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

The work we are doing reflects a deeper commitment to ensuring that every medical/dental graduate has a fair and transparent pathway to complete their housemanship. The challenges are significant, but they are not insurmountable. With continued investment in healthcare infrastructure, stakeholder collaboration, and a collective commitment to ethical practices, the system can and will be further strengthened.

The journey to becoming a doctor is marked by immense dedication, sacrifice, and a commitment to serve humanity. For the newly qualified Nigerian doctor, the housemanship year represents a critical step in transitioning from learning to hands-on medical/dental practice. It is a period of work under supervision, a time to refine skills, build confidence, and prepare for the rigours of independent medical/dental practice. However, in recent years, this crucial stage has become a focal point of frustration for many young doctors, due to the 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 address some of these challenges. With over 12,000 house officers having benefitted from the CHMS since inception, the MDCN would like to clarify issues of concern, highlight what the MDCN has done or is doing, and, importantly, outline a path forward.

I recently came across the story of a young doctor, Onyinyechukwu (Onyinye), who had graduated after years of perseverance through strikes, funding challenges, and personal sacrifices. When it came to time for her housemanship, Onyinye had hoped to serve in an urban hospital where she could build on her clinical experiences in a more resource-equipped environment. Instead, in the option available to her on the portal was a hospital far from her family and familiar surroundings. Initially disheartened, she considered discarding the placement, but after a conversation with her mentor, she decided to embrace the opportunity. Months later, Onyinye shared how the experience of working in an underserved community transformed her perspective on medicine. She saw, firsthand, the critical gaps in healthcare access and how even basic interventions saved lives. More importantly, she found a renewed sense of purpose in serving where she was needed the most.

This story is a reminder that the housemanship year is not just about personal preferences or convenience but also about answering the call to service, even in challenging circumstances. Yet, it also underscores the importance of ensuring fairness and transparency in the placement process, so that every graduate, like Onyinye, feels that their opportunity is earned and valued.

In 2021, the centralised housemanship placement portal was introduced to streamline the placement process and ensure fairness in allocations. The goal was to eliminate the unnecessary delays, favouritism, and unequal opportunities that plagued the old system. By centralising the process, every eligible graduate now has equal access to the available slots. While this system has brought significant improvements, the challenges faced today reveal the complex realities of a growing medical workforce and limited capacity.

A significant issue is the concentration of desire to work in urban centres like Lagos and Abuja, where infrastructure, security, and amenities are perceived to be better. This creates intense competition for slots in these cities, leaving many hospitals in underserved areas with unfilled quotas. Yet, these same regions offer critical opportunities for young doctors to gain diverse experiences, while addressing the healthcare needs of communities that are often neglected.

At present, there are 114 accredited hospitals for housemanship in Nigeria, with only 44 federal institutions participating in the centralised portal. These include federal teaching hospitals, federal medical centres, and some specialist hospitals. Each of these facilities is assigned a specific quota based on functioning infrastructure, available consultants, and capacity to accommodate house officers. Together with the 70 hospitals managed by the states, the military or private individuals/organisations that have been accredited by MDCN for housemanship, the number of available slots for placements is sufficient to meet the current output of medical/dental graduates across the country. However, with a growing output of medical/dental graduates, compounded by the increasing number of foreign-trained medical/dental graduates returning to Nigeria, the available slots remain a challenge. Efforts to accredit more hospitals are ongoing, but the gap between demand and capacity will not disappear overnight.

A significant issue is the concentration of desire to work in urban centres like Lagos and Abuja, where infrastructure, security, and amenities are perceived to be better. This creates intense competition for slots in these cities, leaving many hospitals in underserved areas with unfilled quotas. Yet, these same regions offer critical opportunities for young doctors to gain diverse experiences, while addressing the healthcare needs of communities that are often neglected. Encouraging placements in these areas through targeted incentives and improved infrastructure is a necessary step forward. And, we are committed to doing this.

Still, the pressures on the system reflect broader societal challenges. On a very regular basis, and in contravention of the CHMS, letters of recommendation and outright demands to prioritise specific individuals are a daily reality for the MDCN leadership. While devising strategies to balance key stakeholders’ demands and requests, these pressures test the principles of fairness and equity that the system is designed to uphold. Medicine is not just about clinical expertise — it is also about leadership, integrity, equity, and a commitment to the greater good.

