A bad, discriminatory bill
There is a bill that has passed through its second reading at the House of Representatives. It is generating an uproar within medical circles and outside it. It is a bill that wants medical and dental practitioners in Nigeria to practice for a minimum of five years before being granted a full licence by the Medical and Dental Council.
The aim of the bill, according to the sponsor, Mr Abiodun Ganiyu Johnson, a member representing Oshodi/Isolo Federal Constituency of Lagos State is to halt brain drain in the medical field. He says that the five years will include one year for housemanship and one year for the National Youth Service Corps programme.
According to the President of the Nigerian Medical Association, Dr Uche Rowland Ojinmah about 5,600 Nigerian doctors have migrated to the United Kingdom in the last eight years. It is also estimated that some foreign embassies in Nigeria especially United Kingdom, United States and Saudi Arabia receive on a weekly basis 20 to 25 verification requests from Nigerian doctors wishing to migrate abroad. This comes to about 1,196 applications a year.
According to Dr Ojinmah Nigeria requires a mix of 23 doctors, nurses and midwives per 10, 000 health services as prescribed by the World Health Organisation (WHO). Even without looking at the statistics of doctors available to patients in Nigeria it is obvious that there is a shortage of medical personnel. And even with that shortage, there is the scramble by some of the doctors to migrate to some foreign countries for greener pastures. This puts the Nigerian medical situation under severe stress. You can call it a crisis.
So on the surface Mr Johnson’s proposed bill may seem like a patriotic bill to solve a nagging problem. It is not because when subjected to serious scrutiny it looks more harmful than helpful. The bill seems to be contradictory and illogical. It seems that after graduation the medical doctor is expected to practise medicine for five years without a licence since he will only get the licence at the end of five years. How can that be allowed to happen in any sane society? Secondly, what happens after five years? He is free to take that experience acquired abroad and Nigeria will be the loser for it.
Thirdly, this looks like another forced labour like the NYSC programme. Some of the doctors think this is another form of enslavement. How do you expect a group of graduates – the doctors – to engage in another compulsory labour after the NYSC programme which they are also expected to participate in? This is discriminatory and gives the impression that since they are in a profession that involves life they must endure the punishment unlike most other professionals. That is a way of rewarding this life-saving profession with ingratitude.
Fourthly, the bill is an indication that as a country we do not learn from the past. And if you don’t learn from the past you may repeat the mistakes of the past. We recently had a long strike from our doctors who were complaining of poor pay and allowances and poor infrastructure. We all crawled and begged them to return to work so that we do not create a boom for coffin makers. I am not sure how much has been done by the various governments to improve the welfare of doctors and the infrastructure in our medical environments.
Instead of getting the various governments and the private sector to focus attention on drastically improving the situation on the ground we prefer to go on a wild goose chase in the shape of an unworkable bill. Those scars that those strikes inflicted on our health system ought to teach us some lessons but apparently they have not.
Fifthly, why should the bill focus attention only on medical doctors? Other professionals such as teachers, engineers and technologists are also migrating abroad. You do not create a law to affect only one group of workers when the prevailing situation affects more than one group. Any law that is tailor-made for and targeted at one group, profession or institution clearly lacks the ingredient of a good law: universality of application.
If a law cannot be applied to more than one profession or group or institution then that law is restrictive, discriminatory, unjust, unfair and ill-tempered. Society is the poorer for it if that law does not provide a clear, general guideline as a regulator of public or private conduct. That Johnson bill falls into this category. The truth is that there is a slow growth for many professions in Nigeria because there is very little effort at career development and very little investment in modern technology. Career development in particular is neglected and negligible. In some of our tertiary health institutions, we learn that some doctors use their own resources to procure equipment for their practice because these types of equipment are not available where they work.
The idea is that they do not want to lose their knowledge and skills so they put their money where their mouths are. There are a number of factors that have brought this stunted growth about. One of the reasons is the low revenue available to our governments and their low commitment to prime sectors such as health, education and security. The other auxiliary reason is the declining value of the naira, which has made a lot of infrastructure unreachable because of the high exchange rate. And most of the equipment are imported.
There are various reasons why a lot of our young people, not just doctors, are leaving the country in search of greener pastures abroad. The pastures are not terribly green here because most of people’s household needs including some food items, are imported and sold at exorbitant rates. These wipe away or considerably eat into the earnings of the workers. The low revenue available to governments also affects the level of infrastructure available in these institutions.
There is also the issue of security of life and property. Some highly placed persons have been kidnapped or killed in parts of the country. If we make life more secure and make the pastures greener here many of those who are japa-ing will be happy to return here and make their contributions to the development of their fatherland.
The representatives of the Diaspora Medical Association who have commented on the bill have said so. These associations, which are available in the United Kingdom, the Americas, Germany, South Africa etc have voiced their resentment to the bill. They think that it will be counter-productive and unrewarding. They have asked that the bill be killed at this stage because if passed it will be dead on arrival.
This bill, if passed, will infringe on the individual’s right to freedom of movement. This freedom is enshrined in section 41 (1) of the 1999 Constitution. It states: “Every citizen of Nigeria is entitled to move freely throughout Nigeria and to reside in any part thereof, and no citizen of Nigeria shall be expelled from Nigeria or refused entry thereto or exit therefrom.” Whatever problem there is in the medical field can still be solved without infringing on people’s right to freedom of movement. This 1999 Constitution was enacted during the military era.
It was supervised by the military even though civilians were involved in its formulation. So it has lots of defects that make it less than appropriate for a federal structure. That is why everyone of our nine rounds of National Assembly members have attempted to review the Constitution.
This year a significant achievement has been made with the various sections of the Constitution which have been reviewed by the National Assembly, State Houses of Assembly and signed into law by President Muhammadu Buhari. That, to me, represents what our legislators ought to do with the 1999 Constitution by the devolution of powers to the states and local governments and the expansion of the freedom that ought to be available to Nigerians.
After many years of military rule during which the Constitution was suspended and autocratic and violent laws imposed on the populace, I expect the legislators to begin to dismantle laws enacted during that era that miniaturises our democracy. I expect our legislators to expand the circumference of our freedom in all spheres rather than trying to impose stringent, military-type legislation on Nigeria. This bill under consideration falls into that class of obnoxious legislation that we don’t need in our democracy.
It is true that we have a serious health challenge in our country. By December 30 last year we had 104, 327 medical and dental practitioners on the register of the Medical and Dental Council of Nigeria. Out of this number only 56, 829 doctors are practising in Nigeria today. This means that about 47, 498 doctors are unaccounted for. They are either practising abroad or doing something else in Nigeria or they are simply jobless even though there is a severe shortage of medical practitioners. This is an indication that there are actually limited opportunities for employment in that field.
Some people including doctors have advocated for a declaration of an emergency in the health sector so that the stakeholders can focus more seriously on it. Actually there are very few sectors that do not require serious attention in Nigeria. What of education? What of security? They all need the full and undivided attention of stakeholders in each sector. But health deserves priority attention because it is a life and death affair. If the various governments invest substantial sums of money in improving the operating environment and in improving the welfare of the practitioners we should have a modern health care delivery system.
Part of the problem is that highly placed government officials who should focus attention on this sector like a laser beam are not really interested because they are entitled to free treatment abroad at government expense. If the hospital at the Aso Villa is dilapidated as we learnt sometime ago where do you then expect to find a hospital that does not have dilapidated facilities?