The bill seeking to prevent locally-trained medical and dental practitioners from leaving Nigeria until after five years of practice has been damned for ignoring the root causes of the country’s medical brain drain.
As part of the efforts to curb the exodus of talent from the country, or ‘japa’ (a Yoruba word for “run quickly”) as it is called in local parlance, the House of Representatives concluded the second reading of the bill last Thursday. The bill aims to make it mandatory for medical and dental practitioners to practise for at least five years before getting a full licence.
But many have questioned the motive for seeking to delay medical professionals from taking better opportunities overseas in the context of labour and market principles.
They wondered how this would tackle the infrastructural deficits, low public investment and poor workers’ welfare as well as improve the quality of clinical outcomes or doctor-to-patient ratio in the least.
Yakubu Oloriegbe, chairman of Senate Committee on Health, described the proposed strategy as inadequate to address the multifaceted drawbacks of Nigeria’s healthcare and incapable of resolving the key issues that make the local terrain unattractive to medical workers.
He said efforts should be directed at improving the health system with sustainable investments to make it conducive for health workers to work and achieve better outcomes.
“Resolving the challenge of brain drain in the country’s health sector cannot be achieved through this bill. Rather, we need to address the various factors that make skilled health workers desire to migrate out of Nigeria,” he tweeted on Saturday.
Read also: Medical Students condemn bill to curb migration
“We should advocate for an improved system that will be very attractive and make medical practitioners unwilling to travel abroad to seek better living conditions.”
Countering the position that medical workers must give back to the society after enjoying subsidised training, Oloriegbe suggested that medical students could be obliged to choose between paying the standard market rate for their training or opting for government-subsidised training.
He said those who opt for subsidised training after their qualification should be compelled to work in Nigeria for a certain time or refund the subsidies as practised in some advanced countries.
“To achieve the goal of a mandatory work scheme, we 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,” the lawmaker said.
Razia Khan, chief economist and head of research, Africa Middle East at Standard Chartered Bank, said on Twitter that the idea of mandatory work conflicts with market principles.
She said creating more distortions can only guarantee sub-optimal outcomes.
“There is always a need for regulation in instances where market solutions alone will not deliver the best outcomes. But policy should also focus on what best suits Nigeria’s long-term development needs. Discouraging Nigerians from becoming doctors isn’t it,” she said.
Arinze Madueke, a financial analyst, wondered if the same principle will be applied to salary payment for those who don’t take government subsidy for medical training.
“What is the total cost of unsubsidised salaries to the FGN budget assuming 70 percent of doctors opt for unsubsidised education? Why don’t I take that same money and pay less in Ghana or former eastern European countries? We have to work at both ends of the problem: we should expect to lose people, earn foreign exchange from it, gradually upgrade our health sector and produce more doctors,” he tweeted.
Some other critics said the bill should provide a case for funds saved from the deregulation of petrol pricing to be directed at fixing the health system and the education sector to produce more workers.
Over the last four years, neither the public nor the private sector has been able to rival the incentives used by competitors such as Saudi Arabia or the United Kingdom to lure talent from Nigeria.
Hospitals such as the Federal Medical Centre Ebute-Metta have had to turn to task shifting and flexible arrangements that allow for job hopping to keep certain services running.
The hospital lost a total of 152 workers, including 38 doctors, 42 nurses, 30 combined laboratory scientists, pharmacists and physiotherapists, and 42 others, between January 2021 to August 2022.
Nigeria, home to over 82 million poor with health expenditure per person of $71, has been indirectly offsetting the cost of healthcare delivery for countries such as the United States and the UK, where there is heavy reliance on foreign recruitments to fix their health workforce gap.
The US is a country capable of $10,921 in health spending per individual.
The UK and Saudi Arabia spend about $4,312 and $1, 316 respectively on each citizen, but Nigeria keeps losing the health workers it needs due to higher remuneration, exposure to advanced technologies and improved standard of living.
Instead of a robust health workforce equipped to drive up doctor-to-patient ratio, raise life expectancy and flatten maternal and child mortality rates, the country is grappling with a lean structure that continues to bleed from escalating migration of workers.
Based on data from the register of the Nursing and Midwifery Council (NMC) of the UK, the number of Nigeria-trained nurses rose year-on-year by 68.4 percent to 7,256 in March 2022 from 4,310 in 2021.
About 6,068 Nigerian medical doctors moved to the UK over the last seven years, according to the General Medical Council of the United Kingdom.
The loss of skilled manpower without a sustainable plan for replacement is a development that analysts say is worrying.
In 2020, Nigeria had 1.2 nurses and midwives and 0.4 physicians for every 1,000 inhabitants, slightly higher than the Sub-Saharan African average but worse than many of its regional peers such as Ghana, Namibia, and Zambia as well as structural and aspirational peer countries such as Indonesia and Vietnam.
Nursing shortages lead to errors, higher morbidity, and mortality rates.
According to the World Bank, Nigeria has the highest under-five mortality rate in the world with 117 deaths per 1,000 live births.
Analysts expect a better strategy aimed at the key issues like increased budgeting for healthcare to be brought forward.
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