LADESOPE LADELOKUN 
In a bid to check the exodus of Nigerian doctors to foreign countries, a bill which seeks to compel young doctors to serve their fatherland for five years before they can seek greener pastures has scaled second reading at the House of Representatives. LADESOPE LADELOKUN reports that there is the need by concerned authorities to pay more attention to the factors fuelling brain drain in the health sector.
History records it that the Royal Family from Saudi Arabia used to visit the University College Hospital, Ibadan for treatment. At least, it was something Nigeria’s former Minister of State for Health, Olorunnimbe Mamora, alluded to in his moment of lamentation about the state of Nigeria’s healthcare system presently. Specifically, the minister said Nigeria was a Mecca of sorts for citizens of other nations, who used to visit Nigeria for treatment in the 50s and 60s. Stories were also told of the ‘good old Nigeria’ that gave wings to young people to fly.
Nigeria’s Professor of Virology and former Vice Chancellor of Redeemer’s University, Wale Tomori, confirmed he was part of that story. Baring his mind on the bill aimed at curbing the exodus of young Nigerian doctors to foreign countries during an interview on Channels TV, the 77-year- old scholar, said: “My generation stayed because I had something to work with. It is not about patriotism or lack of it.
Create the enabling environment for people to function. The Diaspora people will come back.” Worried by a reversal of fortune from a country said to be the the toast of citizens of countries across the world for medical care to a country where doctors leave in droves for greener pastures for reasons ranging from decrepit facilities to poor welfare package, a lawmaker in Nigeria’s House of Representatives, Hon Ganiu Johnson, had sponsored a proposed legislation tilted, “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 before granted a full licence by the council in order to make quality health services available to Nigeria”.
The bill has scaled second reading at the House of Representatives. According to Johnson, it was only fair for medical practitioners, who have benefited from taxpayers’ subsidies to un- dergo mandatory service for a minimum number of years in Nigeria before taking their skills abroad. Between 2015 to 2022, according to the Nigerian Medical Association, NMA, Nigeria lost 10,000 doctors to other coutries.
Speaking during a symposium on brain drain in Nigeria’s health sec- tor, President of the Nigerian Medical Association,(NMA) Uche Rowland Ojinma, said there were 24,000 licensed med- ical doctors available in the countryless than 10 per cent of the number needed to meet a WHO recommendation noting that with an estimated 218 million people to cater for, Nigeria would require at least 363,000 additional doctors to meet this target. That was even as the World Health Organisation(WHO) and United States Agency for International Development(USAID) said the health indicators for Nigeria were among the worst in the world.
Meanwhile, despite the intention of the sponsor of the aforementioned bill, a number of Nigerians have questioned the sincerity of Nigerian lawmakers and their right to stop doctors from seeking professional fulfillment in countries with better facilities and better welfare package, even when public office holders spend a fortune on medical tourism. According to Nigeria’s former Minister of Health, Isaac Adewole, Nigerians spend a minimum of £1billion annually in medical tourism.
How lawmakers rejected bill to check medical tourism among public officials In 2019, a bill aimed at regulating overseas medical treatment for public officials at public expense to enable the government focus on reviving the country’s health system was thrown out by lawmakers at a plenary session.
Like other lawmakers, the Deputy Speaker, Yusuf Lasun, had argued that the bill was against his fundamental hu- man rights, describing it as discrimina- tory. “There are two fundamental wrongs in this bill. It is against human rights and it is discriminatory. Do not let us do a debate on this bill, ” Lasun had said. Also, the New York Times had reported how President Mohammadu Buhari spent 170 days in the UK for medical treatment. The BBC, in its report, put the cost of parking fees for the presidential aircraft that took him there at £360,000.
Commenting, human rights activist and lawyer, Inibehe Effiong, described the bill to retain Nigerian doctors in Nigeria for five years after graduation as discriminatory and an infringement on their rights . “I recall that there was time a bill was introduced to bar public office holders and their children from seeking medical attention abroad.
The argument of the members of the National Assembly, who resoundingly rejected that bill was that it was an infringement on the right of the political office holders to freedom of movement and so on. If that argument was the basis for the rejection of the bill ,then the same argument has to apply to doctors. “It will be discriminatory to isolate them from such restriction.
