Mixed reactions trail lawmakers’ plot to bar doctors from migrating

On April 6, 2023, social media was awash with the news of a new bill mandating Nigerian-trained medical or dental practitioners to practise compulsorily in Nigeria for five years before travelling abroad. 

The bill was entitled, “A Bill for an Act to Amend the Medical and Dental Practitioners Act, Cap. M379, Laws of the Federation of Nigeria, 2004 to mandate any Nigeria-trained Medical or Dental Practitioner to Practise in Nigeria for a Minimum of Five (5) before being granted a full licence by the Council in order to make Quality health Services available to Nigeria; and for Related Matters (HB.2130).” It was sponsored by a House of Representatives member representing Oshodi/Isolo II Federal Constituency, Mr Ganiyu Johnson. 

According to a tweet made by the official handle of the House of Representatives, the proposed bill had passed the second reading.  

If the bill scales through in the House of Representatives, then it will be debated on the floor of the upper chamber, the Senate. If it scales through the various stages, then it becomes a law. 

The bill, which has passed through the second reading in the Green Chamber, is part of the efforts to cut down on the increasing number of doctors leaving Nigeria in search of better opportunities abroad.

“The bill, when passed into law, will effectively checkmate the mass exodus of doctors abroad,” the lawmaker who sponsored the bill, Mr Johnson, argued. 

In his argument, Mr Johnson said it was only fair for medical practitioners, who enjoyed taxpayers’ subsidies during their training, to give back to society by working for a minimum number of years in Nigeria before exporting their skills abroad.

In 2018, the Mo Ibrahim Foundation estimated that it costs each African country, including Nigeria, between $21,000 and $59,000 to train a medical doctor. It further noted that Nigeria and eight other African countries (Ethiopia, Kenya, Malawi, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe) had lost more than $2 billion since 2010 from training doctors who later migrated.

On the other hand, the UK, for instance, saves an average $2.7 billion on training costs from African doctors that they recruit. Similarly, the US, Australia, and Canada save respectively about $846 million, $621 million, and $384 million in training costs from African physicians they recruit, according to research. 

The Mo Ibrahim Foundation estimated that Africa had lost $4.6 billion in training costs for home-trained doctors recruited by these four top destination countries. All of these put together may have necessitated the bill sponsored by the Nigerian lawmaker, according to industry watchers.

There has been a mass migration of Nigerian medical doctors to other countries, especially the United Kingdom. This mass migration, popularly referred to as japa, is not limited to medical doctors. Other medical practitioners as well as those in other fields have also been leaving the country in their droves for various reasons, which include but are not limited to poor remuneration, insecurity, lack of job satisfaction, the country’s high poverty rate, among others.

According to a report by Dataphyte, the total number of doctors in Nigeria in 2017 was pegged at 39,912. In 2018, the figure rose to 44,021. However, the number reduced by 44.03 percent to 24,640 in 2019.

In December 2022, the President of the Nigeria Medical Association, Dr Ojinmah Uche, said Nigeria had just about 24,000 actively licensed physicians caring for the country’s over 200 million population. 

But the brain drain is not limited to doctors alone; nurses and midwives are also leaving. A previous report by Dataphyte highlighted this. 

The report noted that as of March 2022, the number of Nigerian-trained nurses who were on the UK permanent register was 7,256, indicating a 159.51 percent increase from the figure in 2018. 

This mass relocation of medical professionals from the country has, no doubt, had enormous impact on the country’s healthcare sector, which, among others, include a shortage of medical personnel. For instance, Nigeria’s doctors-to-patients ratio is far below the World Health Organisation (WHO) recommended 1:600. 

This has posed a lot of challenges to the country, which the bill by the lawmaker hopes to address, according to him. However, medical doctors as well as policy experts have reacted to the bill. 

The President of the NMA, Uche Ojinma, described the bill as something that was dead on arrival and a misplaced priority for lawmakers who he said were feeding fat on the nation’s revenues.

The NMA president, in a report by The ICIR, vowed that medical doctors would challenge the development in court and through a showdown with the government.

He posited that the proper solution should be to find the origin of the problem, which he listed as poor remuneration, insecurity, and lack of job satisfaction.

“…let me make it clear. The solution to a problem is finding out the origin of the problem. You find the cause of the problem, and you sort it out. Under international labour law, you do not restrict a worker from migration as long as he did not commit a crime or he is running away, owing you,” the NMA president said. 

On the House of Representatives’ position that medical doctors enjoyed subsidies on their training and thus should stay for a minimum of five years to give back to the society, the NMA president argued that every Nigerian student went through the same university system.

A development economist and lecturer, Dr Princewill Okwoche, who examined the issue from an economic standpoint, noted that the bill to mandate doctors to practise compulsorily for at least five years before exporting their skills abroad was a great idea given that the amount spent in education subsidy by the Nigerian government was enormous. According to him, a consideration of the bill was long overdue.

“I think it is absolutely a great idea, especially from an economic point of view. The government puts so much money into training its professionals in Nigeria, not just medical doctors. It should therefore be a no-brainer that these professionals are mandated to give back for a stipulated duration of time before transferring their skills elsewhere in the world. The universities have done this quite well, although I am not sure of the disciplinary measures that are in place to prevent beneficiaries of government sponsorship from defaulting on their bond,” Okwoche said.

A tech lawyer and policy consultant, Timi Olagunju, however, shared a contrary opinion. 

While he noted that education was subsidised, he, however, said that the citizens were paying taxes. He also noted that going by the constitution, specifically Chapter Two of the 1999 Constitution of the Federal Republic of Nigeria (As Amended), Nigerians were meant to enjoy free education from primary to tertiary level, citing countries like Norway whose citizens enjoyed free education. 

Speaking further on the bill, he noted that the bill had the potential to cause educational tourism in the medical field as citizens might feel the need to pursue their medical degrees in other neighbouring countries and then export their skills abroad. As such, he said, the bill might not exactly solve the problem of brain drain in the system.

Olagunju further stated that medical doctors somehow gave back to society through compulsory horsemanship and one year of national youth service, noting that mandating them to service for a five years might not be the right policy direction or law as the bill sought to do. He added that the bill was not well thought-out by the lawmaker and questioned if the lawmakers themselves were patronising the medical services in Nigeria.

On way forward, he said that the lawmakers should rather make a law mandating all government officials to start patronising Nigerian medical services as it would lead to more investments in the health sector.

Besides the issue of remuneration and other issues that are major reasons for the migration of medical personnel and resulting in brain drain in the system, he noted that increasing the admission of students into medical fields might also be another way to tackle the issue of brain drain in the system.