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Non-payment of salaries and it’s consequences

Photo by Orzalaga via Pixabay

The plight of Nigerian Doctors

Image by Eve Otoadese for The Circular

“I was being paid less than 200k naira ($174) a month, sometimes I didn’t get pay for 3 to 8 months but had to keep working and relying on my side hustles, until I would get paid everything I was owed at once but that was after months of protest and weeks of strike’’.

Doctor Esosa Osamwonyi

Doctors are facing a severe crisis as they continue to work without receiving salaries for months, sometimes even years. This has resulted in a mass exodus of doctors from the country, leaving the healthcare system in a dire state, situating in a devastating impact on both doctors and patients.

For years, Nigerian doctors have been fighting an uphill battle against a system that consistently fails to pay their salaries on time, if at all. This issue has reached a critical point, with many doctors going months without pay and often going on strike and protests.

Frustrated and disillusioned, many doctors are seeking opportunities abroad where they can practice medicine without the constant threat of financial insecurity. According to a recent report between 15,000 and 16,000 doctors have left Nigeria in the last five years, Muhammad Ali Pate, the Nigerian minister of health and social welfare revealed.

The Development Research and Project Centre (dRPC) has data indicating that in 2015, 233 Nigerian doctors immigrated to the UK; in 2016, that number rose to 279; in 2017, that figure was 475; in 2018, that figure increased to 852; in 2019, that figure soared to 1,347; in 2020, that figure was 833; and in 2021, that figure was 932. The NHS work force statistics June 2023 reports 22,851 Nigerians employed by the NHS

Speaking with Doctor Esosa Osamwonyi, a 42-year-oldNigerian Doctor and former assistant state immunisation officer for the Edo State Ministry of Health who is now working as a G.P registrar at Health Education England, he recalled his journey to England and the toll it took on his family as he expressed heart felt well wishes towards his colleagues who are still practicing in Nigeria. 

For years, I worked tirelessly, studying late into the night, and overcoming numerous obstacles to achieve my dream of becoming a medical doctor. Finally, after years of hard work and dedication, I graduated from The University of Benin and began my career as a doctor, but I soon discovered that the reality of being a doctor in Nigeria was far from what I had imagined. The healthcare system was and still is in a state of crisis, with hospitals chronically understaffed and underfunded. Despite my best efforts, I found myself working long hours for little pay, struggling to provide the level of care my patients deserved due to lack of equipment’s and infrastructures.

As the months went by, I grew increasingly frustrated with the Nigerian healthcare system and watched as many of my colleagues left the country in search of better opportunities abroad, so I began to wonder if I should do the same.

‘’Practicing in Nigeria felt like a waste of my potential, I felt unwanted, unappreciated and I was psychologically exhausted daily, the pressure from my family and loved ones was too much and the country was hard. I had to leave, to survive. I still had a passion to save lives and I didn’t want the country to kill that passion’’.

It was a difficult decision to make, I was being paid less than 200k naira ($174) a month, sometimes I didn’t get pay for 3 to 8 months but had to keep working, whenever I complain to my boss he complained back and said the government were yet to pay but the government were on television and radio claiming to have paid, so it’s a very frustrating situation and I kept relying on my side hustles, until I would get paid everything I was owed at once but that was after months of protest and weeks of strikeI wanted to help people, to make a difference in their lives, But it was hard to do that when I was constantly worried about whether I would be able to pay my bills or put food on the table for my family’’ he said.

The non-payment of salaries is also having a significant impact on the delivery of healthcare services across Nigeria. With fewer doctors available to treat patients, waiting times at hospitals have increased dramatically, and many patients are being turned away due to a lack of medical personnel, while a lot more patients must deal with having their doctors changedevery year. 

Mrs Rita Erewele, a healthcare service user at the University of Abuja teaching hospital, told The Guardian.

wait for hours, sometimes days to see a doctor but there are simply not enough of them to go around. It’s frustrating and frightening because I don’t know when I will be able to get the medical attention I need unless I go to a private hospital, but I don’t always have the money to afford private services, so I go to any pharmacy and describe my symptoms to the pharmacist on sit and they’re the ones that usually end up prescribing drugs for me and my kids”.

Image of an empty hospital
Photo by user_id:1662222 via Pixabay

The Nigerian House of Representatives to address this pressing issue has introduced the Medical and Dental Practitioners Act (Amendment) Bill, 2022, which seeks to impose a mandatory, 5-year, post-qualification work period for doctors trained in Nigeria. The Bill is titled, “A Bill for an Act to amend the Medical and Dental Practitioners Act, Cap M379, Laws of the Federation of Nigeria, 2004 to mandate any Nigerian-trained medical and dental practitioner to practice in Nigeria for a minimum of five years before being granted a full license by the Council in order to make quality health services available to Nigeria; and for related matters (HB.2130)”.

In an interview with Mr Bryan Ehanire, a member of the Nigerian association of resident doctors (NARD) he condemned the bill and the government’s actions. He revealed that members of the associated intend to flee the country before the bill can be passed into law, he also stated that the bill is not a solution to the problem but rather it will create other problems involving doctors getting craftier with fleeing the country and upcoming youths refusing to study medicine because they will be forced into a mandatory 5 year slave labour.  

This bill has been widely criticized and rejected by doctorsand student doctors in Nigeria who claim that the government is doing everything in their power to force them intomandatory labour in terrible working conditions. Trillions of naira allocated to the healthcare budget in the sum of ₦1,172,843,783,900 in 2023 have been misappropriated and remain unprovided and unaccounted for by government officials, who have used the funds for personal gain rather than for their intended purpose. There have been alleged fraudulent activities involving the minister for health and social welfare Muhammad Ali Pate as well as federal and local government mismanagement, allocation of Insufficient funds, inflated contracts, kickbacks, and the diversion of funds to private accounts. In some cases, funds meant for the construction of hospitals and healthcare facilities were siphoned off, leaving communities without access to essential healthcare services.

Ensuring that salaries are paid on time is crucial to retaining healthcare workers as opposed to the bill, the governmentshould tackle the issue of corruption within the healthcare system, allocate more funds to the healthcare sector to ensure that doctors, and all healthcare workers are paid regularly by Implementing a standardized salary structure across all states and healthcare facilities. Addressing other issues such as poor working conditions, lack of equipment, and infrastructure in healthcare facilities would also help retain doctors in the country.

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