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Restricting medical graduates seeking greener pastures: An infringement or valid step?

Nigeria opens door for medical, other volunteer missions abroad

Within the last five years, there have been reports of a high amount of medical doctors leaving the country to go to countries with better working conditions and remuneration, causing a shortage of medical doctors in the country. On the 6th of April, 2023, the Green Chamber of the National Assembly passed for Second reading a bill that seeks to restrict medical personnel from travelling abroad to practise until they have worked for a minimum of five years in the country.

This generated great furore, particularly from the Nigerian Medical Association which claims that the bill is an attempt to infringe on the fundamental rights of the medical personnel. The sponsor of the bill and others in support of the bill, however, claim it is majorly an attempt to protect the investment that the Government has made. This essay considers these two sides of the proposed travel restrictions while concluding that the restriction, though may be to protect Government investment, is still an infringement of fundamental rights and cannot be allowed.

An infringement of fundamental rights or a protection of government investment

Fundamental rights are a group of rights enjoyed by citizens by being citizens of a state and which are constitutionally protected from encroachment. The Constitution of the Federal Republic of Nigeria in Chapter IV provides certain rights which are fundamental and which all the residents of Nigeria enjoy. Foremost among these rights and which the travel restrictions on medically trained personnel infringe on are: the right to dignity of the human person; and the right to freedom of movement.

By the provision of section 34(1)(c) of the Constitution which provides that: no person shall be required to perform forced or compulsory labour, the proposed bill, which seeks to compel medical personnel to work for five years in the country before they could travel abroad to practise, is an infringement of fundamental right of the medical personnel to the dignity of their human person.

This restriction and compulsion to work in the country for five years is tantamount to servitude that is outlawed by the provision of section 34(1)(b) of the Constitution. Servitude is a condition of being a slave or being forced to obey someone else.

Also, section 41 of the Constitution provides that: no citizen of Nigeria shall be expelled from Nigeria or refused entry thereto or exit therefrom. This means that every citizen of Nigeria is entitled to travel out of the country for any purpose such citizen deems fit.

In light of this, medical personnel are entitled to travel out of the country for any purpose, inclusive of practising as a medical practitioner. Hence, restricting medical personnel from getting the license that would enable them to practise abroad until they have worked for a minimum of five years in the country contravenes the provision of section 41 of the Constitution, thus, an infringement of their fundamental right.

Furthermore, while it is trite that fundamental rights are not absolute and that section 45 of the Constitution allows for derogation from certain fundamental rights in the interest of defence, public safety, public order, public morality, or public health, the right to dignity of the human person is, however, not included.

This is not to mention that the restriction contravenes Section 17(3) of the Constitution which provides that: The state shall direct its policies towards ensuring that all citizens, without discrimination on any group whatsoever, have the opportunity for securing adequate means of livelihood as well as adequate opportunity to secure suitable employment.

The employment that most of the medical personnel have is currently not adequate and suitable owing to the cost of living in the country. Preventing them from going abroad where they can get adequate and suitable employment which the Government has failed to ensure despite the significance of their service is, therefore, a violation of their right to secure adequate employment. The fact that the restriction targets only medical personnel also makes it discriminatory.

However, the travel restriction is aimed at combating the menace of the deleterious brain drain seriously affecting the medical sector of the Nigerian state as a recent survey conducted by NOI Poll and Nigeria Health Watch reported by the Guardian Newspaper shows that out of 72,000(seventy-two thousand) medical doctors that are registered with the Medical and Dental Council of Nigeria, only approximately 35,000(thirty-five thousand) are practising in the country.

The travel restrictions could, therefore, on the other hand, be seen as a protection of Government investment. Government Investment means the money that the Government invests in something which in this context includes the money the Government has expended in the training of these medical practitioners.

The argument that the tuition of medical students in Nigeria which ranges from N40,000 to N150,000 is very subsidized compared to the USA, UK, and Canada, though maybe considered simplistic, is an attestation to the fact that the cost of training medical practitioners is high and Government does a lot to reduce the burden on the students.

Nigeria currently has 42 medical schools, of which; 17 are Federal, 18 are State institutions, and 7 are privately owned. The majority of the Institutions are Government owned and particularly Federal where Medical students pay as low as N25,000.

Even some of the privately owned institutions make use of the facility of the Federal and State Institutions that are near them. When, despite all these, there is an exodus of medical doctors, particularly the fresh ones, the Government cannot be expected to stay idle and allow it to continue without any Return on their Investment as it would seem only fair that those who enjoy taxpayers’ money give back to the people, particularly when the country has never had enough doctors to cater to the growing population.

Moreover, medical practitioners are skilled workers and skilled workers owe two moral duties: “obligation of repayment” and “duty of assistance”. The former obliges skilled workers who have acquired skills at the poor state’s expense to pay the costs of training either with money or with their labour while the latter simply obliges them to make their poor compatriots better off. The travel restriction is, in one way, an enforcement of these moral duties as the country cannot keep producing doctors yet still lacks doctors.

Also noteworthy is the impact that the Brain drain or the exodus of medical practitioners currently has on the country. It has left holes that are hard to fill since the ratio of medical practitioners to the population is considerably low. The doctor: patient ratio in Nigeria is about 4:10000—a stark contrast with WHO’s recommended 1:600.

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According to the former Minister of Health—Osagie Ehanire—the country produces about 3000 medical doctors yearly but a report has shown that about 2000 medical doctors leave Nigeria yearly. This exodus, if not controlled, will lead to an overstretching of the already limited workforce of medical doctors. This might further prone more doctors to join their counterparts in other countries leading to more losses for the country.

Conclusion

While the good intention behind the travel restrictions is recognized, the means is, however, not justified as it is an unpermitted infringement of the fundamental rights of citizens. More so, coercing doctors who have set their eyes on the shores of another country to stay would only be to the detriment of patients as legislation would not bring about the passion and desire to save a dying patient.

Rather than restricting these doctors from travelling, the Government should address the cause of this exodus by improving working conditions and investing more in the medical sector. The exodus will be checked by doing this without infringing on the fundamental rights of the doctors.

Olurombi is a 400 Level law student of Olabisi Onabanjo University