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