These obstacles, notwithstanding, we have made and continue to make significant progress. The centralised portal has reduced waiting times for many medical/dental graduates, ensuring a transparent and structured process in placements. Newly qualified doctors are given adequate information on how the centralised housemanship scheme works and they are encouraged to create their accounts on the portal and make their choices directly, based on available slots. Hospitals accredited for housemanship are rigorously assessed to meet standards, including accommodation, call rooms, and a balanced ratio of house officers to consultants. Efforts are ongoing to accredit more state-owned and private hospitals, as well as to increase quotas in existing facilities, particularly in underserved areas.

These efforts align with President Ahmed Bola Tinubu’s commitment to ensuring equitable and improved quality health outcomes for all Nigerians under the Renewed Hope agenda. The Nigeria Health Sector Renewal Investment Initiative (NHSRII), which emphasises governance reforms and health system strengthening, complements these ongoing reforms. Under the leadership of the Honourable Coordinating Minister of Health and Social Welfare, Professor Muhammad Ali Pate, the government and its partners are focused on improving the healthcare workforce capacity, which directly supports MDCN’s work to accredit more hospitals and expand housemanship placements in both urban and underserved areas. These investments reflect the shared vision of a healthcare system that leaves no Nigerian behind.

But, perhaps, most importantly, we need to re-evaluate how we nurture and prepare our young professionals. The culture of entitlement, favouritism, and short-term thinking undermines the very principles upon which the Hippocratic Oath is administered. The housemanship year should not be reduced to a competition for urban placements but seen as an opportunity to serve, learn, and grow in diverse settings.

Systemic reform, however, requires more than just increasing the numbers. It is essential to improve the quality of training and working conditions for our house officers, ensuring that they are not only well-prepared for their roles as independent healthcare professionals but also motivated to remain within the Nigerian healthcare system when they complete the programme. The exodus of doctors seeking better opportunities abroad — popularly known as the “japa syndrome” — is a pressing concern that requires urgent attention. Addressing it means tackling broader issues, including remuneration, security, career growth, and workplace environments. Already, the Health Workforce Migration Policy (2024) developed by the Federal Ministry of Health and Social Welfare (FMoH&SW) and recently signed by Mr President is targeted at ameliorating these issues.

But, perhaps, most importantly, we need to re-evaluate how we nurture and prepare our young professionals. The culture of entitlement, favouritism, and short-term thinking undermines the very principles upon which the Hippocratic Oath is administered. The housemanship year should not be reduced to a competition for urban placements but seen as an opportunity to serve, learn, and grow in diverse settings. For this to happen, a collective effort is needed to foster a sense of responsibility and fairness among graduates, their families, and the broader community.

The work we are doing reflects a deeper commitment to ensuring that every medical/dental graduate has a fair and transparent pathway to complete their housemanship. The challenges are significant, but they are not insurmountable. With continued investment in healthcare infrastructure, stakeholder collaboration, and a collective commitment to ethical practices, the system can and will be further strengthened. This effort will not only address the challenges of today but will also ensure a resilient and equitable healthcare system capable of delivering quality care for all Nigerians, irrespective of where they live.

As part of this commitment, the renovation and upgrading of six federal teaching hospitals across the federation under the Nigeria Health Sector Renewal Investment Initiative (NHSRII) exemplifies the strides being made to strengthen the foundation of medical training and healthcare delivery. These upgrades are not merely infrastructural improvements but are critical investments in the future of healthcare, ensuring that young doctors have access to state-of-the-art facilities for learning and practice.

These efforts signal that we are not just addressing the challenges of today but are building a robust system for the future — one in which every graduate is equipped to contribute meaningfully to the health of the nation and every Nigerian can access the care they deserve. To this end, we call on all stakeholders, across government, professional bodies, healthcare institutions, and society at large, to unite in supporting these reforms. Together, we can ensure that the housemanship year becomes not just a requirement but an exciting transformative journey for our young doctors – a cornerstone for the health sector, and a testament to our collective commitment to a healthier Nigeria.

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