Granary · University · Isaac's House
The Nigerian Medical Association has recently observed a new development in the nation's health crisis: medical students are now intending to leave even before they obtain their licences. The 'japa' phenomenon, which was previously something that affected experienced professionals, is now being seen among undergraduate students as well. The system designed to supply doctors to local clinics is in fact preparing them to leave. Since future doctors are looking for ways to get out of the situation before completing their examinations, the issue extends beyond salary and leads to doubts about whether the country's entire system is still functioning.
Nigeria is not the only country experiencing this issue, although the figures are particularly high in this country. In the 1900s the Philippines set up a system whereby more nurses were trained than were needed at home so that they could work overseas and send money back. Unlike Nigeria, this was an intentional economic strategy on the part of the Philippines. In Nigeria there is no official plan for people to leave; it is more of a leak in the system. This is just as can be seen in the former Soviet republics in the 1990s, when skilled workers left because there were no good jobs available at home. If education produces skilled individuals but the country is unable to support or reward them, then they will naturally move to places where they are appreciated.
The actual issue lies in the nation's infrastructure. The standard procedure for becoming a doctor is now being bypassed. Generally, obtaining a medical degree is based on a social contract: the government provides the education, and in return you work as a doctor. However, when the system is breaking down, hospitals run out of supplies and doctors do not feel safe, so that arrangement ceases to be viable. Medical students have witnessed older doctors being kidnapped or being unable to afford rent. They have concluded that their role as doctors is not sufficiently appreciated in their own country.
When doctors are not appreciated, they lose their sense of purpose and belonging. Rather than seeing themselves as future citizens, the students begin to see themselves as people working for money and start comparing the lives they might lead in Lagos or Ibadan with those of their friends in Manchester or Texas. The internet now lets them compare themselves not only with their classmates but with doctors worldwide.
Trying to keep students will not cure the problem; requirements such as working in Nigeria or restricting the use of their licenses only increase their desire to leave. If the government takes such actions, people will feel trapped. The only genuine solution is to raise salaries, provide better contracts, and improve the health system. Hospitals should be environments where doctors can develop and feel secure, not merely places where they have to make sacrifices. If doctors cannot lead a decent life at home, universities will keep sending them abroad. Students are not abandoning their patients; rather, they are leaving a system that no longer offers hope.
What should be done
· The Federal Ministry of Health should introduce a graduated salary scale for rural and high-stress residency posts which corresponds to the standards in the private sector in order to stabilize retention locally. · The Medical and Dental Council of Nigeria should formalize reciprocal training agreements with foreign health boards so that 'japa' becomes a structured and time-limited exchange. · The Association of Nigerian Medical Students should set up mentorship networks that link students with local private health equity firms to demonstrate viable alternative career paths outside of government employment. · The Federal Ministry of Education should restructure the medical curriculum to incorporate qualifications in health technology and management, to boost the usefulness and earning potential of doctors within the local capital economy.
Segun Jerome
Segun Jerome is the founder of Dadalowa, an education technology company operating in Canada. He also writes about Identity, Education and civilization development.