Academic Crises: Underpaid Medically-Qualified Lecturers and the 94-Day MDCAN UCH Strike

On the 21st of May, 2024, the UIMSA Press published an editorial titled ‘The Cost of Making New Doctors’. That article addressed the hike in fees that has plagued the students of the University of Ibadan since the start of the 2022/2023 academic session, particularly the student doctors who pay the most fees, courtesy of the Health Professional Training Levy (HPTL). Unfortunately, the concerns in that editorial are still very much valid today.  Student associations under the College of Medicine, University of Ibadan (CoMUI), crowdfunded to pay their members’ fees for the just concluded 2023/2024 academic session. Again, unfortunately, a series of events from as far back as a decade ago has shown that the cost of making new doctors is far beyond the fees these students pay during their time in medical/dental school. As a UI medical/dental student reading this, the cost of your emergence as a doctor in Nigeria is significantly more than your promptly paying over 250,000-plus Naira in school fees – that’s if those numbers do not skyrocket in the 2024/2025 academic session.

As of the time of this story, MBBS/BDS clinical students would have been out of school for about 94 days, due to the Medical and Dental Consultants Association of Nigeria, University College Hospital (MDCAN UCH), strike that has been on since December 13th, 2024. These students – God’s strongest soldiers we dare say – have been rendered perpetual city-criers. Crying out to get access to basic electricity, crying out to remain in school after paying so much for education in a federal university, and then waiting on what next tears would be shed for. 

In light of the situation, we sought explanations on why over 500 students are out of school, in-limbo. The journey towards answers is a long ride. Stay with us.

Underpaid Academic/Teaching Consultants in Clinical Sciences, UCH

For the sake of non-medically inclined readers, we’ll try to make this as simplistic as possible while providing some background information. Consultancy is the professional practice of advising in a field of expertise, medical advice in this context. At the University College Hospital, Ibadan, there are two categories of consultants. We have the core clinical/hospital consultants and teaching consultants. UCH primarily employs the former to offer hospital services to patients. The latter are employed by UI primarily to teach clinical students with real-life medical situations in UCH. While both categories have different employers, the reality is that teaching consultants attend to the patients via whom they teach clinical students, such that they offer services to both UI and patients admitted to UCH. Clinical consultants report to UCH, and teaching consultants report to the College of Medicine, UI.

You can interpret the explanation in the previous paragraph to mean that the Clinical consultants are paid by UCH and the teaching consultants by UI. As a clarification to the speculations dancing in the minds of many, our source – a member of Faculty – confirmed that these Clinical consultants, depending on their level, earn about 800,000 to 900,000 Naira monthly. Their colleagues who teach students and attend to patients alongside currently earn about 300,000 to 400,000 Naira monthly plus a ‘small amount of money’ as clinical supplementation. If you are wondering if you read wrongly, you did not. If anything, you would expect that this category of consultants should be paid more given their dual workload. Sadly, we would further learn that the inferior amount they currently earn is paid by the hospital as a clinical duty allowance and clinical supplementation – for services rendered to patients. Their primary employer, UI, pays them nothing. It’s a situation as bad as working for years without getting paid; an anomaly they can no longer put up with, hence the strike action. 

Underpaid Medically Qualified Lecturers in Basic Medical Sciences, UI

While the academic consultants under MDCAN fight for fair pay in UCH, the medically-qualified lecturers who teach preclinical students (200 and 300 Level) are also fighting for fair pay in UI. In their preclinical years, MBBS/BDS students are under the tutelage of medically qualified lecturers – lecturers with undergraduate MBBS/BDS degrees – in the Faculty of Basic Medical Sciences (Departments of Anatomy, Physiology, and Biochemistry). This arrangement has remained an ideal situation over the years and is a major criterion for accreditation by the Medical and Dental Council of Nigeria (MDCN). Unlike the doctors on the Clinical end, these doctors don’t require actual patients to teach preclinical students. Ethically acquired cadavers are used to teach Anatomy, in particular. As a result of their non-medical practice, they earn considerably less than their Clinical colleagues in full-time practice. 

