The Cost of Unending Health Sector Crisis

As the unending conflict between doctors, health workers and the federal government continues, those most affected are patients whose taxes run the hospitals. Martins Ifijeh writes on the need for a holistic approach to resolving the myriad of industrial issues in the health sector

It is no longer news that every year, the Nigerian health sector undergoes an annual ritual simply referred to as strike action, in which case, medical doctors or health workers down tools and boycott attending to patients, as a way of pressing home their list of demands from the government or hospital management.

What seems to be the major worry is that this annual ritual won’t go away any time soon since the government, medical doctors and health workers have not come to an agreeable terms on how best to run the sector without crisis, just like what obtains in the Ministry of Health of developed countries.

Just last week, another bout of indefinite strike action was commenced by the National Association of Resident Doctors (NARDs) across the country, following the rejection by its National Executive Council of a Memorandum of Understanding its leaders signed with the federal government towards the end of last month.

The union directed all its members to down tools until the federal government acceded to their demands, which they say have led to several engagements between them and the federal government wihout success.

It had demanded that all heads of tertiary health institutions that have received funding from the federal government for the payment of all outstanding financial obligations to its members should pay them immediately, adding that its members were demanding the resolution of persistent shortfalls and unpaid arrears of salaries earned in both federal and state tertiary health institutions.

Other issues in dispute include the demand for the enrollment of resident doctors into the Integrated Personnel Payroll Information System (IPPIS) since 2003 and non-implementation of adjusted House Officers’ Entry grade level equivalent since 2014.

The resident doctors are also asking for the resolution of the stagnation of promotion and non-promotion of members who had met requisite criteria despite all collective bargaining agreements and circulars.

Meanwhile, as a way of mitigating the impact of the strike action, the Minister of Health, Prof. Isaac Adewole, directed heads of federal government hospitals to employ the services of doctors, who are currently undergoing the mandatory National Youth Service Corps (NYSC) programme, to ensure that there is no break in medical delivery.

In a statement issued by his spokesperson, Mrs. Boade Akinola, the minister said federal government medical facilities would remain open throughout the striking period while the government would work to solve the problem.

“The minister assured all Nigerians that the federal government health facilities will be open and render services to the people while the government continues to dialogue with the resident doctors to
return to work. He said arrangements are also on to make use of Armed Forces, police and federal road safety health facilities. The minister expressed optimism that the problem will be resolved soon,” he said.

Just as Nigerians were coming to terms with the consequences of the resident doctors’ strike, the Nigerian Union of Allied Health Professionals (NUAHP) and the Joint Health Sector Union (JOHESU) directed their members nationwide to shut down healthcare services come 30th September, 2017 if government refuses to also meet their own demands.

The directive, which was made known last week to all health workers, demands that its members, which are the largest hospital staff across the country down tools, an approach that will not only leave patients stranded, but might play a major role in high number of mortality rate.

NUAHP and JOHESU are demanding the following: “Revamping the infrastructure in the tertiary health institutions, Report of the inter-ministerial sub-committee on critical matters in thehealth sector, Professional autonomy, Headship of departments/units in hospitals, Enhanced entry point (EEP) for medical laboratory scientists and Radiographers and Non- payment of backlog of arrears.”

NUAHP’s President, Dr. Obinna Ogbonna said other discriminatory attitudes by the Federal Ministry of Health (FMoH) to other healthcare professionals are what they called introduction of partisan and discriminatory remuneration packages in favour of medical practitioners and the non–Circularisation and Implementation of Adjusted CONHESS Salary Structure as done for the Nigerian Medical Association (NMA).

Ogbonna said, “It is disheartening to note that the FMoH has been turned to the Federal Ministry of Medical Practitioners. It is highly vivid that the Minister of State for Health, Minister of Health and the Minister of Labour and Employment(FML&E) all being medical practitioners are biased in how they handle demands of other health care professionals under the aegis of NUAHP or JOHESU.

“This was glaringly displayed in the way they negotiated and agreed on all issues presented by the National Association of Resident Doctors (NARDs). This act of discrimination, double standard and preferential treatment of the medical practitioners in the health sector is highly discriminatory and lucid act of favoritism and injustice were all displayed during the process of negotiation,” he added.

Ogbonna however urged well-meaning Nigerians and the royal fathers to intervene and prevail on government to implement all agreements and memorandum of understanding reached with NUAHP/JOHESU on or before the expiration of the ultimatum to avert the looming industrial action.

Meanwhile, JOHESU and the NAHP have called on the Senate President, Dr. Bukola Saraki, and Speaker of the House of Representatives, Hon. Yakubu Dogara, to wade into the looming nationwide industrial action.

In a jointly signed letter, National Chairman, JOHESU, Comrade Biobelemoye Joy Josiah and National Secretary, Comrade Ekpebor Florence, urged the Senate President and the Speaker of the House of Representatives to help save the situation.

The letter entitled, ‘Looming Nationwide Industrial Action: Request for Audience’, and dated September 5, 2017 reads: “We seek for your intervention in the protracted demands and agitations between JOHESU and the federal government since 2014 by granting us urgent audience on Thursday, September 14, 2017 at 10.00a.m. or any other date not later than a week before September 30, 2017.

“We are compelled to seek for your intervention so as to avert indefinite industrial action in the health sector. We are aware of the sensitive and important nature of our service to human lives, hence our proactive measures in prevention rather than curative measure.”

Patients are the biggest losers But in all of this, the major casualty is the Nigerian patient, whose tax payer’s money run government hospitals. Many have lost their lives due to the incessant strike action embarked upon by the medical doctors and other health workers; and also government’s insensitivity to the welfare of its employees in the health sector.

While a visit to some hospitals by our correspondent last weekend showed that skeletal work were still ongoing, patients have continued to feel the brunt of the strike, with some looking for alternative in private hospitals.

For instance, in the National Orthopaedic Hospital, Igbobi, Lagos, it was observed that while skeletal work was still ongoing, no new patient is admitted. Many who came for admission were turned back, while some patients already admitted were seen leaving the hospital.

Mr. Raheem Kola, who brought his son with fractured limb for admission in the hospital, was asked to return back next week (this week) so they can admit his son, with the hope that by then the strike would have been called off.

“So right now am contemplating taking him to a traditional bone setter in Ikorodu, because I can’t take him back home like this,” he said.

The former Medical Director of the hospital, Dr. Oluronbi Odunubi, during an interview with THISDAY had earlier told Nigerians to be cautious of patronising traditional bone setters, as many of them end up doing more harms to the patients rather than healing them.

But the strike action embarked on by NARDs has once again given people like Mr. Kola the option of patronising traditional bone setters, which ordinarily he wouldn’t have used, according to him.

Also in the Lagos University Teaching Hospital (LUTH), Idi Araba, new patients are not admitted. Those already on appointment for last Friday were also told to come back with the explanation that doctors are on strike.

A patient with kidney disease, Mojeed, while speaking with our correspondent, said he was given on appointment for that day, but that he has been in the hospital for hours without being attended to. “They said they will reschedule another appointment with me, as adequate hands were not on ground to attend to patients,” he said.

While doctors, health workers and government continue to prolong their disagreements year-in-year-out, stakeholders are of the opinion that for the purpose of patients, there should be a lasting solution to the various industrial issues in the sector.