LARA ADEJORO writes on how the failure of the government to address the demands of doctors led to industrial disharmony in the health sector and how it can be resolved
The failure of the government to meet the long-pending demands of doctors and other healthcare workers usually plunges the fragile health sector into a health crisis.
When healthcare workers withdraw their services from hospitals, there is always diminishing medical services and patients suffer as a result.
Strikes in the health sector portray a barrier to achieving Universal Health Coverage as envisaged by the World Health Organisation.
According to the WHO, UHC means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship.
“It covers the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course,” WHO said.
The global health body said the delivery of these services requires health and care workers with an optimal skills mix at all levels of the health system, who are equitably distributed, adequately supported with access to quality-assured products, and enjoy decent work, which is consistent with the Sustainable Development Goal Three of the United Nations.
The just concluded five-day warning strike by the members of the Nigerian Association of Resident Doctors, who make up a large number of Nigeria’s doctors depicts how tens of thousands of Nigerians are left without access to medical care.
The 12,000 resident doctors across 79 tertiary health facilities embarked on strike on May 17, to press home their demands.
While medical and dental consultants, nurses, and other paramedics tried to cushion the effects of the strike, many patients still struggled to access care.
Checks at the Surgical Out-Patient, Gynaecology, General Out-Patient, Medical Out-apatient and Medical Outpatient departments at the National Hospital, Abuja, showed that most of the patients were being attended to by nurses, consultant doctors nurses.
Some patients who spoke with our correspondent lamented delay in getting health care.
A patient at the Surgical Out-Patient department, Bako Shuaib said he was waiting to be attended to as of 11am since he arrived at 8 am.
“I am a police man and I came here since 8 am but I have not seen any doctor. They have gotten my details but I am still waiting . I am having a serious headache so I will have to wait till when they attend to me.”
Another patient at the medical Out-Patient department, Ms Abu said she was not aware of the ongoing strike.
“I just came to the hospital this morning, I didn’t know doctors are on strike, I am just hearing now. I have been here since but they said we should wait and they will attend to us one after the other. Some people who were here with me have left,” she said.
Also at the Federal Medical Centre, Jabi, Abuja, there was less medical activities while there was skeletal medical services being rendered to patients.
Our correspondent also observed that there was a low turnout of patients at the hospital.
Lamenting, a female patient who identified herself simply as Nkechi said she was yet to be attended to at the Surgical Out-Patient department at the FMC.
She said, “I have been here since 7 am and this is past 9 am and I have not been attended to. I am still waiting to be attended, even though it’s slow,” she said.
Another patient at the General Out-Patient department at the hospital, Stephen Onoja said, “I am still waiting for them to attend to me. This is my first time here and this is almost 10 am.”
Our correspondent observed that pregnant women who came for the antenatal clinic were also being addressed and attended to by some nurses.
A reliable source who spoke on condition of anonymity, said some patients were discharged at the Accident and Emergency unit of the hospital to seek care in other hospitals.
“The A&E unit here is a eight-bedded and we discharged six patients yesterday (Tuesday) so they can get the care they need. We still have some patients here and we are monitoring how their situation,” the source said.
The doctors are demanding immediate massive recruitment of clinical staff in the hospitals; immediate withdrawal of the bill seeking to compel medical and dental graduates to render five-year compulsory services in Nigeria before being granted full licences to practise; immediate infrastructural development in the hospitals with a subsequent allocation of at least 15 per cent of the budgetary provisions to health in line with the 2001 Abuja declaration.
Other demands are the immediate payment of the 2023 Medical Residency Training Fund in line with the agreements reached at the stakeholders’ meeting convened by the Federal Ministry of Health on February 15, 2023; the immediate increment in the Consolidated Medical Salary Structure to the tune of 200 per cent of the gross salary of Doctors in addition to the allowances included in the letter written to the Minister of Health, Dr Osagie Ehanire on July 7, 2022, for the review of CONMESS; among others.
Terming the doctors’ strike “unnecessary,” the Minister of Labour and Employment, Dr Chris Ngige said the government was already negotiating with the Nigerian Medical Association, NARD’s umbrella body.
But the doctors said their demands are genuine, and they are for the benefit of Nigerians, and the healthcare sector.
