October 1: Resident doctors decry harsh working conditions

As Nigeria celebrates its 64 independence today, the Nigerian Association of Resident Doctors has lamented that the country’s healthcare system still struggles to provide quality care to patients due to harsh working conditions, inadequate training, and poor remuneration for its members.

The president of NARD, Dr. Tope Osundara, expressed concern that despite some governmental efforts to improve the conditions of health workers, many resident doctors continue to work under harsh circumstances.

Speaking exclusively with PUNCH Healthwise in commemoration of the 64th Independence Anniversary, the NARD president noted that resident doctors in Nigeria frequently endure long hours without adequate compensation or incentives, contrasting the situation with practices in other countries where additional work hours are financially recognised.

Osundara cited alarming examples from institutions like the Obafemi Awolowo University Teaching Hospitals Complex, where he claimed essential provisions, such as meals for doctors on 24-hour call duty, were allegedly lacking.

This situation, he noted, had forced many doctors to leave the hospital further complicating their demanding schedules.

Despite recognising some progress made in the last 64 years, the NARD president critiqued the government’s response to the challenges resident doctors face.

Osundara argued that while there have been policy drafts from the Ministry of Health aimed at addressing these issues, actionable plans with concrete timelines are important in making it a reality.

He stated, “The current state of the health care system is suboptimal. Resident doctors still work under harsh conditions. Though the government is trying to improve the working conditions, Resident doctors work long hours and are not rewarded for it. No incentive whatsoever. Unlike what we have in other climes where extra work hours are duly paid for.

“In some hospitals, the welfare of doctors is not prioritised like OAUTHC and some other hospitals where call meals are not provided for doctors which invariably means that a resident doctor on 24-hour call will have to go home to find what to eat during his/her call duty.

“The government’s effort to mitigate against some of these challenges is seen with the drafted policy from the Ministry of Health to address the gamut of issues that have plagued our health system. Beyond policy, however, there should be a workable action plan with a timeline else some of these policies will only remain as random attempts at dress to impress.”

When asked about some major challenges confronting resident doctors in the country, the NARD president pointed to a significant shortage of healthcare personnel, worsened by the ongoing mass migration of skilled professionals seeking better opportunities abroad.

He explained that this brain drain is compounded by inadequate training resources and facilities, which hinder the development of doctors to meet global best practices.

Osundare stressed the dire conditions of some hospitals, including the lack of functioning medical equipment such as CT scan machines, which are essential for diagnosing critical conditions.

According to him, in many areas, patients are forced to contend with outdated equipment or a complete absence of necessary medical technology.

“We still have several hospitals with obsolete medical equipment in the theatre. Some don’t have equipment at all. CT machine is a medical gadget every hospital should have but in some states in Nigeria, you will find just one serving the whole population of the state. Some states don’t have functioning CT scans.

“Unfortunately, our roads are bad which has increased the rate of accidents. There is the issue of poor attention to health and other lifestyle factors that have contributed to the prevalence of medical conditions like hypertension. Accident victims from road traffic and those with cerebrovascular accidents suffer the most from the lack of a functioning CT Scan machine.

“Resident doctors in Nigeria don’t have specific working hours. When they resume by 8 am, for instance, they can end up going home by 8 pm. Thus, increasing burnout for most residents. Some do back-to-back call duty that spans into weeks.

“Poor remuneration for doctors is a major factor. Nigerian doctors are among the least paid globally. The Nigerian doctor’s pay is terrible irrespective of the calculating index,” he noted.

He, however, stressed the urgent need for improved working conditions, including the establishment of specific working hours.

In terms of policy recommendations, the NARD president urged the government to implement measures that would retain skilled doctors and enhance workforce capabilities.

Osundare noted the importance of adequate compensation, regular reviews of working conditions, and comprehensive policies aimed at ensuring the security of healthcare workers, who increasingly find themselves in precarious situations.

He added, “A conducive work environment is also equally important. During long hours of call, doctors in some hospitals don’t have call rooms. Some have call rooms with squalid conditions due to neglect by hospital management.

“Policies seeking to retain our best hands should be prioritised. There should be a policy that is targeted at improving the workforce which should be aimed at meeting the healthcare needs of Nigerians and there should be adequate compensation.

“There should be a policy on regular review of working conditions. The policy of security for all health workers is essentially important as most health workers, especially doctors, are now endangered species.”

Addressing the brain drain, Osundare asserted that the government bears the primary responsibility to mitigate the factors driving health workers abroad.

To enhance the quality of residency training programmes in Nigeria, the NARD president called for the allocation of sufficient resources towards a comprehensive development framework that prioritises modern medical methodologies and innovative practices.

He advocated for in-service training opportunities and international exposure to best practices, coupled with a robust certification process to validate the skills and competencies of resident doctors.

He emphasised the importance of adopting international best practices, which include a focus on continuous training and research in a supportive environment.

He reiterated that mentorship, government support, and incentives are critical for the success of healthcare professionals in Nigeria.

“Quality training during residency has a multifactor component. A robust structure for training, research and service delivery in a conducive environment with good and effective mentorship, incentive and government support is critical for success,” he concluded.