•Medical associations kick
• Residents doctors, colleagues abroad condemn House of Reps move
• Say bill puerile, not well researched
By Cosmas Omegoh
On April 6, this year, Nigeria’s lower legislative chamber, the House of Representatives, triggered an outrage.
The House tabled for a second reading, a bill banning doctors fresh from the Nigerian universities from going abroad to practise medicine immediately after leaving school.
If the bill becomes law, only doctors who have practised for five years in the country will be given licences and allowed to practise overseas. 
Since the content of the bill became public knowledge, doctors and their unions have been lambasting the House of Representatives for the move.
Tempers have been flying, with the doctors vehement that the legislators are grossly ill informed to contemplate such a law, thus picking holes in it, and vowing to stop the legislators on their track.
Johnson’s controversial bill
The proposal is: “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 Practice in Nigeria for a Minimum of Five Years Before Granted a Full License by the Council in Order to Make Quality Health Services Available to Nigeria; and for Related Matters.”
The bill’s promoter is Ganiyu Johnson, All Progressives Congress (APC) member representing Lagos State. He believes when passed into law, it will check young Nigeria doctors from streaming abroad. 
Hear his argument: “Nigeria currently has only 24,000 licensed medical doctors available in the country, less than 10 per cent of the number needed to meet the World Health Organisation recommendation. “According to the President of the Nigerian Medical Association, Dr Uche Rowland Ojinmah, Nigeria requires a mix of 23 doctors, nurses and midwives per 10,000 health services, according to the WHO.”
He quoted Dr Ojinmah as regretting that “a large number of Nigerian doctors emigrated to seek greener pastures in developed countries, noting that 5,600 of them have migrated to the United Kingdom in the last eight years.
“Now, only one doctor is available to treat 30,000 patients in some southern states, while in the North, it is one doctor to 45,000 patients.”
To further buttress his argument, Johnson compared the fees paid in UK and other countries’ universities on the one side, to what is paid in Nigerian universities, concluding that tuition fees in Nigeria’s public medical schools was highly subsidised.
Johnson then went on to say that the tuition fees payable to study Medicine in UK stood ranged between £35,750 and £66,500 annually for four years. Quoting the National Centre for Education Statistics, he recalled that in the United States, to study Medicine, one had to pay between $82,000 and $104,000, adding that in Canada, the tuition fees for Medicine ranged between 52,000 CAD to 169,000 CAD.
Then drawing a final line he said: “But contrary to all these bogus Medicine tuitions in the aforementioned foreign countries, in Nigeria, the cost of studying Medicine in public institutions ranges from N40,000 to N150,000. Therefore, you will all agree with me that medical and dental education in Nigeria is seriously subsidised.
“Despite this subsidy in medical and dental’s education, Nigeria still suffers emigration of trained medical doctors and dentists into the hands of these foreign countries, which an average Nigerian can hardly afford for medical training.
“With the latest mass relocation of trained doctors in Nigeria to the UK, the doctors- patient ratio might become worse, leading to an overstretch of the already limited medical doctors workforce. This might push even more doctors to join their colleagues in a more favourable working environment, resulting in further losses to Nigeria.
“It has also been observed that foreign embassies in Nigeria, particularly those of Britain, the United States, and Saudi Arabia receive on a weekly basis, 20 to 25 verification requests from Nigerian doctors wishing to migrate abroad. This translates into about 1,196 applications a year, while Nigerian people whose resources are being used to subsidise the medical and dental education in Nigeria to train doctors and dentists still suffer from poor health services due to the migration of our doctors and dentists. This is a clear cheat on the Nigerian people.”
Concluding, Johnson said: “In view of the foregoing, this bill, if considered and passed by this Green Chamber, (it) will not only bring about the necessary social justice to the Nigerian people, but also improve the health services available to Nigerians, because Nigerians will be able to enjoy the service of the medical doctors and dentists who were able to get trained through their resources, at least, for the period of five years here proposed before migrating abroad.”
NMA blasts NASS
Expectedly, angry reactions have continued to trail the bill after it was read the second time on the floor of the Green Chamber.
NMA President, Dr Ojinmah while flaying the National Assembly, expressed surprise that “it is now that they have realised that doctors are important. That has become obvious. They can no longer pretend; they can no longer play the ostrich.
“Before now, they were seeing the doctors as abnormal citizens, abnormal professionals, who should stay out there and suffer. It has now dawned on them that the doctors are important.”
Then, he asked: “But is that the right response they should give? No! That cannot solve the problem. The question is: why are the doctors leaving; why are they going for greener pastures?”
His solution to the debacle is simply. “They should make the pastures at home green; that is simple! Pay health workers well; pay doctors something commensurate to international standards.
“Secondly, there is no security of life and property here. That is another reason doctors are leaving; it is not all about money alone.
“A doctor was kidnapped on December 29, 2022. Now, he has not been found. And you think some other doctors will remain here?”