A bill that is targeted at a specific group of persons in a manner that is disadvantageous and seeks to create a disadvantage is unconstitutional because it infringes on the right to freedom from discrimination under Under Section 42 of the Constitution.
To that extent, it is illegal. It is unconstitutional. They have freedom of movement guaranteed by Section 41 of the Constitution. The truth of the matter is that the healthcare system has col- lapsed,” Effiong told Sunday Telegraph.
Nigeria might end up with only native doctor-Johnson
Speaking on a live radio program monitored by Sunday Telegraph, the sponsor of the bill, Ganiu Johnson, said the purpose of the bill was to reduce to the barest minimum, the issue of capital flight and medical personnel. He further stated that before the bill itself, there was a motion he raised about “the medical brain drain issue”.
“The motion prayed for three things. There should be an upward review of the welfare of medical personnel. The government should collaborate with the private sector such as insurance companies to fund the healthcare package and upgrading of health facilities. We have unclaimed dividends lying down there. “They can make use of them by collabo- rating with them. I’m looking at Nigeria as a nation. How many doctors do we have? So, that’s the problem. It will get to a stage where Babalawos (witch doctors) will be the ones treating us. Let me make myself clear. The issue of five years is inclusive of housemanship and NYSC programme. The remaining three years is to their own advantage.”
For the Provost, College of Health Science, Federal University of Lokoja, Mike Ogirima, it is a bill that should not have reared its head. The issue, he said, is one issue that has cut across virtually all sectors, wondering why medical practitioners are singled out. “So, I’m angry at the bill as a professional. It is a bill that is seeking a solution that is bringing more problems to the medical practitioners. We have a problem of brain drain, which is affecting the economy. This brain drain is not just restricted to medical professionals. It is an issue that has cut across all professionals. So, why are we singling out medical practitioners? To say a practitioner who is supposed to be licensed after one year of practice…that’s after one year of housemanship, they are now denying the practitioners, now if you don’t give full license to the practitioners,what happens?
“That means the practitioner will be practising even in our country as a clerk. So, whose money was used to train this practitioner? Whose money was used to train all the professionals that are drifting away from the country? Of course, the international law does not forbid mobilization across the borders. To me, that bill should be put to rest perpetually.” He opined that the legislature should have consulted on the push factors leading to brain drain. “These are the fundamental problems that we should tackle, the push factors: poor working conditions, poor remuneration,” he added.
More troubles as Nigeria enters UK’s red list
Amid the dust raised by the move to compel medical students to serve their father land for five years before they can seek greener pastures, the United Kingdom stopped “active recruitment” of skilled and experienced health and social care personnel from Nigeria and 53 other countries across the world.
As of October 2022, according to the NMA, no fewer than 10,296 Nigerian- trained doctors were practising in the United Kingdom, with Nigeria having the third highest number of foreign doc- tors working in the UK after India and Pakistan. However, in its updated ‘Code of practice for the international recruitment of health and social care personnel in England’, the UK placed Nigeria and the other countries on its red list, which was said to be based on the World Health Organisation Workforce Support and Safe- guard List, 2023. The other countries on the red list include Afghanistan, Angola, Bangladesh, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Comoros, Congo, Democratic Republic of Congo, Côte d’Ivoire, Djibouti, Equatorial Guinea, Eritrea, Ethiopia, Gabon, The Gambia, Ghana, Guinea, Guinea-Bissau, Haiti, Kiribati, Laos, and Lesotho. Others are Liberia, Madagascar, Malawi, Mali, Mauritania, Micronesia, Mozambique, Niger, Pakistan , Papua New Guinea, Rwanda, Samoa, Senegal, Sierra Leone, Solomon Islands, Somalia, South Sudan, Sudan, Timor-Leste, Togo, Tuvalu, Tanzania, Uganda, Vanuatu, Yemen, Zambia, and Zimbabwe.
Solution as problem
Meanwhile, in its reaction, the Diaspora Medical Associations traced some of the causes of brain drain in the health sector to the absence of a system that promotes professionalism, growth, work satisfaction, and a high reliability culture. In a letter addressed to the Speaker of the House of Representatives, Femi Gbajabiamila, the medical experts argued that focusing on one aspect of a problem without taking a holistic approach to a sustainable solution will be ineffective, adding that many are frustrated by the consequences of governance failures that have progressively worsened over the past 30 years.
