Building fairness and equity into Nigeria’s medical housemanship system, By Fatima Kyari 

The work we’re doing displays a deeper dedication to making sure that each medical/dental graduate has a good and clear pathway to finish their housemanship. The challenges are vital, however they aren’t insurmountable. With continued funding in healthcare infrastructure, stakeholder collaboration, and a collective dedication to moral practices, the system can and will likely be additional strengthened.

The journey to turning into a health care provider is marked by immense dedication, sacrifice, and a dedication to serve humanity. For the newly certified Nigerian physician, the housemanship yr represents a important step in transitioning from studying to hands-on medical/dental apply. It’s a interval of labor underneath supervision, a time to refine abilities, construct confidence, and put together for the rigours of impartial medical/dental apply. Nonetheless, lately, this important stage has turn into a focus of frustration for a lot of younger medical doctors, as a result of variation of placement slots, regional preferences, and systemic challenges. The centralised housemanship scheme (CHMS) was initiated by the Medical and Dental Council of Nigeria (MDCN) in 2021, to handle a few of these challenges. With over 12,000 home officers having benefitted from the CHMS since inception, the MDCN wish to make clear problems with concern, spotlight what the MDCN has achieved or is doing, and, importantly, define a path ahead.

I just lately got here throughout the story of a younger physician, Onyinyechukwu (Onyinye), who had graduated after years of perseverance by means of strikes, funding challenges, and private sacrifices. When it got here to time for her housemanship, Onyinye had hoped to serve in an city hospital the place she might construct on her scientific experiences in a extra resource-equipped surroundings. As a substitute, within the choice obtainable to her on the portal was a hospital removed from her household and acquainted environment. Initially disheartened, she thought of discarding the location, however after a dialog along with her mentor, she determined to embrace the chance. Months later, Onyinye shared how the expertise of working in an underserved neighborhood reworked her perspective on medication. She noticed, firsthand, the important gaps in healthcare entry and the way even primary interventions saved lives. Extra importantly, she discovered a renewed sense of objective in serving the place she was wanted probably the most.

This story is a reminder that the housemanship yr is not only about private preferences or comfort but in addition about answering the decision to service, even in difficult circumstances. But, it additionally underscores the significance of making certain equity and transparency within the placement course of, so that each graduate, like Onyinye, feels that their alternative is earned and valued.

In 2021, the centralised housemanship placement portal was launched to streamline the location course of and guarantee equity in allocations. The aim was to eradicate the pointless delays, favouritism, and unequal alternatives that plagued the previous system. By centralising the method, each eligible graduate now has equal entry to the obtainable slots. Whereas this method has introduced vital enhancements, the challenges confronted at the moment reveal the complicated realities of a rising medical workforce and restricted capability.

A major concern is the focus of need to work in city centres like Lagos and Abuja, the place infrastructure, safety, and facilities are perceived to be higher. This creates intense competitors for slots in these cities, leaving many hospitals in underserved areas with unfilled quotas. But, these identical areas supply important alternatives for younger medical doctors to achieve various experiences, whereas addressing the healthcare wants of communities which might be usually uncared for.

At current, there are 114 accredited hospitals for housemanship in Nigeria, with solely 44 federal establishments collaborating within the centralised portal. These embody federal educating hospitals, federal medical centres, and a few specialist hospitals. Every of those amenities is assigned a particular quota primarily based on functioning infrastructure, obtainable consultants, and capability to accommodate home officers. Along with the 70 hospitals managed by the states, the navy or personal people/organisations which have been accredited by MDCN for housemanship, the variety of obtainable slots for placements is adequate to satisfy the present output of medical/dental graduates throughout the nation. Nonetheless, with a rising output of medical/dental graduates, compounded by the rising variety of foreign-trained medical/dental graduates returning to Nigeria, the obtainable slots stay a problem. Efforts to accredit extra hospitals are ongoing, however the hole between demand and capability is not going to disappear in a single day.

A major concern is the focus of need to work in city centres like Lagos and Abuja, the place infrastructure, safety, and facilities are perceived to be higher. This creates intense competitors for slots in these cities, leaving many hospitals in underserved areas with unfilled quotas. But, these identical areas supply important alternatives for younger medical doctors to achieve various experiences, whereas addressing the healthcare wants of communities which might be usually uncared for. Encouraging placements in these areas by means of focused incentives and improved infrastructure is a obligatory step ahead. And, we’re dedicated to doing this.

