Medical Practice in Contemporary Nigeria: Yesterday, Today and Tomorrow

The medical profession has been from time immemorial, and universally, it still remains the most learned and the noble amongst the original learned profession.

The primary 3 learned profession being the physician, the scribe (Lawyer) and the priest (Clerics).

For the benefit of those who may not have taken time to trace the beginning of the medical profession in Nigeria, I say here that the profession was the doyen of all other professions in the pre-colonial Nigeria. In fact, at that period, the medical profession was at the frontline before the emergence of, and growth of some other professions in Nigeria.

During the pre-colonial period, the Medical Officer of Health assumed a kind of larger than life position within the government. Take for example, where you had the District Officers (D.O) of the old, usually at that time a Briton, the next Officers to him was topped by the Health Department headed by the Medical Officer of Health. When the D.O was not around, he handed over the administration to the Medical Officer of Health.

The Medical Officer of Health was regarded as the next in command to the D.O. So, put mildly, the Medical Officer of Health at the district council level was regarded as first among equals. The same thing applied to the National level where the Chief Medical Officer in Lags acted as the Governor General when the Governor-General was on leave to England. This was so, because in England where Medical practice emanated, it was only medical officers amongst the other professions, who were in the topmost social class, followed by industrialists and the Lords.

The next social class was the other elitist groups or professional like the Lawyers, the Estate Surveyors, Architects, Accountants, etc. This is because Medical Officers deal with lives. The implication of the foregoing, at that particular time, was that the medical officers earned by far more than other administrative, accounting and/or legal officers within the district government from the provincial to the national level.

An Administrative Officer Grade One, an equivalent of Permanent Secretary today, earned by far less than the Medical Officer. The same thing applied to all other cadres working with the Colonial Government. The Late Sir, Dr. Kofo Abayomi was the first Nigerian to rise to the position of the Chief Medical Officer of Health of the Colonial Government. It was a plum position that conferred on him the respect of the Colonial Government. This was why the Colonial Government allowed him to reside in the Government Reserved Area (GRA) in South West Ikoyi, Lagos.

The late Sir, Dr. Abayomi was the first Nigerian Civil Servant to live in the GRA. But when the first independent Government came, that state of affair was gradually discontinued and that gave rise to the infiltration of unhealthy external and corruptive influences into the otherwise orderly system of administration. The Nigerian factor cropped in and that led to the emergence of what we referred to until lately as the “era of the super Permanent Secretaries”. The entry of less qualified personnel into the nation’s bureaucracy led to the elevation of mediocrity that we now witness in the Civil Service. Administrative officers who were hitherto below the “elitist class” to which the medical officers belonged were catapulted above them. This now brought the medical and legal professions which were higher in the post-colonial era now at par or sometimes, below to the other administrative positions. This situation has continued to date and something progressively drastic must be done to bring about the needed change. This mishap brought about a situation where the administrative cadre now managed the Government’s budget as well as other paraphernalia of office and was also, accorded more financial power and other considerations, over and above both the medical and legal professions as exemplified by the posts of Chief Medical Officer and the Solicitor-General.

It was a taboo for medical officers at that time to engage in private practice or to run private clinics or hospitals. This state of affairs that was alien to the medical profession at that immediate post-colonial government era, later led to the establishment of private practices by medical officers in government to cushion the effect of loss of status and financial power.

As if this was not enough, when the military took over, they came with the cloak of illegality and hijacked the reins of authority from the politician and the bureaucrats. They used the legal profession to legalize the illegality of their usurpation of power through the barrel of the guns. They used the legal department of government to promulgate decrees that accorded seeming legal basis for the hijack of power. To compensate the legal profession for their collaboration, the remunerations of judges now became by far, higher than those of the administrative class and the medical officers. That was where the rains began to beat us. This led to the exodus of highly competent, highly respected doctor into full-fledged private practice. People like Dr. Olusola Saraki, his partner Dr. Ikomi and the late professor Bello Osagie were in the vanguard of that exodus.

That was the situation during the military. From there on, the depletion of the powers and the financial status of the medical officers continued unabated and even after the military handed over to the highly placid civilian administration. This led to the elimination of the Nigerian Middle class and the pauperization of the lower class to the extent that even the doctors in full-fledged private practice could no longer make ends meet. But when the economy finally took an inevitable nosedive into depression, there was a mass exodus of highly qualified Nigerian doctors to America, Saudi Arabia, Doha in Qatar, Kuwait, South Africa, etc. A Nigerian- Dr. Owens Obaseki who was recently honored with Doctor of Science (Honorius Causa) by the great University of Benin is currently Chief Medical Director of four Teaching Hospitals in Germany.

This is the latest setback on the Nigerian Health Sector. If we have Dr. Owens Obaseki and others like him in the country to play strategic contributory and developmental roles, the face of medical profession would change for the best. Having taken a look at the past, let us now return to the present situation and proffer possible solutions for the way forward.

This period has witnessed more violent trade unionism with its attendant strikes and lockouts and abandonment of patients by doctors, as a result of demands for increased emoluments and wages. Understandably, the take home package for doctors has remained extremely low or rather cannot take them home anymore. The strikes and lockout of patients smacks of insensitivity, which are factors that were alien to the medical profession in those glorious days.

