By Adebayo Obajemu
In deed, the times are bad for the medical profession, and the health sector is nearing collapse, as the strike action embarked on by members of the National Association of Resident Doctors (NARD), intensified last week.
Earlier, the Health Minister Osagie Ehanire had said the action was a big mistake, considering the various challenges facing the sector, urging the striking doctors to return to work.
Last week following the breakdown of conciliatory efforts in the face- off between the Federal Government and resident doctors, the Minister of Labour and Employment, Senator Chris Ngige has transferred the dispute between the two to the National Industrial Court of Nigeria for adjudication.
Efforts by the Minister of Labour and Employment, Senator Ngige, who is the chief conciliator of the Federal Government to broker truce between resident doctors and the government had not yielded any positive results as the doctors have maintained their grounds that until their demands were met, they would not call off the strike.
Business Hallmark findings revealed that Ngige last Thursday formally handed over the trade dispute between government NARD to the National Industrial Court of Nigeria for adjudication.
A copy of the transmission to the Industrial Court was allegedly sent to NARD and the Federal Ministry of Health representing the Federal Government.
It will be recalled that the Minister had given the NARD leadership till the end of work on Wednesday, 11th August, 2021, to convene a virtual meeting of its National Executive Committee to brief its members on the efforts of government with a view to calling off its strike.
The source at the Health Ministry said, “Part of the instrument signed August 11, 2021 by the Minister reads, “whereas trade dispute has arisen and now exists between the Nigerian Association of Resident Doctors (NARD) and the Federal Ministry of health / Federal Government and whereas efforts to promote settlement through conciliation were on-going but had now failed.
considering the facts that members of NARD who are classified as Essential Services workers/employees had embarked on strike on Monday, August 2, 2021 over the issues under conciliation, contrary to the provisions of Section 18 of the Trade Disputes Act CAP T8, Laws of the Federation of Nigeria (LFN) 2004, after attending a Conciliation and Agreement Review meeting on July 22, 2021 and further considering that the Federal Ministry of Health claim to have and produced evidence to having met most of their demands based on the various Memorandum of Action reached during past conciliations especially that of July 22, 2021.
This medium learnt that on Thursday Senator Ngige on attended the meeting of Medical Elders Forum, comprising practising and retired senior medical practitioners, doctors who have served or are serving in top level political offices.
Some of those in attendance included the Chairman of Senate Committee on Health Dr. Ibrahim Oloriegbe, Chairman House committee on Health, Tanko Sununu, all past Presidents of NMA and NARD, His Highness, Dr. Haliru Yahaya, Emir of Shonga, former chairman Seante Committee on Health, Senator Tejuosho, President of NMA, Prof. Innocent Ujah, former Minister of Health , Prof. Onyebuchi Chukwu, Chairman and Registrar of the Medical and Dental Council of Nigeria (MDCN) Prof. Tajudeen Sanusi among others.
Already scores of people at different hospitals across the country have died, as a result of the strike, while private hospitals and clinics have had their hands full.
In the life of this administration, doctors have embarked on strikes for 552 days as at press time.
Addressing reporters penultimate Friday in Abuja, over the strike action that began August 2, the minister said the strike portrayed the doctors in bad light, especially as the country struggles to check the third wave and the Delta strain of the COVID-19 pandemic. Ehanire said innocent Nigerians should not be put at risk because of money-related issues, especially as efforts were being made to address them.
The minister said the doctors should not work at cross purposes with the government and defeat each other’s efforts at providing effective healthcare for Nigerians. Ehanire, who said the briefing was held to disabuse the minds of Nigerians on the strike, added that most of the issues about the strike concerned states and not the Federal Government.
The minister said the strike shocked the government because efforts to address the doctors’ demands were ongoing and called for dialogue to resolve the matter.
The issues for states to address, he said, include the salary arrears owed resident doctors in state hospitals; domestication of Medical Residency Training Act (MRTA) by state governments; speedy release of MRTA-approved funds by states; Minimum Wage-Adjusted CONMESS 2019; payment of COVID-19 inducement allowance by states; accreditation of unaccredited departments in states’ training institutions; and central posting of house officers in states’ institutions.
On the doctors’ demand for hazard allowance, he said the Federal Government had set aside a lump sum for payment to its health workers.
According to him, the Nigerian Medical Association (NMA), the umbrella body, is negotiating on behalf of medical doctors, while JOHESU, the umbrella body of other health professionals, is negotiating on their behalf.
He said as soon as both representatives agree with each other, it will be resolved and the payment of hazard allowance implemented. “NARD is advised to work with the NMA to sort out the delay in payment, rather than blame the government,” he said.
Also, the Federal Ministry of Health had directed house officers undergoing training in hospitals across the nation not to join the NARD strike.
The Minister of State for Health, Dr. Olorunmimbe Mamora, gave the directive Friday at a media briefing in Abuja. “You will recall that we had a memorandum of action on March 31 and had an addendum to it on April 9, 2021.
“But since then, we still have had irregularities in the payment of salaries to the house officers. We had issues with them being non-regular payment and as part of the memorandum of action, it was said that they should be captured back into the IPPIS platform,” the minister said.
NARD, in its communiqué announcing the industrial action, had said house officers were owed 12 months’ salaries.
Mamora said: “House officers are undergoing training; they are not full-fledged doctors. They are not and should not go on strike.”
According to him, house officers work generically across General Surgery, Orthopaedics, Plastic Surgery, and General Medicine and Medical Specialties. He added that they also worked in their designated services wherever possible and were also attached to consultants.
