Being a doctor in Nigeria: Challenges and opportunities for change

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Over the past few years, there have been many anecdotal reports about the challenges that doctors and by extension, other health workers face working in Nigeria. Most Nigerians are familiar with the lack of equipment, the heavy workload, the absence of opportunities for development and poor infrastructure that can be seen in the health sector.

Less widely appreciated are some of the specific challenges that individual doctors face in training and achieving their career goals.

This week, a Twitter user who has chosen to remain anonymous, in a series of tweets told the story of her brother, who is a doctor. Her tweets caught the attention of Nigerian Twitter, and of Nigeria Health Watch as well. In the process of her candid outburst, she highlighted several pertinent issues that we believe merit further attention.

From spending 7 years in medical school, often extended by the disruptive frequent strikes that we have decried in previous posts to the difficulty in finding places to complete the compulsory one year housemanship programme within two years of graduation, the lot of the new Nigerian doctor is not an easy one.

The numerous challenges that doctors face in Nigeria often result in them seeking for greener pastures elsewhere. Source: mscorp.blob.core.windows.net

Then after NYSC, the compulsory one year of national service mandated for every Nigerian graduate, there is the challenge of finding a job, often driven by the paradox that jobs for doctors, in a country that has not met the recommended WHO density of doctors, nurses and midwives can be hard to find. Part of this is probably because of the concentration of health workers in urban areas, but whatever the explanation, the effect is that we often have unemployed doctors looking for work. Even setting up on your own clinic is a challenge because of the cost of equipment, rent and other expenses, unless you choose to cut corners, which some do.

For many doctors, the pinnacle of their career is completing a specialist training programme or residency, to qualify as a specialist. Getting into one of these programmes is again another mountain for the contemporary Nigerian doctor to climb. There is the cost of the qualifying primary examinations and study materials to grapple with, as well as the high failure rate in these examinations.

If the young doctor manages to cross these hurdles, there is the challenge of finding a place in an accredited hospital to complete the programme. Again, these programmes are challenging to complete on schedule because of the aforementioned frequent strikes, the lack of quality educational materials, the high examination failure rates, and the challenge of studying for the examinations while also trying to make ends meet financially. These programmes often take up to five or more years to complete.

At the end of the journey, as a qualified specialist, there is the challenge of finding a consultant job. If this hurdle is again cleared, there are then the challenges of working in an under-resourced health facility, where patients can often not afford treatment, even in the public facilities, compounded by poor work environments and poor management.

It is little surprise that there are more and more anecdotal reports of doctors choosing to leave Nigeria to work elsewhere.

Some of the questions that come to mind reading these tweets are:

  • How can the issue of frequent strikes in the health and education sectors be addressed?
  • How can the process of appointment to house officer programmes be improved? Do we need a centralised system that is transparent and works better at matching candidates to opportunities? Is there a role for a tech solution here?
  • How can we incentivise health workers to make working in the rural areas and poorly resourced parts of the country more attractive? The Midwife Service and SURE-P MCH Schemes achieved some success in this area but appear to both have been discontinued. Are there lessons to be learned from these programmes?
  • How can the process of applying to specialist training be improved? Can there be innovative ways of financing the initial costs? Can there be tech solutions to make the educational materials more easily available and cheaper?
  • Are the high failure rates in the specialist training programmes justified? Are the colleges conducting audits to understand why the failure rates are so high and are they doing anything to address this?
  • Are we doing enough in working out how many doctors or specialists each health facility needs and aligning this to the training places available?
  • Can the process of appointment of consultants and indeed all health workers be more transparent, and better aligned to the needs of each facility, and the outcomes expected?
  • How can we improve the working conditions for our health workers, to improve retention?

These are weighty questions, but ones that we need to address urgently, if we are to buoy the morale of health workers and retain them in the system. If you have an idea or an answer to some of these questions, we would love to hear from you.

Although this piece has focused on doctors, many of these issues resonate across cadres within the health system.

