Surplus Offers, Scarce Interests: Government Jobs for Nigerian Doctors
Happy workers’
day to all working Nigerians, fellow members of my medical profession as well
as the political and bureaucratic movers & shakers of our national destiny.
My growing concern for Nigeria’s healthcare system, now and in the future,
reached a fever pitch recently when I learned of a dangerous reality that can
shoot down the health of Nigerians and tip the country’s economic forecasting
into the sea. If health is truly wealth, owing to the nexus between population
wellbeing and national productivity, the disinterest of a critical mass of our
health workforce in government jobs should stimulate a sense of emergency
requiring at least a Presidential broadcast.
When The Punch
newspaper’s 8th April publication quoted that “the Coordinating Minister of
Health and Social Welfare, Prof Muhammad Pate, said over 16,000 Nigerian
doctors have left the country in the last five to seven years to seek greener
pastures in other countries”, the odious fact was established with
numerical backing from the stables of the health sector leadership. However, such
news of high attrition of medical doctors leading to scarcity of this highly
skilled medical personnel, though unpleasing to the ears of policy makers who
care to listen, is not the shock.
The law of
demand and supply is one economic module that helps to understand employment
matters of offers and acceptance, as well as the effects of rewards and
disincentives on potential jobseekers. Over the past few months, my
participation at some national and subnational health sector events brought me
in proximity with the political & bureaucratic hierarchy of some States who
shared the open secret of shortage of medical doctors across government
hospitals. Imagine, however, that some State Hospitals’ Management Boards
(HMBs) and State Primary Health Care Development Agencies (SPHCDAs) conducted
staff audits, identified hundreds of vacancies for medical doctor positions,
notified the appropriate authorities of these openings, sought & received State
government approvals to advertise, expended public funds on job placements in
the mass media for weeks, but disturbingly found less than ten candidates
‘apply’ for these slots. Although I am yet to inquire if a similar trend
pervades the Federal civil service, this is the current shockwave at the
subnational level of Nigeria’s healthcare system regarding the desire of
medical doctors for government jobs. The offers are surplus, but the interests
are scarce.
Whereas Nigerian
Medical schools have not stopped training and graduating doctors, the. As a
matter of fact, the production quota for medical students across several
government-owned Colleges of Medical Sciences and Teaching Hospitals has been
increased as a policy response to the Japa (foreign relocation) syndrome
among Nigeria-trained medical doctors. Nevertheless, it appears that
intervention amounts to nothing whenever I despondently recall The Nation
newspaper’s report of the induction ceremony into the medical profession for
the Bachelor of Medicine, Bachelor of Surgery (MBBS) and Bachelor of Dental
Surgery (BDS) graduating class of 2024 of the College of Medicine, University
of Ibadan (CoMUI) in July 2024. The Provost, College of Medicine, University of
Ibadan at the time, Professor Olayinka Omigbodun, was cited to have said during
the event; “I am very saddened that most of our doctors want to leave the
country. Actually, when I interviewed them (the medical graduands/inductees), I
learnt it’s only one of them that really wants to stay back and work here out
of almost 150. It is devastating for this nation”. To compound this
imbroglio, I am aware that several medical students in their final years of
training across many medical colleges in Nigeria routinely observe group tutorials
for medical international licensing exams. The craving to work within Nigeria’s
medical industry regrettably dips by the day.
Yes, it is
expensive to train a doctor but the training fees of medical students in
government-owned schools in Nigeria is highly subsidized in comparison to the
huge bills in developed nations. Yes, doctors trained by government
institutions should consider giving back to the nation that afforded them such
affordable medical schooling costs. Yes, the minimum or entry level wage in most
States’ civil service structures is pittance, and this impoverishing take-home
affects every government employee from non-health workers (gardeners, clerks,
administrators, accountants etc.) to other cadres of health workers (nurses,
midwives, community health workers etc.) and not only doctors. Yes, the demand
for doctors’ skills and knowledge in the international market is high with
better paying and working conditions, distorting their desire for Nigerian
government jobs with these intercontinental alternatives.