The President of NARD, Dr Emeka Orji said, “If you hear that the NMA is negotiating, what we are saying is that the NMA is not negotiating because negotiation has not happened this year, let them prove us wrong. We know that salary increment is a product of collective bargaining agreement. We have our facts and they are there. More attention should be paid to the Ministry of Health, these issues have not been addressed by the ministry and it is squarely their responsibility to address them, it is only when they fail that they can now call in the Ministry of Labour to intervene.
“The committee on the upward review of CONMESS was set up by the Ministry of Health, yet that committee has not met this year, they have not come up with a CBA. What happened was that the government offered the NMA a certain percentage without a CBA. Even if the NMA has accepted what the government is offering, where is the circular on the upward review of the circular?”
The doctors say they grapple with poor working conditions, low doctor-to-patient ratio, and meagre pay which is incommensurable to the services they render.
Dr Orji said, “Nigerians deserve to be treated in a well-funded conducive environment by people who are not physically and mentally exhausted, nor financially straitened.”
Meanwhile, the doctors’ demands are not entirely new.
In 2016, The PUNCH reports that the doctors under the leadership of Dr Muhammad Askira embarked on an 18-day strike.
Dr Askira listed some of the demands as payments of members’ salaries, and appropriate placement of members in states and federal tertiary hospitals across the nation.
Other demands were the reversal of sacked members in some hospitals as well as appropriate funding of residency training programme.
In 2017, under the leadership of Dr John Onyebueze, resident doctors went on at least 21 days of nationwide strike due to the failure of the government to resolve the salary shortfall of 2016 and January to May 2017; circularise house officers’ entry point; correct the stagnation of promotion of members and properly place them on their appropriate grade level; among others.
In 2020, the doctors went on a one-week indefinite strike amid the COVID-19 pandemic. The doctors requested the provision of Personal Protective Equipment for all healthcare workers, immediate reversal of the illegal disengagement of all 26 resident doctors in Jos University Teaching Hospital, and the payment of all salaries owed them, in keeping with provisions of the Medical Residency Training Act; among others.
The association embarked on another strike from September 7 to 10, 2020, to press home its demands.
NARD also went on strike on April 1, 2021. The strike was suspended on April 10 due to the intervention of the Speaker of the House of Representatives, Femi Gbajabiamila.
The strike was due to the refusal of the Office of the Head of Service to allow the enrolment of resident doctors on the Integrated Payroll and Personnel information system platform.
Another strike which began on August 2, 2021, was suspended after 64 days. Some of the demands made by NARD were the immediate salary payment to all house officers and an upward review of the current hazard allowance to 50 per cent of consolidated salaries of all health workers, among others.
It is laudable that the Senate Committee on Health and the House of Representatives Committee on Health have begun mediation in the efforts to bring the strike to an end.
Hopefully, with a due review of the Memorandum of Understanding signed between the doctors and the government in the negotiations, the former will have no cause to embark on an indefinite strike as the warning strike ends today, May 22, at 8 am.
The doctors had earlier said if the government does not address the issues raised before the new government takes over on May 29, further industrial harmony cannot be guaranteed.
They said a review of progress will be made at their ordinary general meeting in the coming week to decide the next line of action.
Stakeholders in the health sector called on the government and the doctors to chart a strong path toward addressing the issues as the country cannot afford incessant strikes.
A former President of the Nigerian Medical Association, Dr Mike Ogirima urged the government to fulfil the demands of the doctors.
“I advise the government to fulfil whatever agreement they must have had with any group of health workers and for the workers to be patient enough and pursue those agreements aggressively, not to leave it till the time they are forgotten, because the only language the government understands is the language of a strike,” Prof Ogirima noted.
The President of the Academy of Medicine Specialties of Nigeria, Prof Oladapo Ashiru said the government must invest in the health sector and work towards preventing brain drain.
Prof Ashiru said, “What they are spending on health now is very minimal and the incoming government has to call a strategic meeting of stakeholders to plan a holistic approach to health in terms of infrastructure, remuneration, welfare just as it is done in other countries.
“A qualified doctor can work anywhere in the world, it is a global market and the salaries should be marginally competitive. When we trained abroad, we had to come back to Nigeria because we knew that the salary we get in Nigeria is equally commensurate to what we get abroad but with the devaluation of the naira, it is no longer the same.”
Also, the Secretary of the NMA, Lagos chapter, Dr Ismail Ajibowo said when the right equipment, infrastructure, and the salary are in place, industrial action will be curbed in the sector.
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