It is now a perennial
problem for fresh medical graduates and others in
related medical sciences to secure placements in
the nation’s tertiary health institutions for further
training and specialisation.
Also, some of them like fresh Dietitians and
Nutritionists, specialists in the study of food and
nutrition in relation to health, have only four
institutions where they can go for their internship.
These are the Lagos University Teaching Hospital
(LUTH), Idi-Araba, University of Nigeria Teaching
Hospital (UNTH), Enugu, University College Hospital
(UCH), Ibadan and Obafemi Awolowo University
(OAU), Ile-Ife.


A national survey by the News Agency of Nigeria
(NAN) indicates that the situation is so because of
inadequate funding, lack of infrastructure and
regulation of the number of medical students.
Some stakeholders in the health sector believe that
these were some of the factors hindering the
absorption of doctors, pharmacists, medical
laboratory scientists, radiographers and
physiotherapy graduates in the institutions for
internship or housemanship.
NAN reports that it is mandatory for fresh medical
graduates to embark on a 12-month uninterrupted
housemanship/internship in approved hospitals
and health institutions.
However, in recent times, it has become
increasingly difficult for this crop of medical
personnel to get their placements.
This has led to a large number of them staying at
home for two years, being the time limit for the
provisional licence without getting
placement.


Some medical experts who spoke to NAN also
identified insecurity in some parts of the country,
increase in the number of graduates from medical
institutions and inadequate health institutions as
part of the problems.
Others, they said, included lack of uniform curricula,
non-functional general hospitals and lack of
political will on the part of government officials.
Dr Lekan Ojo, a Nephrologist and Senior Consultant
with the Federal Medical Centre, Owo, Ondo State,
said the country did not have enough institutions to
cater for the teeming number of interns that were
seeking for internship placements.
``Many training centres have exceeded their quotas,
yet they still go ahead to take more people until the
council starts sanctioning them.
``Many candidates also insist on where they want to
do their internship because of payment involved.
``This resulted in non-accreditation of many training
centres because of poor funding from the
government.
``Also, there should be synergy between the
regulatory agency, medical directors and the
respective training institution as well as the Medical
and Dental Council of Nigeria,’’ Ojo said.
Dr Jide Idris, Lagos State Commissioner for Health,
attributes the situation to the non-availability of
spaces compared to the number of medical
students being churned out every year from
universities.
``There are more medical graduates than the
available spaces and the resources.
``We are churning out more doctors, pharmacists
and other medical personnel every year because
everyone wants to study medicine and the
universities are admitting students excessively.
``The case is peculiar to Lagos because it is
saturated,’’ Idris said.


Dr Grace Ijarogbe, a Consultant at the Federal
Neuropsychiatric Hospital, Yaba, Lagos, agrees that
non-availability of spaces for housemanship posed
a serious problem to effective healthcare delivery.
She also said that funding and non-alignment of
uniform curricular were major deterrents, adding
that non-availability of spaces for housemanship
was a serious problem.
``I think it is the incapacity of government to pay for
the internship period.
``There are many teaching institutions across the
country where they can train, and what is needed is
a firm policy and restructuring of the academic
timetable to accommodate every individual.
``The different institutions graduate people with
different policies and they also employ doctors with
these policies. There should be a uniform timeline.
``For example, if it is August or November that
students are to be graduated or taken in, it should
cut across all the institutions.
``So, as they are being absorbed immediately,
others will perhaps be leaving. It can also be twice a
year,’’ Ijarogbe told NAN.
``But, where you have some institutions finishing in
June, some in August and others in January, it
poses a bit of challenge as most
recruitment can be in November and definitely, there
will be overlaps.
``Again, governments should increase funding to
ensure that the curriculum for medical schools is
the same in all the institutions.’’
Commenting, Dr Oyetayo Jeje, a Senior Registrar at
the Federal Neuro-Psychiatric Hospital, Yaba, said
the difficulty was as a result of the number of
graduates being produced yearly.
Jeje, who is the President, Association of Resident
Doctors (ARD), also blamed the insecurity in some
parts of the country for the problem.
``Lots of people, because of insecurity in the
northern part of the country, do not want to go to
that area for their internship or housemanship.
``There is now a lot of concentration and pressure
on a particular region where there are no security
challenges.
``The Federal Government can help in this area by
intensifying the fight against terrorism,’’ Jeje said.