Earlier, the NMA had lamented the murder of one its members Dr Iluobe on December 31, 2022, allegedly by relatives of his patient who passed on at Oghara, Delta State.
In a statement NMA said that while it sympathised with the relatives of the dead patient, killing the doctor could never be justifiable.
“Pain we feel. A man should not be murdered for the selfless act of being on duty on a New Year’s eve,” it said.
Dr Ojinmah also tried to highlight other problems he claimed the government had neglected to address.
“We are also talking about provision of equipment and a comfortable working environment for health workers.
“They should as well stop the unnecessary health sector workers’ rivalry by government actions and inactions. This should be curtailed immediately so that doctors would appreciate their importance and be able to give their best.”
Then hitting the politicians where it mattered, he asked: “Now, why don’t they also make a law against politicians going for medical tourism? Is it not our money that these politicians are spending abroad to treat themselves, while we have hospitals that are in dilapidated conditions?
“I think that the politicians should take it easy. Their actions contradict the principles of justice and good conscience – to force someone to sit back and work for you under very terrible conditions? It doesn’t work that way.”
While further faulting the bill, he said: “One other mistake they made is that they did not notice that more people go to private universities these days. Are they also going to bar those ones from leaving Nigeria?
“What are they legislating? It (the bill becoming law) will not happen and will not work in my time.”
Bill attempt to enslave doctors – NARD
Similarly, the President, National Association of Resident Doctors (NARD), Dr Innocent Orji, faulted the proposed medical bill.
He said: “We consider it outlandish and an attempt to enslave the doctors. We consider the bill a total affront to the Nigerian constitution and the laws that guarantee freedom of movement and mobility of labour. The truth is that the idea behind the bill is understandable, but the bill itself is questionable.
“We believe that the honourable members didn’t do enough research before coming up with the bill. There is research behind every bill; but once you miss that point, you will end up presenting to the public, a bill that is mundane.
“If you look at that bill critically, most of the data quoted were wrong.
“Johnson said we have 10,000 doctors in Nigeria; that is false. He said medical education in Nigeria is subsidised, but to what extent, he didn’t say.
“Before you bring up such a bill, you have to be scientific.
“Is it only medical education that is subsidised? Is there any special subsidy that is given to medical students? The answer is no. In reality, medical students pay higher than other students in Nigerian universities. You cannot just begin to do a simplistic comparism.
“He placed our tuitions side by side with what they pay in USA or in private schools without taking into account what the payments are actually meant for.
“We know that in some institutions, this payment is composite. When you pay, they give you textbooks and all that, but after what we pay in Nigerian public schools you still go ahead to buy your own text books and all that. You pay for your hand out; we don’t have Internet facilities. But in private schools, the payment might cover that. So, it is too simplistic to make that kind of comparism.
“The other issue is that he said that when doctors are qualified, they are not going to give them their licenses until five years. Now, the question is within those five years, what are they exactly going to be doing. Or do they want to create a pool of unregistered doctors roaming the streets?
“We have always said that there is no ad hoc solution to curtailing this challenge. We have told the government what to do; we have said it severally that for the government to solve this problem, they must carry the people involved along. If they don’t do that, they will make a grievous mistake just like the honourable member has made.”
Dr Orji then brought down the sledge hammer: “We are totally condemning that bill. We are demanding that it be withdrawn. There is no need for it to proceed to public hearing because that will be a waste of tax payers’ money. You don’t need to gather people in Abuja to start debating on something that is obviously faulty.”
Then turning to Johnson, he said: “He is a Nigerian and I’m sure that he is watching the global outrage against that bill. Even the world medical association has condemned it in its entirely.
“There is no need grandstanding or doubling down on the wrong pathway. He should quickly withdraw the bill, and then go back to the drawing board.”
To the government, he said: “Go back to the issues we raised so that when you take care of them, this issue of brain drain will be reduced. The government should take care of remuneration; pay people well. You cannot just be paying people what you have been paying them in the past 10 years and expect them to stay.”
He also harped on other challenges. “Improve on the infrastructure; the working environment and security. Think deeply and bring up incentives that will encourage health workers to stay and work. As long as you don’t do that, you will continue having brain drain.”
NARD in a recent communiqué at the end of its emergency extended National Officers Committee (NOC) meeting condemned the bill proposed by Johnson, describing it as modern day slavery.
It said: “The extended NOC observed with shock and disappointment, the
infuriating attempts by Hon Ganiyu Abiodun Johnson and the Federal House of Representatives to enslave Nigerian-trained Medical Doctors for five years post-graduation before they can be issued full
practising licenses or allowed to travel abroad if they so wished.”
As a part of it resolution, NARD’s NOC “admonishes the Federal House of Representatives that the obnoxious bill as sponsored by Hon. Ganiyu Johnson is a clear definition of modern-day slavery and not in keeping with anything civil and so should be thrown away at this point.
