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.
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.