This pay-gap’s first, minor, ripple effect is that doctors tilt towards clinical work in UCH far more than academia UI. To be fair, only a few individuals go into medicine and dentistry with academic inclinations. Another ripple effect of that salary gap is the potential short-staffing of medically-qualified lecturers in Basic Medical Sciences. According to our source, in a bid to balance the gravitation, these doctors are to be paid 75% of the clinical duty allowance in addition to the base salary earned by their colleagues in UCH – as a consolidated payment since they don’t attend to patients. 

Initiated by the Committee of Provosts who informed the federal government about the situation, the said medical doctors were given this consolidated payment until April 2018, when the University of Ibadan, via the Bursar’s Office, stopped paying without a formal consultation or notice. The Medical and Dental Specialists Association in Basic Medical Sciences (MEDSABAMS), an affiliate of the Nigerian Medical Association (NMA), wrote to the then CoMUI Provost, Professor Eniola Olapade-Olaopa, copying the Financial Comptroller of the College, but nothing happened. They further wrote to the Court of Governors which is the College’s version of the University Council. Persistent silence prompted the national body to write to the then Vice Chancellor, Professor Idowu Olayinka, copying the bursar and the University Council. This council consists of members from the Ministry of Education, members appointed by the federal government, and voted members of the Academic Staff Union of Universities (ASUU) also known as internal members. After a series of letters sent to various offices, they received a confirmation from the VC that the bursar had stopped the allowance on the basis that “there was no money to pay these doctors”. The bursar was asked to produce the circular that communicated the situation before halting the payment and he supposedly couldn’t. The Court of Governors demanded that the university return payment to the status quo but nothing was done and letters were sent again, copying the necessary offices. The then council gave an order for the payment to be returned which was supposed to be implemented by the VC through the bursar’s office per due process. However, the VC didn’t implement it until he left office.

This issue lingered until the current VC, Professor Isaac Adebowale, assumed office. Along the line, the federal government integrated the information of universities’ academic staff into the Integrated Personnel and Payroll Information System (IPPIS) against ASUU’s will. ASUU had resisted ab initio on the basis that operations within universities are not as it is in civil service so the federal government was not to use the system for both. Payment issues worsened when academic staff started getting paid from the country’s capital because it meant that communicating any displeasure like a reduced salary would require a trip to Abuja. The university lost some staff to that new development and the Medical and Dental Specialists in Basic Medical Sciences Association continued the fight for clinical duty allowance restoration through the office of the then Accountant General and the Minister of Labour, Chris Ngige, who is ironically a medical doctor by training. They appealed to the federal government and the payment was restored about 18 months ago. However, our source confirmed that arrears weren’t paid to the UI staff because it was a local issue, within the university system.

The affected medical doctors got their payslips from the university. However, the university did not have the power to stop the clinical duty allowance because the federal government paid through IPPIS. When President Bola Ahmed Tinubu’s administration came in, universities were granted autonomy in paying salaries, again via legal backing. Many Northern universities migrated their lecturers back to their university’s payment system, paying what they got from the federal government through IPPIS. However, this wasn’t the case in select southern federal universities like the University of Ibadan, Lagos, Benin, and the Obafemi Awolowo University, Ile-Ife. In UNIBEN, lecturers began to resign and the VC was forced to implement the clinical duty allowance restoration after an investigation. A not-so-similar situation happened in UNILAG and order was restored. All this happened in the last year, except in one university – ours. And now, like wounded soldiers of a never-ending war, these doctors, have been forced to the renegotiation and soft protest tables they abandoned pre-2023. 

Consequences

It takes having one or two medical students as friends or relatives for the consequences of all these to become more telling. In a hypothetically sane environment, a medical student will spend an extra two or three years in school after his mates, who came in for four-year courses, have graduated. The keyphrase there is ‘hypothetically sane’ because nothing about Nigeria is sane. An average medical student in a federal university in Nigeria will spend 8-9 years studying a 6-year course – courtesy of academic strikes and other absurd reasons. 

