The latest NOIPolls/Nigeria Health Watch survey on Nigerian doctors failed to capture real issues. Paul ADEPOJU reports.
On August 3 2017, the report of a new NOIPolls/Nigeria Health Watch survey focusing on Nigerian doctors was released. It quickly went viral. Looking closely, HealthNewsNG identified some shortcomings that could limit the applicability of the report.
According to the report which has so far been published by several national dailies including ThisDay, Daily Trust, New Telegraph and Vanguard, 88% of Nigerian doctors are seeking work opportunities abroad. The report said this development is affecting junior, mid and senior level doctors in both public and private medical institutions such as house officers, corps members, medical and senior medical officer, residents, registrars, consultants and medical directors.
“The United Kingdom and the United States are the top destinations where Nigerian medical doctors seek work opportunities. Consequently, many Nigerian doctors are currently registered to write foreign medical exams such as PLAB for the UK (30 percent), USMLE for the United States (30 percent), MCCE for Canada (15 percent), AMC for Australia (15 percent) and DHA for Dubai (10 percent) amongst others,” NOIPolls stated.
The survey also revealed that high taxes and deduction from salary (98 percent), low work satisfaction (92 percent), poor salaries and emoluments (91 percent) and the huge knowledge gap that exists in the medical practice abroad (47 percent) amongst others, are the leading challenges responsible for the looming brain drain in the health sector.
With the survey making bold claims and very significant figures, it was worth taking a much closer look at the methodology which would determine whether it was done properly and should be handled accordingly.
According to NOIPolls, they deployed a mixed methodology approach employing quantitative and qualitative methods. For the quantitative method, an online survey using a standardized, well-structured questionnaire was employed; and a semi-structured interview guide was utilized for the qualitative approach.
Here’s where the problem is. Segun Awoyemi, a biostatistician at the University of Ibadan told HealthNewsNG that for the online survey, it has been found to ease data gathering, minimize costs, automate data input and handling, increase response rates and enable design flexibility. However, it has numerous shortcomings that have made its application to be of limited usage in general.
“An online survey is not suitable for surveys which ask open-ended questions like the ones NOIPolls asked because there is no trained interviewer to explore the answers of the respondents. Also, this method is not applicable for surveys that require respondents who do not have an access to the Internet. Some examples of these respondents include many doctors that cannot use Facebook not to talk of doing online surveys,” he said.
These two observations are critical to the reliability of this study, particularly the later. NOIPolls probably partnered with Nigeria Health Watch because of the later’s large database of medical professionals (tens of thousands) out of which only about 700 responded.
“Here’s a very strong confounding factor. The respondents could largely be those living outside the country or those that are planning to leave. It is the kind of people that they spoke to that would determine the kinds of response.”
The survey also conducted interviews for about 30 medical doctors in Abuja which is also not representative enough, another statistician told HealthNewsNG.
Furthermore, the biggest shortcoming of online survey method has always been survey fraud. One of the reasons why they are unpopular in scientific researches is the observation that individuals may do surveys for the sake of getting incentives after they have completed the survey, not with a desire to contribute to the advancement of the study. Likewise, individuals who want a particular line of thought to gain prominence could easily hijack the survey and mobilise others with similar line of thoughts to participate as many times as possible which is why this survey’s study design is greatly flawed.
Beyond the technicalities of research, several doctors that were randomly selected from across the country disagreed with the results. A surgeon at the Ahmadu Bello University Teaching Hospital said he travelled out of the country for advanced training and he’s back in the country where he is enjoying good practice.
“Many of my colleagues here regularly travel in and out of the country, yet we are satisfied with what we are doing here. And we are not the only ones. So I will say it is a case of different strokes for different folks,” he said.
A consultant at the University College Hospital (UCH) in Ibadan added that while many doctors would talk openly about traveling abroad, only a few of them are taking bold steps towards traveling out.
“I also talk about traveling out of the country a lot, that’s what we do. We talk about the greener pastures and better pay outside the country. But we are not the only ones doing that. There are better opportunities for lawyers outside the country, even nurses, tailors, carpenters and civil servants. Which is why I’m not surprised by the report. What I’m curious to know is how many people that said they want to leave have actually passed exams, purchased tickets and are actually leaving the country. That’s the only statistic that truly matters,” he told HealthNewsNG.
HealthNewsNG also gathered that there are variations in the perspective of individual doctors from one hospital to another. At the University of Benin Teaching Hospital and Federal Medical Center which had protracted strikes, the doctors were overwhelmingly in support of traveling out of the country while in places like the Obafemi Awolowo University Teaching Hospital Complex Ile-Ife and the UCH Ibadan, several doctors there expressed satisfaction – so satisfied that they had their undergraduate training, house job, and residency training at the same institution where they eventually became consultants and are lobbying for medical school admission for their children.
“At one hospital, the doctors maybe satisfied while at another, they maybe unsatisfied. Generalizing based on 27 doctors in Abuja is not representative enough,” said HealthNewsNG’s columnist Dr Vickie.
The real issues
While there are numerous issues that are encouraging many Nigerian doctors to travel out of the country, HealthNewsNG gathered that there is a rather subtle but increasingly popular trend that are discouraging Nigerian doctors. It is the threat posed by foreign trained medical students who are returning to the country and are getting brighter job prospects than those that were trained in Nigeria.
“We are not really desperate about traveling out, we are more concerned about those coming from outside the country and getting jobs ahead of us,” a medical youth corps member told HealthNewsNG.
In addition to the high monthly association/council deduction from Nigerian doctors’ salaries mentioned in the survey, Nigerian doctors are also complaining about the government-aided discouraging tactics being deployed by several teaching hospitals to reduce what they are paying their doctors, one of such places is the UCH Ibadan.
“What is happening now is a case where there will be 2 senior registrars with different salaries. They decided to change the salary grade which affected senior registrars employed from a particular date. This is one of the hospital’s several cost cutting mechanisms,” one of the affected registrars told HealthNewsNG.
There are also concerns about the duties of the medical examination bodies who are increasing examination fees without assisting candidates to secure residency placement while adding expiry dates to the validity of the results of passed exams.
To a large extent, Nigerian doctors believe that it is within the power of the Nigerian government to deal with the problems, dissatisfactions and discouragements that are making many Nigerian doctors to be unhappy, choosing to grudgingly continue to work. However, they said the inability of the president to fully understand what is going on has put the doctors in a helpless situation choosing to either suck it up and work or seek greener pastures.
“The elders of the profession are not helping matters; in fact they are the ones behind most of our problems. Yet they are the ones the government will turn to if it wants to help us. It’s a form of modern day slavery even though Nigerians would think all is well with us when they see us in ward coats. The truth is all is not well.”