By Lara Adejoro
President of the Nigerian Association of Resident Doctors of Nigeria, Dr Emeka Orji, speaks with LARA ADEJORO on the United Kingdom’s code of practice for the international recruitment of health workers and the proposed bill compelling medical and dental graduates to serve for five years to earn a full licence
How will the UK’s recruitment policy for healthcare workers in Nigeria affect your members?
What we know about the policy is that the UK is trying to ensure that it will not be consciously targeting Nigerian health workers through organised exit platforms without interfacing with the government. It is not only Nigeria that is affected. Following the World Health Organisation report, there are other countries that are affected; countries that have severe manpower shortages in their health sector and the UK does not want to actively poach health workers in those countries. That does not prevent anybody or individuals applying to UK institutions from getting absorbed. You know that what used to happen was that some agencies of UK origin would come to Nigeria to organise recruitment processes.
What the UK is saying is that such institutionally organised recruitment processes may not happen again without discussing them with the Nigerian government. That is not going to stop anybody who wants to go to the UK. You also know that it is not only the UK that health workers go to. There are so many other options.
For us, it is actually quite unfortunate, and we just hope that the Nigerian government does not have a hand in this. We have always said that even if you are not happy with the manpower shortage and, at the same time, people are leaving, we can do what India did since it is obvious that health workers here are sought after. We are well-trained, and other countries are coming for us. Instead of stopping them (health workers) from migrating, the rate of production should simply be increased.
If you are producing like 3,000 doctors every year, you can increase to 6,000, invest in infrastructure, education, and health, and bring up more training institutions because when you do, these people go out there, they are still a source of foreign exchange for the country.
They acquire these skills, and many of them still come back and use the skills to take care of Nigerians.
I don’t see any reason any country will be making efforts to stop its people from going outside to work and acquiring more skills and acquiring forex for the country. I don’t see any reason any government will be working towards stopping that. What government should rather do is if it sees the brain affecting its manpower, then it simply increases production.
Do you think the Federal Government influenced the UK policy?
I remember that around last year, some members of the Medical and Dental Council of Nigeria went to the UK. They met with the officials of the General Medical Council, and there was this speculation that part of what they discussed was how they could prevail on the UK government through the GMC to stop poaching Nigerian health workers because of the massive brain drain we have.
When some of us came out in condemnation of that move, somehow it was quickly denied by some officials of the MDCN. I can’t confirm whether that is true, but a rumour like that sometimes ends up being true, and a few months down the line, you see the UK government come out with this policy of placing Nigeria on the red list. You can put one or two things together and make up your mind on what you think happened.
Have you received reports that some of your members who are processing travel to the UK through any recruitment agency are already affected by this policy?
We have not got reports of that, but that policy will not entirely stop health workers from moving to the UK. They will still be going there, but what they are trying to do is reduce the numbers.
But again, it is not only the UK that people go to.
There are also so many other places. People go to the USA, Canada, Australia, and Kuwait; So the UK policy is not going to stop the brain drain. What will stop the brain drain is when the Nigerian government improves on the level of care, the standard of practice, the remuneration, the environment, and security.
Even if the brain drain is still happening, you simply increase your level of production of health workers so that even if these people go out, you still have enough to take care of your people, and those who have gone out will be repatriating their foreign exchange to you, and some of them will still come back with the experience they have acquired.
Do Nigerian doctors go to the UK more than other countries?
We don’t have any studies in that regard. Many go to the UK; really, the UK is one of the choice destinations, but it is not the only one. I’ve not studied some of the data we have to show the percentage of those going to the UK versus those going to other places.
Why are you not in support of the bill stopping doctors’ migration since the bill is said to address brain drain?
The bill is not meant to address the brain drain. That is what the bill’s sponsors thought they were doing, but I believe there should be research behind every bill. Once you do not do research, you just end up bringing out a proposal that will ultimately embarrass the nation.
That proposal will quickly draw the attention of everybody. Even the figures quoted there are wrong. The NARD has over 10,000 members. We are the largest affiliate of the Nigerian Medical Association, but we also have the Medical and Dental Consultants of Nigeria, General Practitioners, and others.
Second, the sponsor said medical training was heavily subsidised, but that is a vague statement. We expect him to come up with figures and tell us the percentage of medical education the government is subsidising. That will help you to know what to propose as to how this subsidy will make the so-called people that benefit from it serve the nation. The lawmakers went all out to compare the tuition paid in Nigeria with that in the US.
So why don’t you compare the salary structure, the environment, the incentives, and the welfare packages in Nigeria and the US? You wonder what the tuition you pay here and the tuition they pay there are supposed to cover. We know that in public schools, students must pay tuition, but that is not all. There are so many levels of payment you make: you buy your textbooks and handouts, and you buy everything in addition to paying tuition. Is it the same thing abroad? The answer is no.
In private institutions, once you make that payment, they give you your book and a whole lot more. It’s when you get to the level of those details that you begin to know the facts of the subsidy you are talking about.
The other issue is, are you subsidising only medical students? We know that medical students pay the highest fees; is there any special subsidy they give to medical students that they don’t give to others? That is not true.
Again, you say that after you have been trained and have served the country for one year, your licence will not be given to you for five years. What exactly are you going to be doing in those five years without the licence? Do they want to create a pool of unlicensed doctors roaming the streets? What makes you a doctor is that license, so if they refuse to give it to you because they don’t want you to travel abroad, what are you going to be doing? Even if you succeed in keeping the medical doctors, have you really achieved anything? These people are still in the lower cadre. We are losing specialists and top medical personnel.
That is the challenge, but you want to keep those in the lower cadre.
This bill was not well researched, and people were not carried along. Nobody should tell us that they did not hold a public hearing because they did not waste taxpayers’ money to the extent that you read the bill a first and second time.
The bill should be about making the government give doctors housing and car loans. If you do that and someone has keyed into it, the person will not leave. If the government can improve the conditions, I bet you that nobody will want to go anywhere. People enjoy staying in their fatherland, but they are forced to leave when there is no effort or seriousness on the part of the government in addressing the issues.
They don’t mind being second-class citizens in those countries as long as they are in a good environment where their services are well appreciated and well-remunerated, and you have security, incentives, and equipment. There is no medical body in the country that was consulted about the bill. Even the doctors in the National Assembly were not consulted.
Have you written to the National Assembly about that?
We have sent a communiqué to the Speaker of the House of Representatives, and we are calling for an immediate and complete withdrawal of that bill. It doesn’t even have to go for a public hearing. It’s a waste of taxpayers’ money, and people will have to travel from different parts of the country to hear a bill that is dead on arrival.
There is no shortcut to the solution to brain drain. Everything is not about remuneration, but that is key. We have doctors who have worked for over 15 years, but they don’t have a house of their own. Equip the hospitals; we still have doctors on the street who have not been brought into the system because of the bureaucracy of the employment of government hospitals. Our state governors should also be aware of these responsibilities.
They should fund their teaching hospitals and their secondary health facilities.