In Ibadan, Oyo state, Dr Tosin Odulami of Ifetayo
Hospital, said: ``Government should scale up
funding and rehabilitate tertiary hospitals so that
many medical graduates will be admitted without
putting further strain on the health institution’’.
Also a pharmacist, Yemisi Oluwo, said that the
issue of internship placement was not as difficult for
others as that of doctors.
``The reason why many pharmacists want to do
their internship in a hospital is because of the
attractive pay.
``However, once you overlook the pay, there are
many community pharmacies that have been
approved by government to provide internship,’’
she said.
In his contributions, Prof. Oluronbi Odunubi, the
Managing Director, National Orthopaedic Hospital,
Igbobi, Lagos, said: ``We admit according to the
dictates of the Medical Guild of Nigeria and West
Africa.
``The supervisory college prescribes the number of
students we can take out of a list of students that
apply in relation to our capacity.
``We cannot take more than the quota giving to us
as this may attract sanctions; we operate under
strict guidelines and rules by the guild.
``What they take into consideration is the number of
patients, how many consultants and they will also
tell you how many trainees you can have,’’ Odunubi
said.
Dr Theophillus Umeizudike, a Consultant
Nephrologist at the Lagos State University Teaching
Hospital (LASUTH), Ikeja, identified limited training
positions and increase in medical schools as some
of the factors.
``There are limited training positions for internship
in the last few years and this has hindered fresh
doctors and pharmacists from getting placement for
the mandatory one year housemanship.
``In essence, there is a direct relationship between
the number of training spaces for internship and the
number being turned out by the various
institutions,’’ he said.
The Nephrologist said that to close the gap, there
was need to create more training positions by
encouraging the state governments to employ more
consultants to manage the various state general
hospitals.
According to him, this will definitely provide the
increased manpower to cater for the new trainees.
Umeizudike said that the private sector or hospitals
should be encouraged to engage more trainees
than they currently do.
``The state and federal governments can offer to pay
these graduates while on internship.
``The Nigeria University Commission (NUC) should
impress it on the universities and teaching hospitals
to retain up to 75 or 80 per cent of their graduates
to ensure that they have an internship position.
``The Medical and Dental Council of Nigeria (MDCN)
needs to be proactive in resolving this situation
where medical graduates wait for more than two
years after graduation to get placement for
internship,’’ he said.


