Olaopa: Most Nigerian hospitals don’t meet international set standards for RTP

President of the National Association of Resident Doctors of Nigeria (NARD), Dr. Olusegun Olaopa, in this interview with CHUKWUMA MUANYA said there is no hospital in Nigeria today that meets international set standard for residency programme.

• We Have Less Than 11, 000 Specialists For A Population Of 180m
• Govt Should Motivate Doctors Who Chose To Dedicate Themselves To Specialist Care

What informed the Residency Training Programme?
The Residency Training Programme (RTP) is a structured, institution-based, competency training programme for doctors and dentists who have acquired a basic medical or dental degree (MBBS/BDS). On completion of the programme that takes at least additional six years post-NYSC, such specialists are awarded the fellowship of a postgraduate medical college, and are appointable as consultants in their respective specialties. After the mandatory NYSC, medical doctors and dentists can chose two broad career paths- residency programme or career in the civil service. Some, however, decide to pursue private practice or chose a vocation in other fields of human endeavor.

Prior to 1966, all professional postgraduate medical trainings for Nigerians took place overseas. In 1966, then Registrar of the Nigerian Medical Council (NMC) Dr. J. O Mabayoje came up with the idea of starting postgraduate medical training in the country, by establishing a National Postgraduate Medical College, following wide consultations with other medical specialists. This was followed by the development of a curriculum for postgraduate training of doctors and dentists on behalf of the NMC. In 1969, the conduct of postgraduate medical examination was promulgated by Decree 44 for the award of fellowship and diplomas. Following this, the Nigerian Medical Council Postgraduate Medical Examination Regulations and Syllabus was published in 1970.

Residency training programme as offered by the NMC moved through various stages and by conscientiousness of notable individuals like Dr. J. O. Mabayoje, and Prof. E. A. Elebute, it climaxed in the establishment of the National Postgraduate Medical College of Nigeria, by a Decree 67 of September 24, 1979, under General Olusegun Obasanjo.

Though the first Part One Fellowship Examination was conducted in 1973 for candidates in Internal Medicine, Decree 67 of 1979 gave legal backing to the training programme. Along the line, there was establishment of the West African Postgraduate Medical College ratified by a treaty at the Assembly of West African Health Ministers on October 25, 1978. This college mothered the West African Colleges of Physicians and Surgeons (WACP and WACS). These colleges have been the industry that produces medical and dental specialists in the West African sub-region and Nigeria in particular.

Currently, the Medical Residency Training Act, 2018 assented by President Muhammadu Buhari, GCFR in May 2018 is expected to provide the legislative framework for the regulation of this specialist programme.

Why are there not enough spaces to accommodate applicants for RTP?
There are about 41 medical schools with an average of 2,500 graduates of medicine and dentistry yearly in Nigeria. In addition to this, some Nigerians undertake their medical and dental training in foreign universities in the Carribeans, former Soviet Union, India, Europe to mention a few. Nigeria’s population, which is projected at about 180 million, has less than 40, 000 practising medical doctors and dental surgeons. With the World Health Organisation (WHO) recommended 1:600 doctor-to-patient ratio, Nigeria with a physician-patient ratio of 0.4:1000 (Fasola and Fasola), has a long way to go in meeting international standard recommendation in providing adequate medical care for the teeming masses.

Why are more doctors still leaving the country despite the huge shortage in specialists required?
Ironically, doctors’ emigration has drastically increased over the last decade thereby worsening the trend. About 80 per cent of the number of doctors produced yearly are pursuing greener pastures in other places across the globe, and more than 50 per cent of those in this category are successful at their emigration plans within the first 10 years of practice. While many emigrated doctors continue medical practice, after taking qualifying examinations in these countries, over 60 per cent abandon the practice altogether for other vocations and/or professions.

The question arises if basic medical degrees are sufficient to meet the constantly emerging medical problems not only in Nigeria, but also across the globe. The answer is no. The medical residency training is designed to fill the gaps in knowledge by producing experts in various fields of medicine such as cardiology, neurosurgery, oral and maxillofacial surgery, public health, obstetrics and gynaecology, psychiatry, orthodontics to mention a few.

Currently, Nigeria has less than 11, 000 of these specialists to serve millions of Nigerians that require advanced medical needs and research. While these specialists are stacked mostly in tertiary health institutions, a good number of them are also abandoning medical practice for other vocations in Europe and Americas.

Nigeria has about 73 federal and state tertiary and secondary institutions, where various levels of training are ongoing, whether full or partial. Any institution that offers such advanced medical skill training is expected not only to have state-of-the-art facilities that use evolving technologies, but also specialists/consultants manpower that are competent to handle complex medical situations, while providing mentorship for the doctors, who in addition to providing clinical services and research, are also committed to advanced training. The situation in many training institution in Nigeria is that most of these institution even lack basic requirements that meet international standard.

There is no hospital in Nigeria today that meets international set standard for residency programme. Postgraduate medical colleges struggle through day-to-day conduct of activities because of no funding of training colleges and accredited hospitals. Worse still, the government seems to have turned blind eye to this tragedy. The major challenge with training of specialists in Nigeria therefore, is the will of the political elites in defining and treating the health of the people as essential social service, which everyone is entitled to. The few institutions where residency training is taking place are poorly equipped like mere consulting clinics and doctors, staff are poorly motivated. Even for services rendered, doctors are poorly paid and often owed months of salaries for clinical services rendered.

Residency programme is poorly-funded by the government and facilities in these hospitals are outdated. Since the current system is grossly inadequate to meet full requirement of such intense training, government has been advised to re-activate the overseas six-month to one-year sandwich programme, while upgrading existing facilities with the establishment of regional centre of medical excellence in different geo-political zones of the country. With proper funding and judicious spending, expanded and improved facilities, better remuneration and transparency, more doctors will be absorbed into the programme and they will also be motivated to undertake the rigours of the residency programme.