It is no longer news that Nigeria is losing a significant portion of its health workers to brain drain. For instance, in November 2021, 8,983 Nigerian-trained doctors were working in the United Kingdom. Another 727 were licensed in just five months between December 2021 and April 2022, bringing the total to 9,710 with at least 12 Nigerian doctors employed in the United Kingdom every week.
In addition, about 3,895 Nigerian-educated doctors are licensed to practice medicine in the United State as of 2020, with Nigerians accounting for about one in 50 of all licensed physicians who were international medical graduates.
Bill to reverse brain drain
As part of efforts to reverse this trend, the House of Representatives has passed for second reading, a Medical and Dental Practitioners Act (Amendment) Bill, 2022, which seeks to make it compulsory for graduates in medical and dental fields to render services within Nigeria for five years before being granted full license to practice.
Sponsored by Ganiyu Johnson (APC/Lagos) 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 Granted a Full License by the Council in Order to Make Quality Health Services Available to Nigeria; and for Related Matters,” was meant to check the mass exodus of medical professionals from the country.
Johnson’s argument for the bill was that Nigeria currently has only 24,000 licensed medical doctors available in the country, which is less than 10 per cent of the number needed to meet the World Health Organisation recommendation, hence the need to pass the bill into law.
Passing the bill into law will make quality health services available to Nigerians considering the growing trend of the Nigerian population and the current emigration rate of Nigeria-trained medical and dental practitioners abroad, he averred.
“This bill, if considered and passed by this Green Chamber, will not only bring about the necessary social justice to the Nigerian people but also improve the health services available to Nigerians, because Nigerians will be able to enjoy the service of the medical doctors and dentists who were able to get trained through their resources, at least for the period of five years here proposed before migrating abroad,” he further stated.
Stakeholders kick
Meanwhile, stakeholders who spoke with LEADERSHIP Weekend have called on the House of Representatives to reject the bill as it is discriminatory to fresh medical graduates.
The immediate past president, National Association of Resident Doctors (NARD), Dr. Godiya Ishaya told LEADERSHIP Weekend that the Bill portrays hatred towards young doctors that have decided to be trained in Nigeria and who wish to serve Nigerians.
Though the bill seeks to address brain drain in Nigeria’s health sector, Ishaya said, “The bill was structured in a way that once you graduate, you won’t be given full license until you must have practiced for five years.”
He, however, appealed to the House of Representatives to reject the bill.
He continued: “Just as we cannot tell lawmakers not to travel abroad to seek medical care; lawmakers cannot tell us not to travel to advance our education or to work abroad. This is our fundamental right.
“Though the bill has not yet been passed into law, as it is still undergoing the process of becoming a law, I still have hope in our judiciary system. I strongly believe that lawmakers will critically look at it and ensure that the bill will be thrown out because it is discriminatory, it portrays hatred towards a group of people called doctors who have dedicated their lives to serving humanity and caring for the health of Nigerians.”
The chairman Senate Committee on Health, Dr. Ibrahim Oloriegbe said the legislative proposal sponsored by Hon. Ganiyu is not enough as a strategy to address the challenge of brain drain in the health sector.
“This is because the factors responsible for brain drain are multifaceted and the mere denial of full practice license to medical practitioners as contained in the proposal will never resolve and may even aggravate them. Besides, it is not only medical doctors that are leaving the country for greener pastures abroad, there are other health workers, as well as professionals in other fields of human endeavour, trained but leaving the country on a daily basis for similar purposes,” Oloriegbe said.
The chairman said focusing attention on the medical doctors, is like curing one of many ailments that are threatening the life of a dying patient without finding solutions to the others, adding that the issues and facts related to granting of practising license are not understood by the sponsor of the bill.
What the law says
Speaking on what the law says, Oloriegbe said, the piece of the proposed legislation at a minimum violates the right to the “Freedom of Movement” (Sec. 41) and “The right to freedom from discrimination” under (Sec. 42) as guaranteed by the Constitution of the Federal Republic of Nigeria (CFRN) 1999, as amended.
These rights cannot be ordinarily denied by any person or government, the chairman said, “Thus, we can’t be seeking legal redress through an illegal procedure.”
He averred that “A person who is “qualified as a Medical Doctor” cannot be denied a license to practise having been certified qualified, except if he is found wanting in the ethics of the profession. Labour laws will come into place here.”
Furthermore, before the bill can be considered for legislative passage and executives’ approval, the chairman said the bill must explain, “When the 5-year period starts, is it before or after the housemanship?; What sort of license will be awarded to a fully trained doctor instead of a full license to practise under the proposal?; Is there going to be a limit in the doctor’s scope of practice, and to what extent are the limits during the five years waiting period? We need to establish why we are putting such limits; is it for lack of skills or political expediency? What happens after the five years of denial of rights to practise and consequently, how will this law advance the quality of clinical services, education, and research in any system, let alone, a crippled one like ours?”
In the same vein, the president, Medical and Dental Consultants Association of Nigeria (MDCAN), Dr. Victor Makanjuola, told LEADERSHIP weekend that the bill being proposed by the House of Representatives is discriminatory and will fuel brain drain rather than reverse it.
“Many parents who have the means to train their children abroad would gladly do that. Once these children are trained abroad, they would want to work there as well. So, who will take over the doctors who are working here in Nigeria?” he stated.
Fix the health sector, stakeholders said
Rather than coming up with such a bill, the associate director, Corporate Accountability and Public Participation Africa (CAPPA), Aderonke Ige told LEADERSHIP weekend that the government should fix the health sector and make it conducive for health workers. This is the only way to tackle brain drain in Nigeria, she added.
“If the government does not tackle the challenges rocking the health sector, health workers will continue to leave in droves. So I urge lawmakers to look at what is pushing healthcare workers away and what can be done for Nigerians, including the lawmakers to start receiving treatment here in the country, then formulating a bill that further increases brain drain in the country, Ige appealed.
In the same vein, Oloriegbe said resolving the challenge of brain drain in the country’s health sector cannot be achieved through this bill, adding that the Nigerian government would need to address the various factors that make skilled health workers desire to migrate out of Nigeria.
Rather than enacting laws that will curtail the rights of the citizens to free movement and seek better opportunities through legal means, Oloriegbe recommended that lawmakers should advocate for an improved system that will be very attractive and make medical practitioners unwilling to travel abroad to seek better living conditions. “We have to make our pastures greener so that other people’s pastures won’t be tempting to them,” he added.
Nigeria can achieve this when obligating medical students to choose between paying the standard market rate for their training or opting for government-subsidized training, the chairman said, adding that quality education in its real sense can’t be free.
Those who however opted for subsidized training after their qualification would in return be compelled to work in Nigeria for a certain time or refund the subsidies, Oloriegbe suggested, even as he disclosed that this is a practice obtainable even in advanced countries such as the UK.
To achieve the goal of a mandatory work scheme, he advised that Nigeria can enable a system that will guarantee employment opportunities for medical professionals after their qualification and provide inflation-adjusted living earnings for a few years after graduation, in the condition that they stay in Nigeria to practice.
“Apart from providing attractive remunerations, their work environment and career expectations should also be prioritized. Incorporating both measures should give us satisfactory results and importantly, we need to improve our health system with sustainable investments to make it conducive for the various health workers to work. We can be assured of better outputs only if what we input is in good condition,” he added.
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