Already patients have had a rough deal for the past week, as activities and services at various public hospitals across the country continued to be disrupted with many rendering only palliative services.
When Business Hallmark the Lagos State University Teaching Hospital, LASUTH, Friday, there were very little activities around the surgical and medical wards, as many patients were unattended to.
As at the time this reporter visited no doctor had shown up. A aged man who identified himself as Abiola said he brought his sick grandson for treatment. He said “we have been waiting here close to five hours, they keep telling us to wait, that doctors will come, yet none has shown face, I will go to a private clinic.”
At the Lagos University Teaching Hospital, LUTH, the same inactivity was recorded, as all the clinics including the Accident & Emergency were open, but they were devoid of the usual slew of activities as only few patients were seen around when this medium visited around 4.00 pm on Friday.
Media reports suggest that the strike action has paralysed health sector throughout the country.
The President of the Nigerian Association of Resident Doctors, NARD, Dr. Okhuaihesuyi Uyilawa was quoted last Thursday as saying that the statement released by the Minister of Labour and Employment, Dr. Chris Ngige through his Deputy Director of Press and Public Relations, Charles Akpan, claiming that they had a successful meeting was far from truth.
Uyilawa said that despite his effort to persuade the minister to answer some of the demands of the Association before the Exco meeting in Umahia, it all proved abortive as the minister failed to take any concrete action towards their demand.
He said: “The same way the minister claimed that he was shocked that we went on strike despite the fact that we had a successful meeting, is the same way I was shocked that he claimed that we had a successful meeting and was unaware that we will embarked on strike.
“On the Thursday before the last, we met with him and he was aware that more than 90 percent of the things we demanded for are not met.
“Before our meeting in Umahia, we went to him and showed him the minutes of our last meeting and I specifically told him that decision will be taken at Umuahia and that I suspect it may go the way of strike.
“I tried to persuade him to put something on the table before the meeting in Umuahia so that we can have something to tell members.
After the visit we knew that it was empty promises as nothing was done. Even today, nobody has reached out to us despite the fact that we have submitted letters to all relevant agencies of government to intervene.
Since no response is coming in, the strike continues,” he remarked.
Oyin Adeola, a civil servant told this newspaper that “government should have tried hard to prevent this strike coming at a time we are battling with third wave of COVID-19, cholera epidemic and all sorts of ailments. What is happening in this country? What manner of scandalous people are in charge of the affairs of our nation? We have never had it this bad. This government is a criminal racket.”
The latest World Health Organisation survey ranks Nigeria’s healthcare system as the fourth worst in the world. This would not come as a surprise to Nigerians living in a country where there are no ambulance services or a simple toll-free number, like 999 to call in an emergency. In the unfortunate event of a heart attack, the chances of survival in Nigeria are dire.
At a time when people are generally living longer, with a global average life expectancy of 73 years, the average Nigerian will be lucky to attain the age of 60. With a life expectancy of 55 years, Nigeria is one of four countries with the lowest life expectancies in the world, after the Central African Republic, Lesotho, and Chad, based on the latest data from the United Nations.
At the root of early deaths in Nigeria is a healthcare system that has virtually collapsed due to the lack of investment. The latest World Health Organisation survey ranks Nigeria’s healthcare system as the fourth worst in the world.
Professor Tunji Obaro, a medical sociologist told BusinessHallmark that the state of our health care is bad, even in the era of COVID-19, only Lagos State has managed the pandemic well, and just by miracle, the healthcare has not totally collapsed.
“For decades, Nigeria’s health sector has suffered from acute underfunding, whilst the country’s leadership have jetted off to the U.K. and the Dubai, to get the medical care they have callously denied their fellow citizens.
“Even Nigeria’s number one citizen, has just jetted out to UK, he would have nothing to do with the healthcare system he superintends, preferring instead to patronise, unashamedly, the health services built by his peers in the U.K., at great cost to the Nigerian treasury”.
In the last ten years alone, Nigeria has added almost 50 million people to its headcount, more than the entire population of Canada of 38 million, without any commensurate increase in investment in health. The Federal Government budget for health this year for the entire country is a miserly $1.07 billion (N547 billion), less than half the $2.4 billion (£1.7 billion) expenditure budget for Guys’ and St Thomas’ – a government hospital in the U.K. favoured by Nigeria’s ruling elite.
Some have described Nigeria’s hospitals, perhaps too harshly, as where people go to die. With a public health system characterised by a shortage of drugs, equipment and medical specialists, Nigerians seem to have resigned themselves to the possibility of an early death, if unfortunate to be struck by any serious illness.
Apart from, perhaps, a few top private hospitals, the majority of hospitals in Nigeria are no more than mere consulting rooms, lacking in everything. Even empathy is in short supply, with the poor bearing the brunt of ill-treatment from health workers, overwhelmed themselves by the daily throng of patients needing care.
With patients required to meet the full cost of treatment, Nigeria’s healthcare system has literally priced out access for over 100 million citizens living in poverty. Hospitals, however, argue they would be forced to close, if not able to recover the full cost of treatment from patients, in the absence of adequate funding from the government. It is not uncommon in Nigeria for patients to be ‘held hostage’ in wards until a kind benefactor pays their medical bills.
For very serious medical conditions, deposits of over half a million naira are required before treatment can even commence, an impossibility for over half the population, which lives in extreme poverty, according to the World Poverty Clock.
How long the current strike will last depends on how government agrees in action to meet the doctors’ demands.