Nonetheless, the pressures on the system replicate broader societal challenges. On a really common foundation, and in contravention of the CHMS, letters of advice and outright calls for to prioritise particular people are a every day actuality for the MDCN management. Whereas devising methods to stability key stakeholders’ calls for and requests, these pressures check the rules of equity and fairness that the system is designed to uphold. Drugs is not only about scientific experience — it is usually about management, integrity, fairness, and a dedication to the better good.

These obstacles, however, we’ve got made and proceed to make vital progress. The centralised portal has lowered ready instances for a lot of medical/dental graduates, making certain a clear and structured course of in placements. Newly certified medical doctors are given sufficient data on how the centralised housemanship scheme works and they’re inspired to create their accounts on the portal and make their selections instantly, primarily based on obtainable slots. Hospitals accredited for housemanship are rigorously assessed to satisfy requirements, together with lodging, name rooms, and a balanced ratio of home officers to consultants. Efforts are ongoing to accredit extra state-owned and personal hospitals, in addition to to extend quotas in present amenities, notably in underserved areas.

These efforts align with President Ahmed Bola Tinubu’s dedication to making sure equitable and improved high quality well being outcomes for all Nigerians underneath the Renewed Hope agenda. The Nigeria Well being Sector Renewal Funding Initiative (NHSRII), which emphasises governance reforms and well being system strengthening, enhances these ongoing reforms. Beneath the management of the Honourable Coordinating Minister of Well being and Social Welfare, Professor Muhammad Ali Pate, the federal government and its companions are centered on enhancing the healthcare workforce capability, which instantly helps MDCN’s work to accredit extra hospitals and broaden housemanship placements in each city and underserved areas. These investments replicate the shared imaginative and prescient of a healthcare system that leaves no Nigerian behind.

However, maybe, most significantly, we have to re-evaluate how we nurture and put together our younger professionals. The tradition of entitlement, favouritism, and short-term considering undermines the very rules upon which the Hippocratic Oath is run. The housemanship yr shouldn’t be lowered to a contest for city placements however seen as a chance to serve, be taught, and develop in various settings.

Systemic reform, nonetheless, requires extra than simply rising the numbers. It’s important to enhance the standard of coaching and dealing situations for our home officers, making certain that they aren’t solely well-prepared for his or her roles as impartial healthcare professionals but in addition motivated to stay throughout the Nigerian healthcare system after they full the programme. The exodus of medical doctors searching for higher alternatives overseas — popularly often called the “japa syndrome” — is a urgent concern that requires pressing consideration. Addressing it means tackling broader points, together with remuneration, safety, profession progress, and office environments. Already, the Well being Workforce Migration Coverage (2024) developed by the Federal Ministry of Well being and Social Welfare (FMoH&SW) and just lately signed by Mr President is focused at ameliorating these points.

However, maybe, most significantly, we have to re-evaluate how we nurture and put together our younger professionals. The tradition of entitlement, favouritism, and short-term considering undermines the very rules upon which the Hippocratic Oath is run. The housemanship yr shouldn’t be lowered to a contest for city placements however seen as a chance to serve, be taught, and develop in various settings. For this to occur, a collective effort is required to foster a way of duty and equity amongst graduates, their households, and the broader neighborhood.

The work we’re doing displays a deeper dedication to making sure that each medical/dental graduate has a good and clear pathway to finish their housemanship. The challenges are vital, however they aren’t insurmountable. With continued funding in healthcare infrastructure, stakeholder collaboration, and a collective dedication to moral practices, the system can and will likely be additional strengthened. This effort is not going to solely handle the challenges of at the moment however may also guarantee a resilient and equitable healthcare system able to delivering high quality take care of all Nigerians, regardless of the place they reside.

As a part of this dedication, the renovation and upgrading of six federal educating hospitals throughout the federation underneath the Nigeria Well being Sector Renewal Funding Initiative (NHSRII) exemplifies the strides being made to strengthen the inspiration of medical coaching and healthcare supply. These upgrades are usually not merely infrastructural enhancements however are important investments in the way forward for healthcare, making certain that younger medical doctors have entry to state-of-the-art amenities for studying and apply.

These efforts sign that we aren’t simply addressing the challenges of at the moment however are constructing a sturdy system for the long run — one wherein each graduate is supplied to contribute meaningfully to the well being of the nation and each Nigerian can entry the care they deserve. To this finish, we name on all stakeholders, throughout authorities, skilled our bodies, healthcare establishments, and society at massive, to unite in supporting these reforms. Collectively, we are able to be certain that the housemanship yr turns into not only a requirement however an thrilling transformative journey for our younger medical doctors – a cornerstone for the well being sector, and a testomony to our collective dedication to a more healthy Nigeria.

Fatima Kyari is the CEO and Registrar of the Medical and Dental Council of Nigeria.