From Ondo State, Dr Ismaila Busari, the Secretary,
National Association of Government General
Medical and Dental Practitioners, called for the
regulation of students being admitted into medical
schools.
Busari said that if MDCN could take this step, it
would go a long way to mitigate the challenges of
fixing young doctors for internship.
``If admission into the medical schools is not
regulated on time, the problem of fixing or getting
doctors for internship will rise to an alarming rate.
``Hospitals are scared of taking in many doctors on
the programme because of the cost implications.
``I do not think any hospital can pay less than
N150, 000. Now, imagine having like 20 or 30 at a
time,’’ Busari, who is a Senior Medical Officer in the
state said.
In Umuahia, Abia, Dr Nnamdi Ojimadu, says the
revival of moribund state general hospitals across
the country will create room for fresh medical
graduates to serve their one year internship.
Ojimadu, who is the chairman, Nigerian Medical
Association (NMA), Umuahia Zone, attributed the
worrisome development to the few number of
accredited hospitals.
He said that general hospitals in Aba, Ohafia and
Uzuakoli were no longer functional.
He added that the only accredited centres in Abia
were the Federal Medical Centre (FMC), Umuahia
and Abia State University Teaching Hospital.
He noted that each accredited centre had its quota,
ranging from 25 to 30, and that for any hospital to
be accredited it must satisfy the standard laid down
by the MDCN.
Ojimadu said that at least 500 potential interns
wrote the tests at FMC, Umuahia but regrettably,
only 30 persons were taken.
``There should be a synergy between the Federal,
State and Local Governments to revive and equip
the non-functional general hospitals and
consultants to train the interns,’’ he said.
Also, Prof. Paul Ezeonu, a former Chief Medical
Director, Federal Teaching Hospital (FTHA),
Abakaliki, appealed to government at all levels and
wealthy individuals to rescue the nation’s health
facilities.
He decried poor subvention to the teaching
hospitals, describing it as major constraint affecting
the absorption of these categories of medical
personnel.
``Available records show that intake of medical and
health graduates, including doctors, pharmacists
and laboratory scientists for housemanship is on
the decline.
``Funds are not made available for the hospitals to
engage these personnel for the programme in view
of the huge cost involved in remunerating them,’’
Ezeonu said.


A former Commissioner for Health in Ebonyi, Dr Zigy
Nwagene, expressed regret that many medical
students passed through difficulties in securing
placement for internship.
He identified inadequate funding of health
institutions and limited space to absorb the large
number of graduates for the programme as some of
the problems.
Nwagene urged government at all levels to increase
budgetary allocation to the health sector to enable it
to accommodate more medical students for the
programme.
From Benin, Edo, NAN learnt that medical doctors
and pharmacists decried the inability of medical
students to secure spaces for their one year
compulsory housemanship/internship.
Dr Omorogbe Owen, the president, Association of
Resident Doctors, University of Benin Teaching
Hospital (UBTH) Chapter, said that accommodation
of graduate doctors for housemanship varied from
one hospital to another.
According to him, while some hospitals have
increased the number being absorbed, others have
reduced the number due to several factors.
``I don’t have the current statistics for doctors on
housemanship in UBTH, but I know there is a
decline in the number being absorbed due to
financial issues and personnel cost,’’ he said.
A pharmacist on internship in one of the
government hospitals in Benin, who pleaded
anonymity, said the Nigerian factor had made it
difficult for pharmacy graduates to undergo
internship.
According to the intern, you need to know someone
before you can be absorbed in a government
hospital to undergo the programme.
She said that most of her friends, who graduated the
same time with her, had yet to get spaces in
hospitals for internship.
In Lafia, Nasarawa State, some medical experts
want the state government to build more medical
facilities and upgrade the existing one to cater for
the increasing number of patients in the state.
Dr Omolei Friday, state chairman of NMA, said that
fresh doctors usually encountered difficulties in
getting where to undergo the one year mandatory
housemanship in the state.
Friday said that the difficulties were largely due to
inadequate public health facilities to provide the
training, mentorship and supervision of the interns.
``Apart from that, there is also inadequate number of
required specialists and consultants that will train
the interns.
``If government at all levels can build more medical
facilities and upgrade the existing ones, then
medical students will have places to undergo their
housemanship,’’ he said.
Dr Egba Edego, the Chairman, Medical Development
Committee of Dalhatu Araf Specialist Hospital
(DASH), Lafia, blamed the challenges on the limited
slots provided by MDCN and shortage of resources.
Edego said that the number of doctors and
pharmacists graduating every year from medical
schools was more than the existing medical
facilities.