To better put things into perspective, the current 600-level medical and dental students of the University of Ibadan came into school on Sunday, 22nd of April, 2018. This is March 2025, seven years later, and they don’t see themselves writing their final exams anytime soon. That might not look unusual until you realise they resumed clinical school (400-level) in 2021. Some have had to revisit their 1st of January, 2025 tweets stating this is the year they become doctors, with depressing quotes expressing uncertainty. The current 400-level students had their White Coat ceremony – to mark their entry into clinical school – on the 15th of April, 2024, and were expected to write part II MB exams in July 2025. This is March 2025 and they don’t see that happening anytime soon. The current 300-level medical students just finished their Part I MB exams on the 26th of February, 2025, and they can’t, even with the help of a telescope, see themselves resuming clinical school anytime soon. The current 200-level students don’t even know their fate. Would they also write MB I and be stuck with 300-level students? Come April 2025, there will be seven classes in MBBS and BDS at the University of Ibadan, with the final-year students not knowing how long before they don the induction mufflers. The students who have paid inordinate fees to learn the science of medicine are now suffering for it. The affected consultants are not ready to back down on their fight – rightly so. Students are even more helpless. The cost of making new doctors now includes hope, prayers, and wasting away while we watch our mates in other disciplines move on with their lives.

These scenarios indicate how disastrous this MDCAN strike will be if not resolved soon. In the case of the underpaid medically qualified doctors in basic medical sciences, short-staffing is not an exempted ripple effect. Basic Medical Sciences now has far fewer lecturers in the faculty than they did at the beginning of the 2022/2023 academic session. The Department of Physiology went from about five medically-qualified staff to one, and even that lone figure is debatable due to the lecturer’s appointment in UCH. In the just concluded session, the Department of Anatomy lost two doctors to relocation and favourable conditions elsewhere. If that does not communicate our dire situation, the department went from having 12 medically qualified doctors to a current 6 – with no shot at replacement anytime soon. It’s a no-brainer that they would lose more in subsequent years, not due to retirement but to resignation. The department has put out calls for applications many times, but no applicants seem to be interested, considering the gap between deserved salary and paid salary. If this goes on without an intervention, the College of Medicine, UI, will fall short of the criteria imposed by MDCN and the National University Commission (NUC) for accreditation. The future of undergraduate medical education at UI is at stake and not many people seem to realise the gravity of that imbalance.

As our source put it, many doctors who previously worked under UCH but resigned to join the College of Medicine, UI, to pursue promotion and academia incentives now regret the decision. They are stuck with burdensome work without commensurate pay. This distinction between UCH and the College of Medicine, UI, even extends to basic issues like electricity distribution. The former is headed by the Chief Medical Director (CMD) and the latter, by the Provost. The CMD is primarily responsible for the hospital and to the Ministry of Health. On the other hand, the Provost remains obligated to the university. This dichotomy wasn’t the norm until Prof Olikoye Ransome-Kuti became Nigeria’s Minister of Health. That is one of the reasons students could protest for a 100-day plus blackout in UCH and power would be restored to the hospital, leaving out medical students’ residences. It’s politics, somewhat.

As at the time of writing, the best that has been done so far are stalled negotiations with a supposed intervention to take place soon. Our source confirmed that meetings have been going on but none seems to point the affected parties and onlookers to a light at the end of the tunnel. With just six days until another 100-days anniversary, severe actions need to be taken by the University to rectify these issues and protect the future of the nation’s brightest minds, as well as the hands that mould them. ‘Ibadan Medicine!’ and ‘Ibadan Dentistry’ should be more than just chants. For the millions of lives dependent on the emergence of these students as doctors, the Federal Government has to intervene. They must honour their 22nd November 2024 resolution to migrate all medical lecturers to the Consolidated Medical Salary Structure (CONMESS). The alternative is death; of dreams, our prestige, and the health sector, slowly but surely.

Emmanuel Ibitunde

Peter Adeyemo