The House of Representatives is planning to curtail the migration of Nigerian-trained medical doctors until after five years of practice. This bill, which has passed its second reading in the lower chambers, aims to prevent brain drain as the number of medical doctors in the country continues to decline.
While there has been migration of medical personnel (doctors and nurses) to other countries such as the UK, the USA, and Canada, those that are in the country have been fighting for improved welfare, which has not yet come.
Compared to other countries, Nigerian doctors earn far less than their colleagues working in other countries. This, amongst other factors, has led to migration as doctors try to boost their incomes.
The Federal Government increased its minimum wages for workers in 2019. This increment trickled down to all categories of workers under its payroll, including medical doctors.
However, the amount paid to doctors is still a far cry compared to what is paid to counterparts in most of the countries Nigerian doctors migrate to.
Data from the Organization for Economic Cooperation and Development (OECD) show that most Nigerian doctors are in the United Kingdom, the United States, Canada, Ireland, and Germany.
Wages of Nigerian doctors
The salaries of medical doctors in the country have seen some increment over the years. Data from the National Salary, Income and Wages Commission (NSIWC) show that in 2019 a medical doctor at entry level (2/1) received NN1,812,600 ($5,911.94) per annum.
In 2010, doctors were paid N1,551,986 ($10,464.47) annually. In 2011 it was N1,562,586 ($10,292.36) annually, and N1,562,586 ($9,987.77) in 2014..
Comparison to other countries
Details show that salaries paid to medical doctors in Nigeria are far less than what those who migrated to other countries earn. Salary comparison in 2019, when the last minimum wage was effected, shows that Nigerian doctors’ annual salary was $5,912.
However, those in Canada received $75,460 the same year. In the US, it was $79,400, but $63,600 in the UK. in Germany, this was $143,500; $83,927 in France, and $70,386 in Italy.
These amounts increased in the subsequent years for the countries except in Nigeria where exchange rate fluctuations led to decline in real earnings.
Compared to what is attainable in other countries, the amount paid to doctors in Nigeria in 2019 was less than 10 percent of what those in other countries received.
Lingering issues with doctors in Nigeria
Medical doctors in Nigeria have embarked on industrial actions (strikes) several times to ventilate their demands in the last two decades. They carried out this action for 265 days between 2000 and 2021. The last was an indefinite strike in 2021, which was called off on October 6, 2021.
In 2022, the doctors threatened to go on strike again as they bemoaned the loss of over 150 nurses in a space of three years. They fought for salary increases, better working conditions and improved state of healthcare system in the country.
The National Association of Resident Doctors (NARD) protested inconsistencies in the new circular on an upward review of the Medical Residency Training Fund (MRTF), unpaid arrears of the new hazard allowance, failure to pay the skip arrears for 2014, 2015, and 2016, and failure to pay some of its members the minimum wage adjustment.
Other points of contention included the delay in the Consolidated Medical Salary Structure (CONMESS) upward review, payment of salary arrears of its members in state tertiary health institutions running into several months, including Abia, Imo, Ondo, Ekiti, and Gombe states, and lack of domestication of the Medical Residency Training Act (MRTA) in the majority of states across the country.
A medical practitioner with an international organisation, Dr Jeffrey Ajoko, said the lawmakers were taking a wrong step.
“I don’t think the lawmakers are going about it correctly. I believe the bill is an attempt to remedy the increasing shortage of doctors in the country, which is being worsened by their mass exodus in search of greener pastures. Instead, they should critically analyse the reasons why doctors are leaving and attempt to handle, if not all, then at least some,” he said.
Dr Ajoko highlighted the underfunding of the health sector and the lack of critical equipment needed for diagnosis and treatment. This, coupled with the poor remuneration of medical doctors (after factoring in the cost of living in the country), was affecting the sector negatively.
He said, “Seizing the license of doctors for five years will translate to forced labour and buttressing the fact that doctors’ welfare is totally neglected.”
A legal practitioner, Basil Hemba, said the legislators were going about it in a wrong way. He cited a similar instance where the Benue State Government established a scheme to provide medical personnel in rural areas.
He said the state government paid medical students in the clinical stage of their training but they were expected to work for the state government for at least two years after graduation.
“This was able to make doctors available for rural areas for some time,” he said.
However, an economist, Dr Dan Aladu, explained that while it was wrong to force medical doctors to stay for five years before leaving, doctors must understand that their subsidised education was also an investment and the state must demand the return on that investment.
“Education in Nigeria is subsidised, which means you have to give back when necessary. Doctors must not be leaving for greener pastures when they are highly needed, especially when their studies are subsidised,” he said.