group of workers, it cannot work. There are several issues that have to be considered, if we look at the salaries of all workers in the country, it has been depreciated on a yearly basis by the devaluation of the naira. Government has to ensure that this does not happen.”

Ashiru argued that the naira adjustment has devalued the naira, thus making salaries not to be competitive for doctors, nurses, pharmacists, all health workers, and everyone else.

According to him,” The government should first create an enabling environment for doctors to remain in Nigeria. Take, for example, Canada and America; they make sure that their salaries are competitive so they cannot lose their medical staff to each other. They should look at the productive sectors of the economy of the country and the service sector too. But if we look at the wages in this country, we see that the groups taking the chunk of the money are administrative and the legislative. There is a reversal there, and it requires that government would have a comprehensive look at the strategic balancing of remuneration.

“When I became a professor in 1983, my salary was about the equivalent of almost 2,000 pounds a month. It was in naira, but with that salary, I could buy myself a first-class ticket to go with my wife on vacation. Now, if you are to go to London today, even with a salary of about N500,000, it would not buy a flight ticket which is about $250 as of today. This is why people have to go to where they will be comfortable.”

Ashiru explained that the Academy of Medical Specialties has set up a committee to look into the issue and would make recommendations to the government in due course.

“But this still requires that the country sets up a proper group of people to look at this and compare with the rest of the world and make sure that the salaries of those productive economies and existential service economy are competitive”, he said

On curbing brain drain, Ashiru argued that the first thing to be looked at is the salary structure.

According to him, “The drains on our reserves are the national and state assemblies, the executive arm and the legislative arm. Nigeria is relatively poor, yet our legislators are the highest paid globally for doing what exactly and they want to make this kind of law? It is clear that the reps should look at themselves first, they should start from the top.

“In America, if you are getting something, you have to generate something. That is the law. What funds have these people generated? How much have they saved the country? They are consuming the resources that we are working for. So, we have to look at how doctors are well paid in Saudi Arabia and the UAE, which are oil-producing countries like Nigeria. Why is our own different?

“Training of doctors in Nigeria is subsidised by the government, correct? So, if the government has subsidized their training it is not out of place, the health sector in a place like Britain is heavily subsidised, even in America, the training of doctors is subsidised if you are an American citizen, it is the same thing in Saudi, it is not only in Nigeria that training is subsidised”.

Debunking the relevance of the claim that the training of doctors was being subsidised, Ashiru said, “if you are an American citizen, what you pay to be trained is less than what a non-citizen would pay, there is a lot of ignorance going on and there is no sin greater than ignorance. There is a deliberate effort by the foreign government to promote brain drain.

There is an external factor trying to capture and poach on our trained experts from Nigeria to go to their own country to work and they are paying them peanuts. They go to Britain and let them do the lowest of work, go to America. But we should value our own. In 1979 when I finished my postgraduate, they were asking me to stay behind, but I was ready to come back, because I knew that over here, I would be paid good salary that I could live on. And that was the story until 1983-1984. By 1984 when we got the Structural Adjustment Programme (SAP) and devalued our currency, that was the beginning of our problem”.

Declare national emergency in health sector – Dr Kayode Adesola, President ANPMP

The Association of Nigerian Private Medical Practitioners, ANPMP, has however called for a declaration of a national emergency in the nation’s health sector in view of the proposed compulsory five-year service by the House of Representatives. The National President of the Association, Dr Kayode Adesola, said declaring an emergency in the health sector would assist in proffering sustainable solutions to attrition of health workers, improve healthcare facilities, and reduce disease burden.

Noting that the proposed bill was ill-conceived and would not tackle brain drain, which is multifaceted and requires a more comprehensive approach to tackle it, Adesola said the bill would worsen the brain drain in the country because medical doctors do not need Nigerian licences to practice in other countries.

“We have teaching hospitals, general hospitals and primary healthcare centres that are dilapidated with outdated equipment. Political leaders are seeking medical treatment abroad while the citizens are left to suffer in a country that has one of the best doctors in the world. Before, it was the young doctors leaving, but now, the consultants are leaving.
Many health workers left because of insecurity, not just poor remuneration or poor working conditions,” he stated.