The letter read in part: “We recognise the problems posed by the exodus of Nigerian medical professionals from our health system including, but not limited to decreased access to health care services, lack of quality of care, care delivery deserts the inability to adequately enact healthcare and public health policy due to lack of manpower and leadership resource.
“The medical or dental practitioner is the glue that keeps the team functional and the leading force for an effective health care delivery system. Similarly, the medical and dental professional bears the burden for systemic failures resulting in the maladaptive structure fostering stress, undue burden, physical and mental anguish, lack of job satisfaction, poor working conditions and much more. “The major cause of brain drain includes a poor care delivery framework from a failure to invest in healthcare to foster a conducive environment. The system does not promote professionalism, growth, work satisfaction nor a high reliability culture.
Other major drivers include very poor welfare packages, high level of insecurity, limited opportunities for employment, sub specialty training, socio political and economic instability. “The majority of these issues stem from outside healthcare system and is outside of an individual’s control. Indeed, good governance and commitment to future investment in healthcare would improve conditions in the country that will allow security, good education for children, improved compensation, as described in the Abuja Declaration.”
Speaking on Channels Television’s Politics Today, the NMA President, Dr Ojinma Uche, stated that the bill would worsen the problem it intends to solve. “That is not the solution. You will discourage young medical students from reading Medicine. My own fear now is that it may have spooked the doctors that will be planning to leave in a year to start leaving immediately, before they are clamped down.
“If you now decide that Nigerian doctors cannot have full or permanent li- cence for five years after graduation, automatically, you have made them house officers for five years.” In the same vein,Prof Tomori harped on the need for the Nigerian government to take a cue from India. “There was a time when Nigeria was a Diaspora for Indians. Wasn’t it? The Indians were teaching in our secondary schools. The Indians are coming back. They are the ones heading Dangote company. They are not coming back to teach because they have facilities in their country. Their country’s government created an enabling environment for their trained personnel to stay. That’s the solution. It’s not by making draconian laws because you want people to stay for five years. Doing what? They have not ad- dressed the basic things. Before creating that law to say stay for five years, you have to create the enabling environment for people to work. If he doesn’t have a place to go, no electricity, no hospital, what is he going to do in five years that he is going to stay? So, you solve that problem first before you make those stupid laws.”
Apart from medical doctors, Tomori said, engineers, IT experts and other professionals are also leaving because they can’t find professional fulfillment.
It’s a misguided legislative adventure – Mike Ahamba , Inibehe Effiong
Senior lawyer, Mike Ahamba(SAN) and human rights activist , Inibehe Effiong , described the bill that seeks to compel medical doctors to work for at least five years in Nigeria before they can seek employment abroad as a misguided legislative adventure. In separate interviews with Sunday Telegraph, the lawyers described the bill as one capable of worsening Nigeria’s human rights record.
Ahamba said: “The law says there’s freedom of movement. How can a person go and read medicine and you don’t give him good conditions of service. He now wants to move out and you’re saying he shouldn’t go. It’s just funny. The National Assembly has refused to engage as advisers some good lawyers because they do a lot of things that are not consistent with the law. For me, I would be surprised if the doctors don’t fight it individually. It’s not a collective thing. If you have a visa to travel to London, they say you won’t travel, you have a right to sue them.”
Ahamba further argued that, “creating another law to stop people from enjoying their fundamental rights doesn’t work. What will help us is to have a better ad- ministration that will make sure that doc- tors are properly maintained. Is it only doctors that are going? Young people are leaving this country in droves. Did the doctors read on scholarship? There should be a condition of service . If conditions of service improve, fewer people will go out of the country. But if you keep things as they are, you can’t stop a person from looking after his future, particularly if he didn’t read on scholarship.”
According to Effiong, Nigeria currently has a president, who does not have faith in the healthcare system of his country, stating that doctors cannot be barred from offering their services to countries that take the health and medical care of their citizens seriously. “What they are supposed to do is to probe into why there is no sufficient in- vestment in the health sector and why the welfare of medical practitioners, not just doctors, is not properly attended to,” he admonished. He, however, asserted his belief that the bill would be defeated, describing it as a distraction from the real issues.
