The Nigerian Medical and Dental Council Needs New Policies to Protect its Junior Workforce -By Nzube Ifediba

It’s 2024. About four months since the gruesome death of Dr Vwaere Diaso, the house officer who fell ten floors in a faulty elevator at the General Hospital in Lagos Nigeria. Amidst the outcry on X and other social media channels, the Lagos chapter of the Nigerian Medical Association (NMA) set up a panel to investigate the cause of death. Four months later, the public has yet to receive information on the findings of the probe.

This event is against the backdrop of an unprecedented migration of health workers from Nigeria to the global North. Currently, an estimated 9000 have migrated out of Nigeria, with a projected 85% to migrate in the future. Unfortunately, Nigeria is among the 55 countries listed under the WHO workforce safeguard list, with a workforce that is below the median (49 per 10,000 population). The health workforce shortage in Nigeria has significantly hindered the achievement of health-related sustainable development goals. Nigeria, which contributes to the highest burden of HIV/AIDS has just under 2% of the global supply of doctors. Furthermore, universal health coverage, a core of which includes equitable access to health care in remote areas, remains elusive.

Underfunding of the health sector has remained a common reason for the health workforce shortage. In 2023, only 5.75% of the national budget was allocated to healthcare. Although this was a significant increase from the previous year’s budget, the allocated proportion was below the 15% recommended by the AU in the Abuja Declaration in 2001. Health workers in public facilities have a different story to tell. In a phone conversation with Dr Solomon Amadi, a previous president of the Association of Resident Doctors, University of Port Harcourt Teaching Hospital, Dr Amadi who has experienced two labour strikes in his tenure, and a total of five labour strikes from 2020 to 2023, insisted that although the government allude their inability to meet their requirements to a shortage of funds, corruption and lack of government commitment and political will are stronger reasons. He concluded by saying “The reasons for these strikes persist and I can tell you that we may still go on strike next year.”

It would seem that there is no end in sight to the chronicity of underfunding of the health sector. The current economic landscape in Nigeria makes it unlikely that 15% of the national budget will be allocated to it. Currently, stakeholders have urged the president to include the health sector in the supplementary budget in which areas like security and social packages for the indigent were prioritised.

With these in mind, the medical council and medical associations in Nigeria cannot sit and watch as doctors continue to emigrate, and sweep every action under the rug of “underfunding from the government.” There is a need for internal policies to protect the health workforce, particularly the junior workforce who make up a significant portion of the migrating health workforce.

The one-year mandatory housemanship program is more than just a season for training entry-level medical doctors. It is a season when convictions about career trajectories are solidified. According to the Medical and Dental Council of Nigeria, house officers are not permitted to engage in labour actions and strikes. The argument is that strikes can disrupt the flow of clinical rotations and affect the quality of training. While this argument seems logical, it has created a loophole for exploitation where junior doctors are overworked, underpaid, and disregarded with no chance of voicing their complaints.

My time as a junior doctor at the University of Port Harcourt Teaching Hospital Nigeria was a nightmare. Apart from working long hours to make up for our grossly understaffed numbers, apart from going through the mental torture of late salaries, and at one point, considering holding placards like our colleagues at RSUTH who had to take to the streets to protest unpaid salaries, I had to deal with, on many occasions, the outright disregard from senior colleagues.

A house officer is at the bottom of the medical totem pole, and as with most apprenticeship styles of training, is often subjected to all sorts of undignified situations. I was made to run mundane errands during my training: from picking up food from the canteen to running errands for patients to buying snacks to ironing ward coats. On a particular occasion, after collecting permission from a consultant to rush off to the bank to resolve an issue regarding my long-awaited salary, I received a call from my registrar who was screaming on the other end of the call, where was I? She needed me to pick up her shoes from her car. It was then I decided that I would have nothing to do with the residency program in Nigeria, no amount of training was worth the attacks on my dignity.

I wasn’t the only house officer going through this treatment. It was a common thing then for house officers to congregate on our various Whatsapp groups, lamenting our lots. We couldn’t protest in any way, any protest would be an avenue for the dreaded extension. It was common consensus then that the quicker you finished your house job and got out of the system, the better.

Considering the circumstances behind Dr Vwaere Diaso’s death. One, the faulty elevator was located in the house officers’ quarters. Two, the elevator had been faulty for about four years and nothing was done. And three, three months later, the public is yet to know the outcome of the probe. Could this be a sign of a greater problem? For example, a lack of regard for the significance and importance of junior staff? Would the elevator be fixed in time if house officers had gone on protracted labour strikes at the General Hospital? Would the results of the probe be out if house officers had protested and led demonstrations?

I do not in any way absolve the federal government of its lack of political will and commitment to the health sector. But as much as we want to point fingers, we must also look inward and see the fault lines within our rigid and hierarchical style of training, and open up to other training styles that foster mutual trust and respect.

The Medical and Dental Council of Nigeria (MDCN), as a matter of urgency, should implement policies that protect the junior health workforce. Consideration must be given to teaching methods that humiliate, stifle, and shun junior doctors into silence. Junior doctors should be confident in their ability to express their concerns without any fear of intimidation and extensions. As a matter of urgency, the NMA Lagos chapter should inform the public of the results of their probe concerning the death of Dr Vwaere Diaso.