The unethical practice of government-employed physicians sending patients to private clinics has been denounced by the Nigerian Medical Association (NMA) and the Medical and Dental Council of Nigeria (MDCN). Although it is legal for consultants with ten years or more of expertise to operate private clinics beyond regular business hours, their scope is tightly restricted to consultations; they are not permitted to perform procedures or accept patients. Referrals to their government hospital are required for any essential treatments. Allegations of patient diversion continue in spite of these rules, leading to enquiries and disciplinary measures.
Also, in a recent warning against this practice, for example, the Abia State Government said that any doctor found guilty would be subject to severe penalties. When two nurses and a doctor in Anambra transferred patients from a government hospital to private facilities, their wages were halted. Similar to this, the University of Ilorin Teaching Hospital began looking into these claims against its employees in July 2023. Dr. Enejo Abdu, MDCN Deputy Registrar, explained that any physician found to have engaged in this misconduct may be subject to sanctions, such as the suspension or permanent cancellation of their medical license.
In Nigeria’s healthcare system, patient diversion remains a serious concern.
Based on official complaints, these cases are investigated and prosecuted by the Medical and Dental Practitioners Investigation Panel and the Medical and Dental Practitioners Disciplinary Tribunal. Prof. Bala Audu, president of the NMA, pointed out that proper process must be followed before any action is taken and that many patient diversion claims are still unsubstantiated. In Nigeria’s healthcare system, patient diversion—the practice of government-employed physicians moving patients from public hospitals to private clinics for their own benefit—remains a serious concern. In addition to undermining public confidence, this unethical behaviour puts a financial pressure on patients and puts further strain on Public Health institutions’ already meagre resources.
According to a study done in South-East Nigeria, 8.4% of the 407 respondents who first sought care in public hospitals were sent to private institutions run by the attending public hospital physicians. The doctors or, occasionally, the nurses, were the ones who started the diversions. Patients who are subjected to such diversions frequently have significant financial difficulties. According to the same survey, the average cost of care in private hospitals was roughly ₦32,104 ($105), while the average cost in public hospitals was estimated to be ₦9,960 ($33).
Healthcare system frequently suffers from overpopulation.
Due to the higher expenses, over half of these patients said they had serious to extremely bad financial consequences. Many turned to borrowing money, selling personal belongings, or making out-of-pocket payments in order to make ends meet. With the exception of farming, public officials are not allowed to engage in private practice under Section 2(b) of the Fifth Schedule of the Nigerian Constitution. Medical professionals are excluded from the Regulated and Other Professions (Private Practice Prohibition) Decree No. 1 of 1992, which permits them to practice privately after hours. The purpose of this exception is to strike a balance between the possible dangers of conflicts of interest and the necessity for more medical services.
There are several reasons why patient diversion is so common. Nigeria’s healthcare system frequently suffers from overpopulation, a lack of facilities, and a shortage of medical supplies, which makes some doctors look for better places to work. The incentive to divert patients is increased when doctors augment their income through private practice due to inadequate compensation in the public sector. Given the high workload and 30:100,000 doctor-to-population ratio, physicians may choose to operate in private practice, where they can treat fewer patients in better circumstances.
Related Article: State of the healthcare system in Nigeria
Enforcement is still difficult despite current regulations. The Medical and Dental Council of Nigeria (MDCN) is in charge of overseeing medical practice and dealing with unethical behaviour. However, systemic problems, such as insufficient resources and monitoring, frequently make enforcement actions less effective. Although several examples have resulted in enquiries and penalties, there hasn’t been much of an overall effect on reducing patient diversion. Nigerian patient diversion is a complex problem with roots in structural issues in the medical field. To solve this issue, all-encompassing approaches are needed, such as enhancing working circumstances, providing competitive pay, and fortifying legal frameworks to safeguard patients and maintain moral medical standards.