Conversely however, these trade unionism instruments have become survival strategies for the guarantee of the basic needs of the doctors who chose to remain in Nigeria. Painfully now, medical doctors are involved in so much unethical practices in an attempt to make ends meet. With further deterioration, medical doctors have now come up with even more strident survival strategies, having lost faith in the ability of the bureaucracy to take charge of their increasing welfare needs. Meanwhile, these doctors continue to spend all their time in the consulting rooms and theatres in the service of the Country and Humanity.

This led to the second level of violent agitations that culminated in the taking over of the administration of all hospitals throughout the nation by Medical Officers. This is why today the Chairmen of the Boards of Directors of Hospitals are medical doctors and the Chief Medical Director is the Chief Executive. The import of this is that the Doctors have taken their own destiny in their hands. Before now, the Director of Administration or Secretary to the Hospital Management Bard at the State level was the Chief Executive.

But even with the doctors now at the policy making level and at the Chief Executive level, we are still experiencing little or no improvement in the welfare and salaries of doctors. Their lots are yet to improve in spite of taking over the apparatus of office in their fields of operation. As a result, there is a massive exodus of Nigerian doctors into politics.

This has brought the likes of Dr. Olusola Saraki, Dr. M.A Majekodunmi, lately Dr. Peter Odili (Former Governor of Rivers State), Dr. Chimaroke Nnamani (Former Governor, Enugu State), Dr. Bukola Saraki (Former Governor of Kwara State), Dr. Chris Ngige (Former Governor, Anambra State), Dr. Olusegun Mimiko (Governor Ondo State), Dr. Dalhatu Tafida (Former Senate Majority Leader), Dr. Emmanuel Uduaghan (Governor Delta State), Dr. Chris Oghenechewe, Dr. Ifeanyi Okowa, Dr. Nkadi Okocha-Ejeko (My humble self), Dr. O Mamora, Dr. John Ogbeide, Dr. F. Amadasun, Dr. Tony Manzo, Dr. Ibrahim Olaifa, Dr. Dalyop Dantong, Dr. Mohammed Pate, Prof. C. Onyebuchi, Dr. Precious Gbeneyl, Dr. Peter Ebireri, Dr. Alex Ideh.

Others abound in the National Assembly and the State House of Assembly, as well as Honorable Commissioners and Ministers in the governments of the Federation into active political participation. Even some medical doctors have emerged as speakers of State House of Assembly, a terrain which was hitherto considered an exclusive preserve of Lawyers and those in the social sciences. Dr. Olorunnibe Mamaora (one of us) for example, was the speaker of the Lagos State House of Assembly in the first term of Governor Tinubu’s Administration, before moving on to the Senate.

As if these are not enough, some doctors have emerged as Chairmen of Political Parties at State and National Levels. Dr. Ahmad Adah Ali, former National Chairman of the ruling Peoples’ Democratic Party is an accomplished medical doctor. I must also mention the former chairman of PDP in Imo State, Dr. Alex Obi, who is also one of us. There is also a prevalence of medical doctors at local and ward levels taking into active politics.

This is another version of medical brain drain into the political arena. All these are pointers to the fact that the status and the working environment of the Nigerian Doctors have deteriorated abysmally from the post-independence era to now. This is the foundation of the crisis that we have today in the medical profession. The doctors are trying to wind the hands of the clock backwards to the old glorious days. How feasible is this without a counterfeit contribution from authorities at all levels?

For there to be any meaningful change, there must be general overhaul of the system. And this must be the concern of government at all levels. The value of education has fallen to the extent that to produce quality graduates has become impossible. Government should put more funds into education to produce quality graduates, particularly medical doctors. These graduates (in the medical profession) should be empowered to commit their lives to their profession.

What is the way out of this grim situation painted above?

The Government and the Nigerian State should begin to realize that for a country to move forward, it needs high quality health care delivery service for our entire citizenry. This can only be achieved by proper education of the medical doctors and massive attention to the needs of the doctors and infrastructure within the medical environment. The scant social recognition given to the medical practitioner needs to be reversed from what it is today, since this will engender hard work and patriotism among them.

There must be a robust attempt to put in place a workable and acceptable National Health Insurance Scheme that will guarantee continuous flow of patients to both public and private hospitals where they will have qualified doctors to attend to them rather than avail themselves of the service of quacks running some dingy clinic in the nooks and cranny of the country. This will enhance the financial power of the doctors and bolster job satisfaction.

There is urgent need for the medical services to be removed from the civil service salary structures. This should translate to the setting up of the National Health Service Commission that would be run and managed from the consolidated revenue accruing to the Country. There must be an urgent constitutional amendment to bring the medical profession to the pedestal of other civilized countries like the United States of America where we copied the Presidential System of Government for a position of Surgeon-General based in the Presidency, who will advise the President on all health-related matters. There should be an urgent legislation to make it mandatory for Pharmacists to sell important drugs only on Doctor’s prescription or request and lab test.

These are some of the ways to reactivate the medical profession in the country. There are indeed so many suggestions that can help take the profession from its current state to a glorious height. Since one is not an island of knowledge, there is ample opportunity for one to suggest ideas to move forward. With some synergy and syndication between you and those of us in the shadows of the corridor for power, we should be able to hammer out a comprehensive blueprint that will serve as a compass to the right direction that the medical profession should be headed to, thereby making it attractive once again.