On April 6, this year, Nigeria’s lower legislative chamber, the House of Representatives, triggered an outrage. The House 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 licensed to practise.
The sponsor of the bill is Honourable Ganiyu Johnson, a member of the All Progressives Congress (APC) representing Lagos State. He strongly believes that once passed into law, the proposed legislation will end the massive movement of young Nigerian doctors abroad.
His argument is, Nigeria has only 24,000 licensed medical doctors in the country, which is less than 10 per cent of the number needed to meet the World Health Organisation’s (WHO) recommendation, hence, the need for the bill. He said, considering the growing trend of the Nigerian population and the current rate of emigration of Nigerian-trained medical and dental practitioners, passing this bill into law would provide Nigerians with quality medical services.
To further buttress his argument, the federal lawmaker compared the fees paid in the United Kingdom and other countries’ universities on the one side to what is paid in Nigerian universities, concluding that tuition fees in Nigeria’s public medical schools were highly subsidised. Thus, making it mandatory for the nation’s medical professionals to reciprocate.
Many Nigerian doctors have moved to the developed world, searching for greener pastures. About 5,600 of them have migrated to the United Kingdom in the past eight years. Now, in some southern states of the country, only one doctor is expected to treat about 30,000 patients while in the North, the ratio is a doctor to over 45,000 patients.
Nigeria is not the only African country losing its medical staff to developed nations. Virtually every African country is affected. Statistics from Britain’s Nursing and Midwifery Council showed that up to March 2002, over 2,000 African nurses left their countries to take up jobs in Britain. For instance, South Africa lost 2,114 nurses and midwives to Britain and Zimbabwe, 473 nurses.
Since the content of the bill became public knowledge, doctors and their unions have been lambasting the House of Representatives for the move. Tempers have been flaring, with the doctors claiming that the legislators are ill-informed to contemplate such a law, thus, picking holes in it, and vowing to stop the lawmakers on their track.
Expectedly, the National Association of Resident Doctors (NARD) rejected the bill. In a communique issued after the association’s emergency National Officers’ Committee (NOC) meeting, the resident doctors were particularly shocked by the bill’s sponsor, Hon. Johnson, and his attempts to enslave Nigerian-trained medical doctors. Also, an umbrella body of Nigerian medical doctors and dentists practising outside the country known as Diaspora Medical Association petitioned the National Assembly over the bill.
Similarly, the Medical and Dental Consultants of Nigeria (MDCAN) also faulted the bill. According to MDCAN, the proposed bill is harsh and discriminatory, lacking the basic ingredients of good faith. In a statement signed by the President, Dr Victor Makonhuola, and the Secretary-General, Dr Yemi Raji, MDCAN noted that the bill violated Section 34 (1) (b) of the Nigerian Constitution.
While we appreciate the passion and concern for the health of Nigerians as shown by Johnson in proposing this bill, we think it is misdirected, ill-informed, and poorly thought through. We wonder why the legislators should focus on medical doctors when Nigerians across all professions are fleeing the country to seek greener pastures abroad. Focusing attention only 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.
The bill is undemocratic. It infringes on medical personnel’s freedom of movement to seek good means of livelihood elsewhere. It is laughable that these same legislators and their cronies in government who frequently go on medical trips overseas are now telling doctors where to work. Why do they not make a law against politicians going for medical tourism? Is it not our money these politicians spend abroad to treat themselves, while we have hospitals that are in dilapidated conditions?
The real motive for seeking to delay medical professionals from taking better opportunities overseas is yet to be seen. What Johnson advocates blatantly violates the acclaimed labour and market principles. The question is: how would the proposed law tackle the vexed issues of infrastructural deficits, low public investment, and poor workers’ welfare, as well as improve the quality of clinical outcomes in the least?
On the issue that medical workers must give back to society after enjoying subsidised training, it must be emphasised that bonding already exists in the civil service with clear guidelines for its application. Governments at both state and federal levels provide full sponsorship for university education at both undergraduate and postgraduate levels, with a proviso that they will bond individuals who benefit from such sponsorship for a specified number of years. This does not apply to subsidies.
Resolving the challenge of brain drain in the country’s health sector cannot be achieved through this bill. Rather, Nigeria needs to address the various factors that make skilled health workers desire to migrate from the country. They should direct considerable efforts at improving the health system, with sustainable investments, to make it conducive for health workers to work and achieve better outcomes. Besides, their work environment and career expectations must be prioritised.