Nigeria’s Federal House of Representatives wants to prevent Nigerian-trained doctors and dentists from leaving the country until after 5 years post-qualification.
The bill seeks to prevent Nigerian-trained medical or dental practitioners from being granted full licenses until they have worked for a minimum of five years in the country.
This bill is wrong. It is not the right way to treat doctors and dentists who work in some of the most difficult circumstances to save lives in Nigeria. This is bound to further worsen brain drain in Nigeria.
The main question is, why do Nigerian medical doctors emigrate? This question was answered by Nigerian medical doctors themselves in the 2018 NOI Polls/EpiAFRIC ‘emigration of Nigerian medical doctors survey’, which I co-led. The reasons that doctors gave for emigration are numerous but easy to fix if the Nigerian government is serious about reversing brain drain.
More than 700 doctors were interviewed and these were some reasons for emigration: high taxes and deductions from salary (98%); low work satisfaction (92%); and poor salaries and emoluments (91%). Majority (87%) believe the Nigerian government is unconcerned with mitigating the challenges facing medical doctors in Nigeria. However, improved remuneration (18%), upgrade of all hospital facilities and equipment (16%), increased healthcare funding (13%), and improved working conditions of health workers were top recommendations to reverse brain drain.
The survey also found that it cost $25,188 to train a medical doctor in public universities in Nigeria. Compared to other African countries, Nigeria is Africa’s wealthiest country but ranks seventh in the amount spent by African governments to train medical doctors: South Africa ($40,373), Zimbabwe ($37,500), Malawi ($32,952), Kenya ($32,225), Ethiopia ($28,620), Zambia ($26,529).
Simply put, Nigeria is not the only African country paying for training of doctors in public schools. Further, tertiary education is heavily subsidized for other professions too. Will the lawmakers also ban other professionals from emigrating?
It is glaring that the lawmakers are not concerned about the cost of medical tourism embarked upon by Nigerian public officials. For instance, President Buhari has made medical tourism a mainstay of his healthcare plans. At one point, he traveled to the United Kingdom for his medical care and stayed there for more than 100 days. Shockingly, the cost of Buhari’s medical tourism is borne by taxpayers.
We pay for his expensive foreign medical care and yet we do not know what ails Buhari. Without a doubt, going by the frequency of visits to his UK doctors, the cost of his treatment (and fueling of the presidential jet) would pay for training of hundreds of doctors in Nigerian public schools. Shouldn’t Buhari and other public officials lead by example and seek healthcare in Nigeria? Should the Federal House of Representatives also enact a law banning public officials from seeking healthcare abroad?
Migration is a human right. Therefore, Nigerian lawmakers do not have the right to stop Nigerian-trained medical doctors and dentists from emigrating. Except the lawmakers are bent on breaching their fundamental human rights.
Alternatively, these are five ways to ensure both doctors and the government get the best deal out of the current brain drain in Nigeria.
First, listen to doctors and improve the conditions of service as unpacked in the ‘emigration of Nigerian medical doctors survey’. An obstetrician and gynecologist working at a public tertiary hospital we interviewed said, “I think that one of the major issues is the work environment, the working equipment and what to work with. There was a time I was doing a procedure that should not take more than five minutes, and I spent over 45 minutes on the procedure just because of the equipment I was working with.”
Junior doctors are also negatively affected by the poor conditions of service. “The work conditions are very poor. As a house officer you are responsible for covering 4 — 5 wards when you are on call, each ward having an average of 20 beds in the surgical department, and a minimum of 40 beds in other departments. And you are responsible for giving these patients intravenous medications sometimes three times a day (sometimes late at night).”, said a house officer.
Second, engage governments and employers in countries where doctors emigrate in covering the cost of their training. A research published in the British Medical Journal has a similar recommendation. The top 10 countries Nigerian-trained doctors emigrate to as follows: UK, USA, Canada, Saudi Arabia, Australia, UAE, Caribbean Islands, Ireland, South Africa and Botswana. For example, more than 5,000 Nigerian-trained doctors have emigrated to the UK in the past 8 years.
Should the UK government and employers of doctors there pay back to the Nigerian government the more than $150 million spent on training these doctors? This is a debate the lawmakers should have to ensure equity.
Third, revise the cost of training of doctors and dentists to reflect today’s economic realities. However, such revision is bound to disenfranchise students from poor families. There are ways to mitigate that. A percentage of the more than 3 trillion naira ($7.5 billion) 2023 fuel subsidy should be channeled towards training of medical doctors and dentists in Nigeria.
If this is done, the entry requirements to medical and dental schools should be made more competitive, while reserving a portion of the admission for children from low-income families. Student loans should also be made available to those who simply want to take a loan, pay for their training and pay back to the government over several years.
Fourth, ban public officials from using public funds to pay for their healthcare in foreign countries. Nigerian presidents and all public officers must access healthcare locally if the governed are to pay for it. In 2022, Vice-President Yemi Professor Osinbajo showed example by going to Duchess International Hospital, Lagos for a surgical procedure. Buhari should be the last Nigerian president who travels to foreign countries to seek healthcare paid for by taxpayers.
Lastly, set up a mechanism for Nigerians who emigrate to reserve a proportion of their remittances back home for health insurance for their friends and families. This would increase healthcare financing in Nigeria. In a previous piece, I advocated for channeling one percent of diaspora remittances for health insurance. Going by the $19.5 billion Nigerians in diaspora remitted back home in 2021, at least $195 million (more than Nigeria’s annual healthcare budget) could be added to the health insurance sector in Nigeria. This would improve conditions of service for health workers, availability of modern healthcare equipment and more.
Health workers in Nigeria are dealing with a lot. Lawmakers should make laws to make their work easier and improve the health of all Nigerians.
Image: Jamiu Oyelakin