Nigeria under producing medical doctors – MDCN

Is the council planning any innovations this year 2015?Three years back, computerisation came up. We have perfected it. We are being assisted by USAID. They are strengthening our computerisation and IT system, so now we can do almost everything online. Fresh doctors from university, going for housemanship, can register right from their medical school online. […]

Is the council planning any innovations this year 2015?
Three years back, computerisation came up. We have perfected it. We are being assisted by USAID. They are strengthening our computerisation and IT system, so now we can do almost everything online. Fresh doctors from university, going for housemanship, can register right from their medical school online. Those finishing their internship and preparing to go for youth service can also do their registration online. Other categories of registration, especially additional qualifications and those on temporary registration can do same.
That means you actually can tell the number of doctors and dentists registered in Nigeria.
On our master register, we have over 72,000, but this includes those that died, those who left this country, expatriates who left. The actual doctors practising within the country, we can only give an estimate. Those on ground might just be about 45,000. There are maybe 15000 to 20000 Nigerian doctors working outside. The list also includes expatriates who came and worked and went back to their countries, doctors who have exited or died. They are all part of the 72,000.

But this number is quite below the ratios WHO recommends for a country as big as Nigeria, why?
We are worried. Day in day out you find other nationals coming to work in this country, becaue the number we are producing is not enough. We produce 3,000 to 3,500 doctors annually and this not enough. Going by WHO recommendation of about one doctor to 600 patients, we have over 3,000 patients per doctor in this country. We need more and the current medical schools don’t have the capacity to add more quotas for training, the specialists on ground are not enough. You have one specialist going around two to three medical schools, trying to teach students.
 
Specialisation seems to be an issue, doctors these days don’t bother to specialize in particular fields. What’s your take on this?
Specialising in any field is another herculean task. A doctor, after medical school, does internship, youth service, then goes back for another five years minimum to specialise in something for only God knows how long. Some doctors are afraid. Instead some cut corners to go for some programmes maybe one or two years which doesn’t confer that specialist status on doctors.
You have doctors working with NGOs or private hospitals. Some may claim to be specialist because they have done a programme for one or two years, which actually doesn’t make them specialists. For you to be a specialist, you need a minimum five years, ten or even more of training. Doctors running away from specialisation is a matter of choice. What we need is basic doctors. To have more specialists is a plus for us.
We have three tiers of health system. Most of our primary health system is not well staffed, with inadequate facilities as well. A lot of things make doctors run away from specialisation. Not that they don’t specialise, they prefer to leave the country, specialise and remain abroad or look for greener pasture. The very few here are in tertiary health system. Coming down to secondary and primary, you don’t see specialists there. Why they run away from specialisation is best known to them.

Does these have any implication on the health system?
When you don’t have your own, you have to depend on others. By now, Nigeria  should have enough specialists if government is keen on this aspect. Government has to come in and make some incentives available. From the education sector, the ministry of education through the NUC, people should get scholarship to go for higher degrees or even abroad. If such project can be created for the health sector to sponsor doctors and other health professionals, I think we will improve on the status of specialists we have in this country.

How many universities are really accredited to offer medical programmes?
We have over 100—federal, state, private, faith based. We have 31 universities fully accredited to offer medical programmes, eight dental schools (all federal). Others are coming up, at various stages of accreditation.

Any improvement in health since the exhibition last year for hospitals?
Council was invited to look at the exhibition, with a view that allowing exhibition should not amount to advertising. In health, advertisement is against the ethics of the profession. Why we were there is to ensure showcasing does not amount to advertising as being the best in a field. Having this exhibition from time to time is good, and asking hospitals to merge to provide services is also good. We are not against it.

How will that help?
It is not limited to Nigeria. We have personnel who go abroad for such exhibition and bring back home equipment or facilities they need to improve in their hospitals. By such, the facilities compete healthily in improving services.

There have been acrimony among health professionals, degenerating to strikes. What’s your sense of the differences and what would you proffer as a lasting solution?
Acrimony is natural, whether expressed or not expressed. Each profession must know its level of competency, what the system expects. If everybody abides by that without rancour, each one limits himself to his own competence of training, once there is this respect for one another, I believe this acrimony will not continue. As long as people are not ready to respect each other, that’s when you continue to have this acrimony. Again, disparity in pay and welfare brings on this disharmony. If I train as a specialist, there are some benefits I stand to gain, compared with a generalist. These are issues others shouldn’t look at and become envious. Respect for others and respect for the tenets of your profession is key. Disharmony comes in because the values and ethics of the profession have gone down. If people should strictly adhere to the values and traditions of their various professions, honestly everyone would have respect for each other.

It has been said that paying health workers on the basis of number of patients attended to would improve care. Do you buy that?
That would mean privati-sation or commercialisation of services. Civil service is not built on pay as you go. Rules of engagement have to be reviewed. Even in US, UK where government allows consultancies to flourish, people from outside come to manage government businesses, not government itself doing the business. Your package depends on your input – man hour, the duty you are able to cover. If we are to introduce that kind of system here, people will become very busy and people who want to earn will justify the pay they are being given. If government wants to do it, I think it would involve a lot of review of the current system in the civil service.

But would it improve quality of care?
Sure. If you know that if I work for three hours continuously, this is what I earn or if I work for one hour what I get won’t be as much as three hours, people will sit up and give the best in them.

Is it something you are likely to recommend as a regulatory body?
It may not be within our purview. We are concerned with producing people that will do the job, quite different from delivering the job.

Has the tribunal seen increase of number of doctors facing it?
We have a number being prosecuted before the tribunal. They are on increase because people are becoming aware of their rights. In the past, people say a doctor is next to God, but people are becoming aware and that statement does not hold water. For anyone who errs, there is somewhere you can report that doctor and he will be thoroughly probed whether he is doing his job right or not. People know MDCN, what it does—it has a disciplinary body, an investigative police, a tribunal.