Despite these
sentiments, imagine committing six years or more of your life to studying
Medicine & Surgery in college. My medical class at Olabisi Onabanjo
University got admission into medical school in year 2001, with Joint
Admissions Matriculation Board (JAMB) examination results of year 2000, and
graduated with Bachelor of Medicine & Bachelor of Surgery degree (inducted
as medical doctors) in March 2010. Add
one year of internship (housemanship), one year of National Youth Service Corp
(NYSC) and another four to six years of Fellowship/specialty training. It’s
such a draining experience all the way. In other words, imagine committing
fifteen years of your life to a medical professional knowledge & skills
acquisition. At the end of the training tunnel, can majority of clinicians in any
State government service in Nigeria, who are neither working within the public
health space where there are occasional extra benefits nor holding
administrative positions that harbour additional remunerations, can truly say
they have found/or will find ‘economic’ light?
Before you unfairly
accuse the disinterested and emigration-seeking doctors of disloyalty to their
country or being unpatriotic, make sure you have answers to the pitiable
working conditions of Nigerian doctors. Look around government hospitals and see
doctors’ (and other health workers’) plights of high patient volume, poor or
non-existent call rooms & food, poor security measures in most hospitals
that expose those on night duties to criminal attacks and assaults by patients’
relatives anytime of the day, poorly netted windows & dysfunctional doors that
predispose them to mosquito bites and snake attacks at night. These
unacceptable conditions of service meted out to doctors do not exonerate the roles
of some (fellow) doctors, who double as Chief Medical Directors/Medical
Directors (‘system’ management positions that are outrightly different from
‘clinical’ management of patients but have been exclusively - illogically so -
reserved for medical doctors in Nigeria), in the infrastructure ruins, financial
atrocities, management flops and leadership recklessness across several
government hospitals.
Again, this
conversation cannot be done outside the reality of an over-centralized public
governance structure that Nigeria’s political and bureaucratic classes appear
to intentionally protect for personal greed of a few. Our current dysfunctional
structure unfairly appropriates more legal, geographical, administrative,
political and economic powers & opportunities to the Federal government
than the 36 States, Federal Capital Territory and 774 constitutionally
recognized Local Government Areas. As much as I acknowledge the remarkable
increase in monthly allocations accruable to the 36 States since President Bola
Ahmed Tinubu-led Federal government stopped the leech called oil subsidies for
market-resonating pricing of petrol, there is more to be done. I am of the
strong opinion that a near-total or complete departure from the age-long
“central revenue collection and sharing” culture is one major fiscal
game-changer required to build buoyant subnational economies. Not until then,
State governments will remain incapable of paying globally competitive
emoluments or providing universally qualitative hospital environments to attract
and retain substantial numbers of locally trained medical doctors within their
systems.
Finally, and in
addition, government needs to pay as much attention as it gives State Houses,
Legislative offices, and other places that directly serve the personal & working
interests of political office holders, to construction & maintenance of
government healthcare facilities for a befitting physical working environment
for medical doctors and other healthcare workers. While I am not advocating for
doctors to shy away from government employment in Nigeria, I believe the
afore-mentioned issues need to be systematically but urgently addressed to
re-gain the confidence and interest of Nigeria-trained medical doctors in government
employment. I so submit!
Dr.
Adetolu Ademujimi is a Medical Doctor, Health Finance Specialist, Author,
Reformer, Coach, Public Policy expert and social entrepreneur who can be
reached in Abuja via adetoluademujimi@gmail.com
💪🏼💪🏼
ReplyDeleteThis is absolutely true of our Healthcare system today. Indeed there are opportunities but no personnel with little or no interest .
ReplyDeleteGovernment should make the jobs more attractive inorder to retain the available ones.
This is nothing but the truth. I wondered when recently I read of increase in number of Nursing intake to a great multiple than what it used to be! Thinking allowed, I was like well, it would have been better if the working conditions are reviewed positively.
ReplyDeleteThis is the bitter truth about our health system today but do government care? The welfare packages of healthcare providers, including their remuneration need total overhauling to effect any change or reversal.
ReplyDelete