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Chukwunenye: Department-based training, instead of hospital-based may solve RTP crisis

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Consultant Obstetrician and Gynaecologist/Medical Director of Optimal Specialist Hospital Surulere, Lagos, Dr. Ugochukwu Celestine Chukwunenye, told CHUKWUMA MUANYA that in order to improve the participation of more private hospitals in Residency Training Programme (RTP), internship should be made to be department-based, instead of hospital-based.

Why is the Residency Training Programme a difficult thing now for many?
One of the changes that one expected in the last three years in the health sector is establishment of processes that would lead to accurate data collection and collation for meaningful dissemination and discussion. But alas, as the soldiers would say it, we are at a “stand still, no easy” situation. Some may even argue that we have lost more capacity, therefore deteriorating or retreating from target to use military parlance once again.

How many doctors are affected by the crisis?
It is difficult to give an accurate data on number of medical graduates in Nigeria because there is no officially published figure annually. There are 17 federal medical schools, 16 state medical schools and eight private medical schools in the country. Of these, 27 have full accreditation; five have partial accreditation, while the rest are yet to scale through the accreditation hurdle as at 2018. With the largest producing about 210 medical and dental graduates annually, and the medium-size schools producing about 100 medical graduates annually, and the small schools about 50 medical graduates annually, a figure of about 2,000 medical graduates is often quoted. The quota allocated to the 27 fully accredited medical and dental schools is 2,710 students, while the five with partial accreditation have a quota of 250 students allocated to them by the Medical and Dental Council of Nigeria (MDCN), making a grand total of 2,960 medical and dental students.

Now, it is assumed that a sizeable portion of these students may not make it through the medical and dental schools, but added to this number, are foreign medical graduates who return to the country annually to do their housemanship.

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Again, there is no hard data on the number of places available for the one-year housemanship programme but the MDCN has approved a total of 3, 129 places in the teaching hospitals (1,845), federal medical centres (456), general/specialist/military hospitals (691), and private hospitals (137) in the country.

Ordinarily, the number of approved places for internship should be able to absorb the current number of approved quota for the various medical schools. But before the present attempt at minimising the problem through admission quota rationalisation, medical schools were admitting and graduating larger numbers, leading to a huge backlog.

What is the solution?
The present affliction is caused by a paucity of funds (real, imagined or contrived) for the internship programme, especially at the teaching hospitals. Some of the hospitals are said to be admitting less than half of their approved quota for internship. As a result, the lucky few are severely overworked, breaking all the International Labour Organisation rules and regulations for workers. A few have died as a result, while many live with the trauma for the rest of their lives, not being able to overcome the psychological consequences of such a stressful work.

For a hospital to be approved for internship training, it must, among other requirements, have the essential four departments of Internal Medicine, General Surgery, Paediatrics, and Obstetrics and Gynecology, with a good flow of patients. The salaries of interns are varied and depend on the employer. The Health Ministry’s budget for internship each year has remained opaque.

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In the light of dwindling budget provision for health, what is needed is some thinking outside the box, instead of advising young medical graduates to abandon their dream of practising medicine for fashion design, hair styling, cobbler work, farming, fishing, cattle rearing etc, why then did they pass through the rigours of medical education? Our fashionable honourable minister has been quoted to deny making such a statement, and I am inclined to believing him. However, I wish he could take definite steps to solve this teething problem for our young doctors.

In order to improve the participation of more private hospitals, internship should be made to be department based, instead of hospital based. There are many private hospitals that have good departments in one or two of the specialty areas that can be assessed and approved for internship in those departments.

The Health Minister needs to look more closely at the budgetary provision for internship, and how it is being applied in various hospitals under his watch. A foundation in the banking, telecoms, oil and gas industries can be approached to help sponsor some interns annually, at least until this crisis is over. Where there is the will, there is always a way. A wise man cannot spend millions of naira training his wards only to allow some distant friends enjoy the fruits of the training and his hard work. Brain drain or drain brain must stop for our healthcare system to get better.


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