• Govt not serious in tackling issue, says Makanjuola, MDCAN president
From Magnus Eze, Enugu
President, Medical and Dental Consultants’ Association of Nigeria (MDCAN) recently, Dr. Victor Makanjuola, in this interview, spoke on the cause of medical brain drain in the country and other sundry issues.
Excerpts:
How would you rate the medical environment in the country and the health system generally?
We are definitely not where we are supposed to be. We have major challenges currently that threaten even the stability and continued existence of the medical or the health system in general and that is one of the focuses of this meeting that we are here to discuss those major challenges.
One of those major challenges is emigration of members of our association and other healthcare workers to greener pastures. We have doctors, nurses, physiotherapists and other healthcare workers leaving the shores of this country for other places, creating a huge deficit in the health workforce in the country.
We all know how important the workforce is to providing healthcare. Even if you have all the gadgets and infrastructure, there is nobody to handle the infrastructure to utilise them appropriately, our healthcare delivery will suffer greatly.
We are not where we are supposed to be with regard to the health system. We also have the problem of underfunding the health sector. No previous governments in Nigeria were able to achieve the 15 per cent budget to the health sector as agreed at the Abuja declaration in 2001. So, that’s also a major challenge.
We also have a problem with infrastructure that some of those things required in those hospitals are not provided even for those who are around to work with them. A major problem is power generation and distribution in most of our health facilities. The payment for the public power supply has been difficult because it runs into millions
Allocation to those hospitals for overhead is usually meagre compared to what they have to pay the distribution companies. That means they have to resort to generating power by themselves through diesel generators. All these are making it difficult even for the administrators of the health system to keep up in providing good care for Nigerians.
What brought about the issue of tax in your last conference in Enugu?
One, as a country our perception of what tax is, how it is to be paid and the responsibility of the citizens including doctors has been poorly understood over the years. We really want our members to be properly educated as to the current tax laws in the country. What is their liability to the government and what they can get from tax legally from the government as well. That is one of the major reasons we have brought in tax. We are also having discussions; we have written to the governors’ forum.
The government generally is reluctant to have an awesome increase in salaries and the indirect way you can increase somebody’s disposable income is to reduce the tax. We are also looking at measures we can take to encourage those who are living within the country.
Can you reduce the tax burden in some areas, not the total tax but certain allowance that are peculiar to health workers? Can we have a reduction for health workers on those allowances? Those are the reasons we brought in tax experts to educate us in the meeting.
One of the resource persons spoke about over 100 consultants leaving the shores of this country last year. Do you have more details about that?
I am conversant with that because he actually mentioned that they are our figures, MDCAN. These are figures we provided to the general public and more importantly to the government through the Office of the Head of Service.
Right now, we have estimated 500 left within the last two years. And that was in March last year. If we are going to include from March last year to now, the figure will even be much more. By our survey, we found out that over 500 consultants are not just doctors.
Those are people it took a minimum of 12 to 13 years to train them to get to that level. And we are aware that the junior colleagues, the medical doctors are also leaving in droves as well as nurses and a few other groups of health workers.
This is a major problem for the country that needs immediate action. I can say without mincing words that we have not seen that level of seriousness in terms of remedying this level of brain drain by the government. It appears the reality of the situation is not apparent to them or the government is overwhelmed or simply does not care that this number of people in the health sector is leaving the shores of the country. It is a major problem we have at hand.
What are those actions you think the government should take?
Everyone knows that remuneration is a major reason why people are leaving. People go to countries where they earn about 10 times more of what they are currently earning in Nigeria. While we are not expecting the government to have a ten-fold increase in the salary of health workers, even one-fold of the current one will be an improvement and will help some people to decide to stay.
Remuneration is a major factor and we have been working with the government on this but really nothing concrete as at this moment. We know that working conditions are very important to every health worker. Having access to certain loans, provisions in their facilities also helps in keeping people. Having the assurance that you can work till you are 65 or 70; elongating the age of retirement of members, consultants as well as for other health workers.
We have been discussing this for a couple of years now without the government directly buying into this. And we have other countries actually increasing the age of retirement generally across the board even without any provocation. I am sure you heard that France recently increased the age of retirement to 64.
We think all these conditions of service issues, remuneration issues and improvement in the general security of the country will encourage a lot more people to stay. Particularly, we have to improve the security of the hospitals.
As journalists, I am sure you are aware of how bandits raided hospitals, picking children from the wards, kidnapping doctors and nurses to their camps and using them as medical aides at bandits’ camps. We need extra security in all our hospitals across the country, especially those in the rural areas where these bandits are more likely to operate.
