Unilorin medical mess as a metaphor

If they explain Nigeria to you and you understand, then you are one in a billion. I herein provide yet another instance. It is estimated that the country, with a population of 220 million, has just about 55,000 doctors. That comes to one doctor per 4,400 Nigerians. The World Health Organization (WHO) recommends 1/1,000. For a country with such a severe shortage of doctors, you would expect all hands to be on deck to address the national emergency. You would expect some extraordinary measures. One would be to create incentives to slow down or halt the “japa” syndrome that is ravaging the sector. Another would be to accelerate the training of more doctors to fill the huge void.

But Nigeria is peculiar. That is why we are Nigeria. We are making it harder to produce more medical doctors. We have a policy that strictly limits the number of medical students that can be trained per year. You would think that our pathetic situation would make us sit down and think up intelligent solutions. You would expect that we should be aiming to ramp up the numbers by improving the capacity of our medical schools in terms of faculties and facilities. What does it take to improve facilities? Is it not brick and mortar? Is it not equipment? Will this bankrupt Nigeria? Will it cost us more than it does to sponsor pilgrims or buy kola nuts and Tom Tom candy for government houses?

This article was prompted by the unfolding mess at the University of Ilorin Medical School where the fate of many students is now hanging precariously because of a failure on the part of the university authorities. From what I have been reading, it is clear that Unilorin overshot its quota for the admission of medical students for years. The Medical and Dental Council of Nigeria (MDCN), which regulates medical practice and training standards in Nigeria, does not take this infraction lightly. If a medical school has only 100 slots, the MDCN will induct only 100 doctors. But how will the MDCN penalise Unilorin for the infraction without punishing the students as well? That is the question.

Here is the mess. Unilorin has now trained medical students who cannot be inducted because the school overshot its admission quota. While it normally takes six years to train for a Bachelor of Medicine, Bachelor of Surgery (MBBS) degree, some students have been at the school for eight years and are still not sure of being inducted because of the quota quagmire. According to reports, over 200 students are affected by this, 44 of whom have been at home since last year. To solve the problem, the Unilorin management may have to adopt an algorithm that will delay the careers of many students. Creating the induction index will obviously involve a complex and confusing matrix.

If I were a medical student who has been at Unilorin since 2018 and I am still unsure of being inducted for no fault of mine, I would be frustrated. I would be depressed. I would have nothing but resentment towards the authorities. I didn’t offer myself the admission. Like other students, I have toiled through thick and thin, taxed my parents and relatives to their last kobo to survive in school, and studied under the most unfriendly conditions. Having endured the torture till the end, I am now being told that I cannot graduate in 2026. I am not even sure of graduating in 2027 or 2028. My offence? My university, in conjunction with JAMB, went above its allotted quota for medical school.

The issue here is not that the doctors were not properly trained. It is not that they failed their papers. It is not that they are incompetent. It is simply that Unilorin — not the students — breached an admission rule. For emphasis, I will keep saying the university was wrong to overshoot its quota, but why would you refuse to take delivery of a baby because the mother got pregnant before her wedding day? The students that will not be inducted underwent the same training and wrote the same exams as their colleagues, but they will be asked to stay at home for more years because of a breach of quota. And this is a country that needs 200,000 more doctors as urgently as yesterday!

One major measurement of a country’s development is access to quality health care. There is no country called “developed” in the world today that does not have a sound health care system. Here in Nigeria, we are not only short on quality facilities, but we are also short on numbers. If a doctor has to attend to four times the recommended number of patients per day, there is no need to ask why the public health system is hostile to the ordinary Nigerian. Our doctors are simply overworked. They are stressed. Many of them have become bitter and angry with the system. And it is the poor that inevitably bear the brunt. The elite, of course, receive their own injections in Europe and UAE.

As things stand, we need hundreds of thousands of more doctors to be able to meet the WHO recommended ratio. When faced with a shortage of personnel, advanced countries, such as the US and the UK, created a pathway for foreign doctors and nurses to increase the numbers and meet their needs. Common sense! But in Nigeria, we created a quota to limit the number of doctors we can produce. Please, make it make sense. In the UK public hospitals today, there are Indian, Pakistani and Nigerian doctors everywhere. The country is also ramping up the training of more British doctors to avoid relying on foreigners in the future. That is a combination of short- and long-term actions.

Nigeria is actually slowing down its own progress as much as possible. Our universities are bragging that they are rejecting students who apply to study medicine. They even celebrate it as a badge of honour! This is a country where the incentives to be a doctor are not there. Those who want to study medicine actually have a passion for it, otherwise why can’t they study some more lucrative courses in the Nigerian environment? With all the stress that medical students go through, we should be happy that some Nigerians are still interested in studying medicine. If not that something is not right with our policymaking, how can we be rejecting them and celebrating it as if we just won a trophy?