“The House, however, agreed
with him (Johnson) on the palpable dangers of the current menace of brain drain
in the health sector and promises to work with the government to
reverse the trend when the government is ready to come up with genuine solutions to the problem.”
NARD warned that “the extended NOC reiterates that any attempt by the government or any of her agencies to enslave Nigerian medical doctors under any
guise would be strongly and vehemently resisted by the association.”
NARD’s boss, Dr Orji, disclosed that the body had officially tasked the House of Representatives to withdraw the bill saying: “We have done that through an official statement which has been delivered to the Speaker of House of Reps. We are watching what they will do; we are also having our national emergency meeting in two weeks time. We are hoping that by then, that bill would have been withdrawn. We are waiting on our members and hoping that any directive they give us we will carry out.”
Diaspora doctors too kick
Similarly, Nigerian doctors under the umbrella of Diaspora Medical Associations (DMA) have written a protest letter to the Speaker of the House Representatives and even the Senate, urging them to stand down the bill.
The title of the letter is “Re: A Position Statement from Diaspora Medical Association – Bill Seeking To Restrict Newly Qualified Medical Doctors And Dentists from Leaving Nigeria.”
The letter was signed by leaders of Nigerian doctors practising in different countries around the world. They include Dr Al Amin Dahiru, president, Nigerian Medical Association-Germany (NMA-Germany); Dr Emeka Ugwu, president, Nigerian Doctors’ Forum, South Africa (NDF-SA); Dr Chinyere Anyaogu, president, Association of Nigerian Physicians in the Americas (ANPA); Dr Chris Agbo, president, Medical Association of Nigerians Across Great Britain (MANSAG) and Dr Nnamdi Ndubuka, president, Canadian Association of Nigerian Physicians and Dentists (CANPAD), among others. They condemned the Johnson bill, insisting that it would be counterproductive.
The letter read in part: “The Diaspora Medical Associations have observed with keen interest, the ongoing deliberations in the Green Chambers of the National Assembly regarding the proposed bill sponsored by Hon. Ganiyu Johnson,
to mandate any Nigerian-trained medical and dental practitioners to practise in Nigeria for a minimum of five years before being granted a full license by the Council.
“The bill which purportedly seeks a way to
address the adverse effects of brain drain, may not be the most effective intervention to resolve the situation. It will be counterproductive and will not achieve its intended goal.
“We recognise the problems posed by the exodus of Nigerian medical professionals from our health system including, but not limited to decreased access to health care services, lack of quality of care, care delivery deserts, the inability to adequately enact healthcare and public health policy due to lack of manpower and
leadership resource.
“The medical or dental practitioner is the glue that keeps the team functional and the leading force for an effective health care delivery system. Similarly, the medical and dental professional bears the burden for systemic failures resulting in the maladaptive structure fostering stress, undue
burden, physical and mental anguish, lack of job satisfaction, poor working conditions and much more.
“The major cause of brain drain includes a poor care delivery framework from a failure to invest in the healthcare to foster a conducive environment. The system does not promote professionalism, growth,
work satisfaction nor a high reliability culture. Other major drivers include very poor welfare packages, high level of insecurity, limited opportunities for employment, sub-specialty training, socio-political and economic instability. The majority of these issues stem from outside healthcare system and are outside
of an individual’s control. Indeed, good governance and commitment to future investment in healthcare would improve conditions in the country that will allow security, good education for children, improved compensation, as described in the Abuja Declaration.
“The migration of professionals is not limited to the medical and dental practitioners alone. So, the question is why is the medical and dental profession being targeted? Focusing on one aspect of a problem without taking a holistic approach to a sustainable solution will be ineffective.
“Young professionals leave the country in search of better opportunities. Many are frustrated by the consequences of governance failures that have progressively worsened over the past 30 years. The unfortunate reality is the healthcare
system is in a state of serious neglect, training and career development opportunities are limited further
impairing earning potential. Insecurity is rampant. Equity and justice are lacking for the average Nigerian.”
The body then told Speaker Femi Gbajabiamila: “We look up to your leadership in embracing the purposeful systemic solution and ensuring that a ‘quick fix’ attempt does not worsen the situation. We in Diaspora, support the position statements from other stakeholders, including Medical and Dental Consultants’ Association of Nigeria (MDCAN), Nigerian Medical Association (NMA), National Association of Government General Medical and Dental Practitioners (NAGGMDP), and Nigerian Medical Students Association (NiMSA).
“We will continue to support positive changes and growth of our health sector, in all spheres and look forward to engaging with Hon. Abiodun Ganiyu Johnson and other members of the National Assembly in doing the serious work necessary to stop and reverse the brain drain. Diaspora healthcare workers would be willing to return to Nigeria if an enabling environment exists – reversing the trend and helping to solve the problem.”