Beyond the official statement by the Nigerian Medical Students’ Association (NiMSA) vehemently rejecting the recently passed bill preventing Nigerian-trained medical or dental practitioners from obtaining their practicing licence up until 5 years post-graduation, aimed at halting their migration out of the Nigerian Health system. The Medical and Dental Consultants’ Association of Nigeria (MDCAN) also lend their voice and stands in solidarity with the medical students and young doctors by totally refuting this bill proposed by the National Assembly.
This was done via a 3-page press release on the 7th of April 2023, indexed, MDCAN/2021-2023/PRL/007 which openly addressed and critically reviewed the proposed amendment bill to restrict young doctors. As the outcome of this bill, if passed into law, will affect them directly, increase workload inefficiently and cause a massive ripple effect that would be counterproductive.
RE: BILL PROPOSING BONDING OF FRESH MEDICAL GRADUATES FOR FIVE YEARS
We received with a rude shock the news of a Bill purporting to make it mandatory for fresh medical graduates to provide services to Nigeria for up to five years before receiving a full registration and license to practice. This proposal is such that they would not be able to leave the country until after five years post qualification. It is even more worrisome that the bill has passed through the second reading.
While the idea of bonding medical doctors and indeed all health workers is not novel and has been repeatedly whispered in government corridors since the recent escalation in health workforce brain drain, a thorough interrogation of the possible merits and demerits with stakeholders has ensured it remained a whisper which was gradually tailing off. This Bill has released a genie in the bottle.
The passion and concern for the health of Nigerians demonstrated by Honorable Abiodun Ganiyu Johnson in proposing this bill as panacea for physician brain drain is commendable albeit misdirected, ill-informed, and poorly thought through. In fact, this Bill has the possible effect of doing the exact opposite: aggravating the exodus which we have been working with the Executive arm of Government to mitigate. It is pertinent to state that none of the suggestions of the inter-ministerial committee on brain drain and bonding of health workers has been implemented till date. Perhaps, a simple consultation with the primary constituency to be affected by the Bill would have afforded the Honorable member a clearer understanding of the hydra-headed nature of the problem he is trying to solve.
This Bill, without making any assumptions about the ill intent from the proposer, simply lacks the basic ingredients of good faith in the sense that it is both discriminatory and harsh, to say the least, and not in the interest of the people. The following reasons underscore our suggestion that a further consideration for the passage of Bill will amount to a wild goose chase in addressing the challenge of brain drain;
1. The Bill erroneously assumes that only newly qualified Doctors are emigrating from Nigeria. Recall that MDCAN has, over the past two years, been in the forefront of calling the attention of policy makers in Government and other critical stakeholders to the ongoing, massive health sector brain drain. Our 2022 survey revealed that over 500 consultants were estimated to have left Nigeria over the preceding two years. Along with sister Associations in the health sector, we have provided to the appropriate Agencies of Government both useful and practical suggestions on how to remedy the situation. You may wish to know that fresh doctors work under supervision of the more senior ones. Without addressing the retention of the more senior doctors, coercion of the fresh doctors to stay in the system will be a futile effort if quality and effective health care delivery is the ultimate desire of the proponents of the Bill. The question now is, are we going to have another Bill to mandate the senior doctors to stay in the system for 10 years?
2. Curiously, the Bill violates the constitution of the federal republic of Nigeria, as Section 34 (1) b states that “no person shall be held in slavery or servitude” while section 34 (1) states that “no one shall be required to perform forced or compulsory labour”. This Bill is therefore an excellent example of modern-day slavery. It is shocking and very disrespectful to consider this rather odious Bill as a measure for regulating one of the noblest professions.
3. Bonding already exists in the civil service with clear guidelines for its application. The government at both State and Federal levels do provide sponsorship for university education at both undergraduate and postgraduate levels, with a proviso that individuals who benefit from such sponsorship will be bonded for a specified number of years. For this Bill to therefore consider bonding medical doctors who never benefitted from any public sponsorship is therefore an anomaly, and a clear attempt to reap from where one has not sowed.
4. The idea that Nigerian trained medical doctors received heavily subsidized education pure fallacy. Tuition has remained part of the fees paid by every medical student, usually higher than that of non-medical students in most universities. The fact that this amount is smaller relative to other countries – especially the developed countries – does not amount to subsidy, as every graduate who is lucky to get gainfully employed afterwards pay back by earning salaries far lower than their peers in developed countries. The irony is that generation that had federal and state governments’ scholarships and meal subsidies campus are the ones suggesting bonding of students who are self-sponsored.
5. A major reason for the exodus of health workers is unemployment and under-employment. This Bill erroneously assumes the capacity of the federal government to employ all the doctors for the next 5years post qualification. This is a capacity which even the most optimistic of analysts know that the government lacks. Is the Bill then trying to increase the pool of unemployed and disenchanted Nigerians?
6. Health care workforce shortage is a global phenomenon that requires international collaboration to address, through well thought-out, fair, and just guidelines. Hence, enacting a law to address such a global issue with a local quick fix is an over kill. All that the recipient nations need to do is to review guidelines for foreign graduates to include those who are yet to have full registration in their country but with evidence of completing medical education. Such review by recipient countries will render the proposed Bill redundant, while hastening the exit of newly qualified doctors. Some jurisdictions are already accepting Nigerian medical graduates with provisional registration for house-manship.
While we look forward to the public hearing to clarify our views on the floor of the Parliament, it is our hope that the points enunciated above will get the proponents of this Bill to strongly consider its withdrawal to save cost on further legislative processes on the Bill. We hereby convey our total rejection of the Bill and pray that it should be thrown out completely.
Laws and policies that enhance the rate of production of good quality health care manpower while promoting the desire and willingness of health care workforce to stay back in the country should be the core focus of the National Assembly at this time. As the National Assembly remains the bastion of our democracy, laws that will make light of the most draconian military dictatorship should not emanate from our Hallowed Chambers.
May God bless our dear country.
Signed,
DR VICTOR MAKANJUOLA
PresidentDR YEMI R. RAJI
Secretary General
However, according to a Professor of Obstetric Anaesthetist and member of MDCAN, who spoke with Hon. Ganiyu Abiodun Johnson on this issue – the law maker who presented the bill; he explained that he meant well, and his reasons were towards halting the ongoing massive brain drain out of the Nigerian Health sector and ensuring availability of quality healthcare for Nigerians. Furthermore, he stated that they are pushing for the upgrade of designated hospitals, also revealing that there’s going to be a public hearing where doctors can submit a memorandum making their points.
Summarily, this conversation highlights that the bill can be stopped if the right things are done with advocacy and lobbying in the right places.