From Birnin Kebbi, NAN reports that the rejection of
fresh medical doctors and pharmacists for
housemanship and internship respectively, was due
to limited spaces allocated to the hospitals by the
regulatory bodies.
Dr Balarabe Aliyu, the Head of Clinical Services,
Federal Medical Centre (FMC), Birnin Kebbi, said
that presently, only 12 medical students were
absorbed at the centre.
``The previous year, the centre received 12 students
on housemanship but it has the capacity to absorb
24 to 30, but we were compelled to abide by the
limit of the regulatory body,’’ Aliyu said.
He said that the centre had applied for additional
slots for doctors on housemanship for effective
service delivery.
Aliyu said the centre also built a 20-apartment
hostel accommodation for medical students on
training and they were placed on monthly salaries
commensurate with what the policy stipulated.
From Kaduna Zone, the survey indicated that no
fewer than 2,000 medical doctors graduated
without undergoing housemanship.
A medical practitioner, Dr Abdulrahman Shehu, who
is also the NMA secretary in the state, said that
government at all levels should create more
vacancies for doctors and pharmacists to undergo
housemanship.
He said that most general hospitals did not have the
required manpower and equipment to enable the
doctors to undergo their housemanship.
``This is a pre-requisite for a doctor to acquire
before he/she is registered, if not, the person
cannot practice,’’ Shehu said.
He said that private hospitals could also be
upgraded and accredited for the medical doctors to
use for housemanship.
Shehu said: ``We have a situation where doctors
graduate and stay for over four months without
securing a place for housemanship.
``Some of the accredited hospitals in turn sell forms
for as high as N5, 000 to thousands of applicants
and later employ just 30 or less. This situation
needs to be addressed.’’
In Kafanchan, Dr Zakka Musa, a private medical
practitioner with Sauki Hospital, Kafanchan, urged
governments to make it mandatory for the
absorption of medical doctors temporarily in their
places of primary assignment as National Youth
Service Corps members.


In Yenagoa, Mr Solomon Edere, the Director,
Medical Laboratory Science, FederalMedical Centre
(FMC), blamed insufficient health facilities for the
inability to absorb fresh medical doctors and
pharmacists for housemanship.
Edere said that if adequate health establishments
were available, many medical graduates would be
absorbed for the mandatory internship or
housemanship.
``The main reason is that admissions into the
universities are more than the training institutions
on ground.
``Government at all levels should initiate plans to
overcome these challenges.
``On our own part, we have been taking the number
that we can accommodate.
``Normally, we have 60 interns approved for us, but
we cannot not take such a number because of
limited available facilities,’’ Edere said.
Also, Dr Godspower Eseimokumoh, the Director,
Medical Science, Bayelsa State Ministry of Health,
said the ministry was up-to-date in absorbing fresh
medical doctors, pharmacists and laboratory
scientists for their internship.
According to him, the Ministry of Health in Bayelsa
absorbs 300 fresh graduates annually and has
taken the number for 2015.
``Well, absorbing them depends on what is in the
budget, we do not restrict them, but we are doing
things according to budget.
``We are taking 150 doctors, 75 pharmacists and
75 for medical laboratory scientists, totalling 300 in
the ministry,’’ the director explained.
The NMA Chairman in Bauchi State, Dr Muhammad
Yusuf, blamed the Federal Ministry of Health and
MDCN for the restriction placed on the training of
house officers at a given time.
Yusuf said that as a result of this, most house
officers had to wait for one year in some cases
before proceeding for their training.
He said that each training institution was expected
to train house officers in four departments --
Gynaecology, Obstetrics, Paediatric and Surgery --
for a period of three months each.
``Therefore, since the number of graduating
students is increasing, they probably have to wait
for those that are already receiving their training,’’
Yusuf said.

The story is not different in Katsina State as Dr Kabir
Suleiman; NMA Chairman, says that lack of
adequate training centres was militating against the
absorption of fresh medical doctors and
pharmacists for housemanship.
Suleiman said that there was a criteria set up by the
regulatory body for a hospital to qualify as a training
centre for fresh doctors and pharmacists.
He said that before a hospital could qualify to serve
as a training centre, it must have consultants that
would train the new doctors.
He said that the situation had impacted negatively
on some health institutions in the northern part of
the country.
According to him, Katsina State has shortage of
medical doctors due to the mass movement of
doctors and consultants out of the state and lack of
training centres for fresh doctors.
Suleiman appealed to the regulatory body to provide
more training centres for the doctors and
pharmacists to enable them to contribute to the
development of the nation.