Don’t get me wrong: the MDCN is not committing a crime by being strict. It is only carrying out its mandate. The problem is that Nigerian policymakers, regulators and legislators often work in silos. That is why our polices are hardly based on a robust, well thought-out process. There are obvious gaps in the policy process. We have a problem and want solutions. What problems have we identified? What are the dimensions? How can we address the problems one by one and as a whole? How can institutions think and work together to achieve our goals? The MDCN is only mandated to enforce standards. Upscaling the quality of faculties and facilities is clearly none of its business.

May I emphasise that medical education is not a joke and we cannot prioritise quantity over quality, but there should also be no suggestion that quantity and quality are diametrically opposed. Someone will argue that the issue is capacity — that we do not have the facilities to train a huge number of doctors, hence the need to limit the numbers. Good argument, I concede. But where there is a will, there is a way. I did my secondary school in my village at a time Nigeria was short of teachers. But we had a system that allowed foreigners to help out. Indians taught us physics, chemistry, maths, and further maths. During my A Level, a Ghanaian teacher took one of the courses.

I conclude. My suggestion regarding the Unilorin situation is that the MDCN should temper justice with mercy and allow the arrears to be cleared. It should offer a one-off amnesty, lest it becomes an excuse for other medical schools to flout the quotas. I am happy that the council is regarded as a no-nonsense regulator, but there is a time for rigidity and there is a time for flexibility. All the students have undergone the same training and have the competence needed at their level, so why delay their integration? Agreed, rules are rules and rules are good, but rigidity must not cloud reason. Moreover, Nigeria urgently needs more doctors, but the raging question is over quota not quality.

And if I may ask, what is urgent at this time: maintaining the status quo in the midst of shortages or improving the capacity of medical schools to produce more doctors? This, I insist, is the conversation we should be having, not quotas. We need a national emergency to accelerate the training of more doctors. The ministry of health, ministry of education, MDCN, National Universities Commission (NUC), universities, legislators and all others in the ecosystem must take this seriously. We have an emergency on our hands. Our public health system is actually a shambles. The least we can do is not to kill the dreams and aspirations of young people who still want to be doctors against all odds.

AND FOUR OTHER THINGS…

‘AKU ORIIRE’

You would think I won a lottery on Friday when news broke that the kidnapped pupils and teachers in Oriire, Oyo state, had been released after nearly two months in captivity. We have had cases of mass school abductions in the north in the last 10 years, but they were usually resolved in weeks. The Oriire kidnappers had beheaded a teacher and looked resolute to hold on to these kids. I actually feared we had another Chibok situation at hand. My condolences to those who lost loved ones in this sad saga. I hope the government will do more to protect the vulnerable areas as the security forces continue their onslaught against the forces of darkness holding the nation down. Progress.

NO INTERVENTION

Our senators never cover themselves in glory. Not that they care, in any case. Whether or not to probe the Presidential Foreign Intervention Promotion Council (PFIPC) scandal is entirely their prerogative, but the reason they gave is an insult on our intelligence. How can the upper chamber say it is not going to probe a matter because the president is already probing it? Really? When did we descend to this ridiculous level? The legislature is supposed to be a check on the executive in a presidential system. A budget of N1.3 billion was approved by the legislature for the PFIPC and the senate won’t probe this? They are inevitably promoting suspicions of a grand cover-up. Shame.

AKARA DRAMA

As someone who has spent decades promoting and advocating for small businesses — which I see as the engine room of the economy and the biggest employers of labour — I have been amused at the outrage against Mrs Remi Tinubu’s support for akara business and petty trading. I want us to cast aside our misgivings with anything APC and tell ourselves the home truth: enterprise is the fastest route out of poverty and unemployment. About 20 years ago, I invested in a company started by my partner in crime, Chidi ‘Uzor, to give loans of between N10,000 and N100,000 to petty traders. Their lives changed forever. Politics or no politics, let’s respect enterprise and the dignity of labour. Vital.

NO COMMENT

Senator Ali Ndume finally met with President Bola Tinubu on Thursday after publicly complaining that he had lost access to him. “We used to have this interaction before, but somehow it stopped. Now, the interaction has resumed,” Ndume, who had always been critical of Tinubu, said after the meeting. The senator representing Borno South came up with some nuggets, particularly telling Nigerians that the president alone cannot solve the security problems. It reminds me of when the late Oba Okunade Siwuade, the Ooni of Ife, visited President Ibrahim Babangida in 1993 after the annulment of the June 12 presidential election. “Babangida is talking sense,” he said. Hahahaha.

•Written By Simon Kolawole