On April 6, 2023, Nigeria’s House of Representatives announced that a bill to mandate fresh Nigerian-trained doctors to work for five years in the country had passed the second reading. The bill aims to stop the mass exodus of doctors from Nigeria. If the bill becomes law, this category of doctors will only get full licenses from the profession’s regulatory body after working for five years.
The seemingly nationalistic bill grossly violates sections 34 and 35 of the Nigerian constitution, guaranteeing Nigerians’ rights to dignity and personal liberty, respectively. Also, just like the ill-thought naira redesign policy, this proposed law portends enormous danger to Nigerians. It could catalyze the brain drain in the country’s health sector, negatively affecting healthcare access by over 200 million Nigerians.
Nigerian lawmakers must dump the enslaving bill. Civil Society Organizations (CSOs) should support Nigerian health workers opposing the bill. To lawfully and effectively address the mass exodus of health workers from Nigeria, the government must be willing to review and invest in sustaining the country’s healthcare systems.
From the current bill stage to amend medical and dental practice, Nigeria’s legislative framework requires the bill to go through a public hearing and a third reading. After this, it would need the Senate’s agreement before it gets to the president’s table for a final decision. These stages allow Nigerians to pressure lawmakers to do away with the bill before it becomes law.
Section 34 of the Nigerian constitution says: “Every individual is entitled to the dignity of their person. No person shall be subject to torture, slavery or be required to perform forced labour.” The amendment bill simply asks to force doctors to perform labour against their will. Section 35 of the same constitution gives every Nigerian citizen the right to personal liberty, including deciding where to render their services and how long they choose. Lawmakers of good conscience must reconsider the bill and thrash it.
Organized labour unions must not leave doctors to fight the unconstitutional bill proposition alone; labour unions like the Nigeria Labour Congress and CSOs must form a coalition with health practitioners’ bodies to pressure the legislature to dump the bill. Right from the public hearing, the alliance must burst the erroneous concoction that forms the bill’s basis. The argument by the Lagos House of Representatives member, Ganiyu Johnson, who is sponsoring the bill, on the reason for the emigration of health workers is inaccurate.
Indeed, Nigeria has witnessed a massive brain drain in its health sector, but the doctors are not to blame for this. Johnson’s argument that doctors are trained with taxpayers’ money and need to give back to their country is also weak and a cover to take away doctors’ liberty. The Medical and Dental Consultants Association of Nigeria (MDCAN) has faulted that argument.
MDCAN’s reaction to the bill explains that “The idea that Nigerian trained medical doctors received heavily subsidized education is pure fallacy. Tuition has remained part of the fees paid by every medical student, usually higher than that of nonmedical students in most universities. The fact that this amount is smaller relative to other countries – especially the developed countries – does not amount to subsidy, as every graduate who is lucky to get gainfully employed afterwards pays back by earning salaries far lower than their peers in developed countries.”
The reasons why doctors leave the country are a web of multiple factors. These reasons take root in the government’s poor investments in health systems. The fruit is the brain drain. Governments at all levels, including policymakers, must understand the situation’s complexity and be willing to act accordingly to fix it. A fire-brigade approach that stifles freedom will not solve the problem. Instead, it will worsen the situation.
If the bill scales through the legislation, it could institutionalize a five-year ‘work to gather money for migration’ syndrome amongst doctors. This way, doctors would only need to wait five years to emigrate. During forced labour, these doctors are not motivated to give their best, which can reflect poorly on the quality of services to patients.
The problem with the bill could start while it is still in the pipeline. The bill could trigger other non-doctor health workers to initiate and expedite a migration process. They will do that because they fear other unfavourable policies that the government may unleash next. Ultimately, health outcome worsens. Nigeria can lawfully fix these problems in sustainable ways.
From medical education and training to health infrastructures, the government must partner with private organizations like insurance banks, health-focused non-governmental organizations, international donors, and other corporate bodies to achieve sustainable sector financing. These partners can provide funding, in the form of loans or as their corporate social responsibility, to revamp the health sector.
Nigeria’s medical schools struggle to train students and resident doctors due to a lack of basic infrastructural facilities. The government must spend more on healthcare to show commitment and encourage investors and the private sector.
In 2022, state healthcare budgets declined from 11 percent in the previous year to 4.65 percent. Lagos State allocated 2.76 percent to healthcare that year. Nigeria can only build sustainable health systems with significant financial commitments to healthcare. With 5.75 percent going to healthcare, the sector got the biggest chunk of the 2023 federal government budget. It is not enough.
By 2050, Nigeria is projected to overtake the United States as the third most populous country. With 400 million people by that time, the country’s healthcare system will have to cater to twice the number of today’s patients.
To save Nigeria from terrible health outcomes in the present and in the future, the legislature must dump unfavourable policies that could increase the health sector’s brain drain. If legislators fail in their duty, the president must refuse to assent to the bill to avoid a violation of the Constitution.
David Adetula is a writing fellow at African Liberty.