The Federal Government recently said that it might ban medical doctors in the public sector from private practice. The Minister of Health, Prof. Isaac Adewole, who disclosed this to newsmen after the Federal Executive Council (FEC) meeting in Abuja, said that a committee had been set up to consider the matter, especially as it relates to the laws of the land and professional ethics.
Nigerians are sharply divided on this issue. While some support the contemplated ban, citing conflict of interest, others who oppose it have argued that the ban will trigger an exodus of doctors from public to private practice, and thereby worsen the nation’s already fragile healthcare delivery system. Some medical doctors, including members of National Association of Resident Doctors (NARD), have advised government against the ban because they consider it a time-bomb that could explode and throw public health institutions into disarray.
NARD President, Federal Medical Centre, Abuja, Dr. Emmanuel Obayi, said the ban will witness an exodus of brilliant and very experienced doctors from public to private hospitals where the remuneration is higher and more regular. On the contrary, the Chairman of the Committee of Chief Medical Directors of Federal Tertiary Hospitals, Prof. Thomas Agan, supports the plan to stop public health workers from engaging in private practice, stressing that it is one of the ways to restore sanity in the health sector. This is a matter which the government needs to treat with caution.
But, what do Nigerian laws and professional ethics say on this burning issue? The Code of Conduct for Public Officers in the 5th Schedule of the Nigerian 1999 Constitution, (as amended), precludes all full time employees of the government from engaging or participating in the running of any private business, profession or trade, except farming. And, there is no arguing the fact that doctors in government hospitals are full time public officers. However, Part E, 49 of the 2008 Code of Medical Ethics avers that medical practitioners and dental surgeons in full time employment in the public service in Nigeria are free to engage in private medical or dental practice in their spare time. The provision of this Code is contrary to the position of the extant 1999 constitution and, as Section 1, subsection 3 of the constitution says “If any other law is inconsistent with the provisions of this constitution, this constitution shall prevail, and that other law shall to the extent of the inconsistency be void.”
Without preempting the recommendation of the committee set up by the government to consider this matter, we advise that the government consults widely before taking a decision. The issue of public servants engaging in private practice should also not be restricted to doctors alone.
Allowing doctors in public service to engage in private practice has its advantages and disadvantages. With the shortage of experienced medical doctors in our public hospitals on account of the brain drain to other countries, the poor remuneration of health officials in public institutions, and the paucity of required medical equipment, an outright ban of private practice among the doctors may worsen the shortage of doctors and threaten the delivery of quality service to the people. It may also further encourage more medical doctors to look for greener pastures overseas. Some of the doctors in the public health institutions may move to private health facilities which have prospects for higher remuneration and better medical equipment.
On the other hand, allowing doctors in public hospitals to engage in private practice creates the problem of conflict of interest and divided loyalty, which also compromises the quality of service. Instead of a ban, government may be better off coming up with stringent rules to ensure that public sector doctors and all other public sector workers live up to their responsibility, and stiffly sanction them when they do not. The doctors should be made to do the jobs for which they are paid.
Government should also embark on the training of more doctors, considering that the number of doctors in the country is not enough for our population. It should make plans to increase the welfare of doctors to curb the incessant brain drain in the sector. Our doctors should be paid competitive wages. They are yet to be paid wages that are commensurate with their qualifications and responsibilities. Increasing the salaries of doctors will stem the frequent industrial actions in the sector. Above all, government should ensure that all health workers in the public sector offer quality services to the people. It should also properly equip the hospitals to reduce the frustrations fueling the unbridled movement of doctors outside the country and medical tourism by top public servants and other affluent Nigerians.