Adeleke Oluomo Olusegun wrote: Health Sector strikes: the underlying issues. For some years, Nigerias health sector has been perennially embroiled in one strike after another. Investigations have shown that beyond ego and pecuniary interests of the leaders, there are also supremacy battles among the diverse professional groups within the health care delivery system fuelling the strikes even as government officials appear befuddled in the whole affair. While arguments and counter arguments abound, one thing is certain. This problem will not go away as long as the government continues on this current path. A brief history of the problem will help us put things in perspective. Dateline is 1985,prior to Babangida appointing Olikoye Ransome kuti as minister of health,the adminstration of hospitals in the Nigerian health sector was managed by professionals called Hospital Administrative Professionals like every other serious country all over the developed world. Olikoye quietly took away the adminstration of hospitals from this group of professionals, and handed it to his colleagues. maybe he meant no harm. Incidentally,the objective of having professional hospital administrators at the helm of hospital adminstration is to avoid the bickering that pervades the health sector and save the sector of this huge distraction and loss of well-trained health professionals to the politics of hospital adminstration like it is now the case where you have senior experienced doctors more in the politics of hospital adminstration than in the actual practice and training of young medical professionals. The doctors ran the health sector in a perceived biased manner, creating positions and awarding offices to themselves. To worsen issues, the career progression of other health workers was stunted. Aside doctors, no other health worker could proceed beyond grade level 14. Only doctors ran almost all the units in the hospital. As far as to the management board of teaching hospitals, doctors were most prominent. Taking up almost all available positions, even those outside their professional domain. In 1991, NMA was given MSS/MSSS (a different salary structure) while other health workers were left in the old structure. This led to series of industrial crises which had not been fully resolved before Professor Osotimehin’s era which compounded the problem. In 2009 NMA secretly bargained with the government, to achieve the consolidated medical salary structure. Several warning went out to the Salaries, Incomes and Wages Commission then not to allow NMA to break ranks with the other Unions/Professional Associations but the government agencies collaborated with Prof. Osotimehin , former Health Minister, to give NMA another salary structure – CONMESS. Further widening the gap in remuneration between doctors and other health workers. As shown by Nigerian Television Authority in March 2009, the NMA leaders jubilated wildly and expressed joy and happiness in being given CONMESS. These actions opened Pandoras box. Other health worker began to agitate for equality or fairness. Hence they came under the umbrella of JOHESU to press home their demands. First, JOHESU negotiated its own salary structure (conhess) which was eventually approved. Although conhess is still comparatively less than conmess, it did not go down well with NMA, who insisted that a ratio of 4 to 1 must be maintained between doctors salary and other health workers. The reason for its insistence on relativity remains largely unclear In January 2014, after a series of strikes, the federal government again approved an upward adjustment to conmess for doctors, which would be captured in the 2015 budget. It had also paid 2 months arrears to the doctors. JOHESU has also insisted that its salary structure (conhess) must be reviewed upwards, and captured in the 2015 budget just like that of the doctors. But there has been perceived unwillingness on the part of the ministry of health, Hence the reason for its ongoing strike. Top on the list of JOHESUs demand is that its members be appointed as consultants in their field and allowed to reach the zenith of their careers. This was initially approved through a circular, after which some health workers were appointed as consultants, and remunerated accordingly. This too did not augur well with NMA. It insisted that the tittle consultant should apply to medical doctors alone. It eventually went on strike, to demand a withdrawal of the circular. To appease the doctors, the ministry of health withdraw the circular, rescinded the appointments already made and deducted the already paid allowance from subsequent salaries. The issue was brought before the national industrial court, which then upheld that the ministry of health has the right to confer the consultancy status to who ever it deemed fit. In a recent circular the ministry has again approved consultancy status for other health workers. The chief medical directors, created the office of DCMAC (deputy chairman medical advisory committee) and appointed doctors to run the office. against the teaching hospitals act, while refusing to promote other health workers into the directorate cadre as outlined by their scheme of service, even after a circular from the ministry. In a counter plot, JOHESU insisted that hospital administration should be left to health administrators, as it was in the past, or the position of chief medical director should be left open for all qualified health workers to vie for, to avoid the perceived oppression. It also demanded that its members must be promoted to the directorate cadre as outlined in its approved scheme of service. JOHESU further went on strike to press its demands. NMA responded by demanding for the creation of the office of surgeon general, which must be occupied by a doctor only, and appointment of four DCMACs in all hospitals. It went on strike to press home these demands also. The position was approved by the federal government, although no appointment was made. These are just some of the salient issues causing the present unrest in the health sector. The handling of problem by the federal ministry of health in my opinion has been poor. Its decisions has been biased, and seemed to be tilted in favour of doctors most times. To the extent of disregarding court ruling to appease doctors. But on the other hand, JOHESU must realise that equal treatment would not be fair in the health sector, where doctors spend more time in training than others. My humble suggestion is that the ministry of health should set up a reconciliatory meeting, to allow NMA and JOHESU dialogue and work out its differences to a point were they can coexist peacefully. To resolve the money issues, the government should bring both bodies under the same salary structure. Relativity should be taken care of at the point of entry. That is, the doctors should be allowed to start at two grade levels above other health workers. As regards the issue of consultancy status, it is unfair for the ministry to appoint other health workers to the position simply by promotion. It would amount to handing it over to them on a platter of gold, when doctors have to study and school painstakingly for 5-6 years to get to the same position. To create room for fairness, the various councils regulating nursing , laboratory science, pharmacy, physiotherapy and radiology practice in Nigeria should be allowed to run their own post graduate programmes, to train consultants in those fields. Aside these professions, others do not merit a higher status. Some of these councils have put a bill before the national assembly to establish their own post graduate programmes. It is sad to note that for unknown reasons, NMA has been vehemently against it. Other health workers must recognise the fact that a doctor is the leader of any health team, and has had more years in undergraduate study, hence it is only fair that they are given a head start in the labour market. On the other hand, doctors must realise that they do not own the hospital, neither are they more important or better educated than other health workers. Simply put, it is a team effort. No matter how many goals a striker scores, the team will suffer defeat if the goalkeeper decides to walkway from the pitch. The banter of referring to other core clinical staff as support staff and paramedics must stop. As regards hospital administration, there is no clear cut solution here. But our hospitals were better off when we had hospital administrators in charge. Let everyone one else focus on their jobs. Finally, Nigerians must realise that it is neither NMA nor JOHESU that suffers the effect of these incessant strikes. It is you and i. They dont give a damn about the masses. The entry point and consolidated Salaries of doctors and health workers is big compared to what an average graduate earns in Nigeria. A friend of mine (a laboratory scientist) currently on internship earns around 120k monthly , and that amount has recently been reviewed upward again. A house officer gets close to 200k and they are still asking for more! If this trend doesnt stop, we are in trouble
Posted on: Mon, 24 Nov 2014 19:35:25 +0000
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