Some of the affected interns expressed their
displeasure over the unpleasant situations they
were passing through in seeking for placement.
Mr Martins Francis, a final year medical student at
Usman Danfodio University, Sokoto, urged
unemployed doctors to take advantage of their
period of waiting to acquire additional qualification.
``The world is increasingly becoming competitive
and as such, one must be up to date to have an
edge over his or her peers,’’ Francis said.
Also, two final year medical students at the Lagos
State College of Medicine, appealed to the federal
and state governments to build more hospitals that
would absorb more house officers.
One of the students, Mr Moses Ibrahim, said that he
applied for internship at the LUTH in September with
the hope to be absorbed.
``If I am given the licence and I do not get a
placement by December, 2016, my licence will
expire.
``What it means is that I will have to apply for
another examination to be conducted by MDCN.
``It is really a challenging experience for house
officers,’’ he said.
Another student, Mr Yusuf Abdusalam, appealed to
governments at all levels to build more hospitals.
``I also applied at LUTH and about 1,000 house
officers applied in the same institution and the
chances are very slim.
``Most house officers concentrate more in the
Southern part of the country to do their
housemanship due to the crisis in the North-East.
``This is a contributory factor to why there are more
house officers looking for placements where there
are no facilities to work,’’ he said.


Also, Mr Ogbonnaya Chukwu, an intern at FMC,
Yenagoa, attributed their ordeals to ``too much
politicking in the health sector’’.
According to him, politics that is inherent in the
hospital management boards and small size
capacity of the laboratories are major contributing
factors.
``Some hospitals are in the habit of selling forms to
thousands of candidates and end up taking less
than 30.
``The process is far from being transparent and
from my own perspective, this amounts to taking
undue financial advantage of the hapless
candidates, who are desperately looking for
placement for housemanship.’’
Another intern, Mr Joe Anya, blamed the situation
on poor funding of health institutions.
Also, Chinazam Onwusiribe, said that many
hospitals were willing to absorb interns within the
limit of their resources and urged the Federal
Government to increase funding of the institutions.
``Engaging interns for the one year training is
additional burden to the hospitals.
``Although, they may be willing to take as many as
possible, they are constrained by the paucity of
funds,’’ Onwusiribe said.
Reacting, Mr Moses Onwe, a graduate of laboratory
science, University of Nigeria, Nsukka, said that
since 2013 when he graduated, he had yet to find
an approved health institution for his
housemanship.
Onwe urged the medical bodies to do the needful to
alleviate the sufferings being faced by fresh medical
graduates in searching placements in institutions.
He said they needed a document to prove that they
have undergone the programme in their respective
profession and become qualified professionals.
``If you go to any hospital or health facility looking
for a space for your housemanship, all you will hear
is that there is no space or the hospital has no
money to pay,’’ Onwe said.



But Dr Ayoade Adedokun, the Chairman, Medical
Advisory Committee of LASUTH, said there was
need to increase the number of hospitals that would
absorb house officers.
``I do not believe we have enough institutions to
take them on as interns and house officers.
``Some of the reasons are that we need certain
calibre of senior doctors to oversee the work of
these officers; unfortunately, we don’t have enough
of those doctors.
``We must pay the house officers some allowance,
because it is a tedious period for them; it is also a
problem as not many hospitals are ready to pay
them,’’ he said.
He disclosed that LASUTH was in the process of
interviewing about 300 house officers of which the
institution planned to absorb about 80 of them.
He said: ``Again, there is an accreditation to be done
by the MDCN because no hospital can take more
than what is allowed by the council.
``MDCN does the accreditation periodically and
assesses the calibre of doctors that are available’’.
(NAN)


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