In our work across the country, although there are many challenges and some poor practices, we have also been impressed by the many Nigerian doctors, nurses and other health workers, who continue, against all odds, to try to deliver good care to their patients. We need to do more to support them, while tackling poor practice wherever it is found.

Are you a doctor, nurse, midwife, lab scientist or other health personnel working in Nigeria? We would love to hear your story of both the challenges and the rewards of working in the Nigerian health sector. Tweet at us or comment on Facebook using the hashtag #BeingADoctorInNigeria. Let us begin a conversation that will hopefully give birth to solutions for our health sector.

We have reproduced the original tweets with permission here to preserve the anonymity of the author.

Discussion5 Comments

  1. How so true this account of the challenges doctors face is.I can sincerely relate with what this writer has written because i am a doctor who trained in a Nigerian University and everything she said i went through and probably much more.I spent 10 years in undergrad school to qualify as a medical doctor.This was largely as a result of the incessant strikes in the university as at the time.we lost two years to strike and to make matters worse i also lost two additional years on my account.(had academic issues).I graduated,had my mandatory housemanship and NYSC and i thought i was ready to conquer the world,but alas it was not to be.I passed my primary exams almost immediately but had to wait another 7 years to get a space for my post-graduate residency training in the specialty of my interest.The system is still very hostile as it continues to get stricter and more difficult.The rules get changed every now and then and the fees for the exams continue to increase at astronomical rates that one begins to wonder whether it was worth it after all. We can make things better if we chose to and this is a call to all and sundry to put the interest of all concerned when it comes to decisions that concerns all.Let the greatest good for the greatest number be our watch word and not trying to make things difficult for the sake of making things difficult for the other person because you have crossed that hurdle.My personal philosophy after having faced all this challenge is that “i will always make things better than i met it” and seriously i mean this.Thank you.

  2. I see the problems of the health sector in Nigeria as enumerated in this article as part of the rottenness of the Nigerian society. Aside the lack of infrastructur and opportunities in the health sector, which need not be so if we were a people who can manage our affairs (why can’t all general hospitals and specialist hospitals in every state in the country be training centres for interns and residents? Why?), the relationship between medical students/residents and their teachers and examiners is near zero. Too many medical teachers, lecturers, and examiners do not see their students and residents as human beings but as “accursed creatures” who should not become doctors or specialists. These teachers, lecturers, and examiners see themselves as LORDS, DEITIES, and GODS who must punish their students by ensuring they fail their examinations, rather than ensuring their students pass examinations. In fact, I can say they derive joy, perhaps sexual satisfaction (could it be a form of sexual perversion), to see their students fail. When and how this tradition crept into the medical education in Nigeria I do not yet know.

    • We do not like to tell ourselves the truth—the hard truth. We prefer image laundering to facing reality. So, to briefly comment on the problems of the health sector in Nigeria as enumerated in the tweets:
      The problems are reflections of the general Nigerian society. If we were a people who know how to manage our affairs every general and specialist hospital in every state in the country will be equipped to train interns and residents. And if cottage hospitals and PHC’s are well equipped, no doctor will look for work in the country. The same is true for other heath workers.
      The failure rates of both medical students and residents in their examinations will drastically reduce when the teachers, lecturers, and examiners do not see themselves as lords or gods but as teachers whose duty is to ensure every student passes his/her examination. No one who rightly gains admission into a medical school is a ‘block head’ that cannot pass medical examinations. It is the teachers and examiners who ‘make the students/residents block heads’ because they do not want the students/residents to pass the examinations.

  3. What I can say here is not different. The difficulties we are facing in the field is poor working conditions especially in the rural areas where social amenities are lacking. I am working in the rural clinic and I have to sometimes use my pocket to do somethings. But unfortunately government are given effort to most at the urban centers forgotten that most of them (government official ) are from villages and their families, parents and relatives are living there.

  4. While it is easy to blame the “Nigerian Society” or the government, we should also remember that the systems for assessing and accrediting medical doctors were created by doctors and are still managed by doctors. Thus, the power for reform rests entirely with them. The question is: are they willing or interested in reform or improvement?

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