NIGERIAN DOCTORS HAVE ABUSED STRIKE WEAPON THE rot in Nigeria’s health care delivery system has once again been brought to the fore as doctors embark on yet another strike that has crippled public health care services nationwide. As some patients die and others writhe in agony, with no physicians to attend to them, doctors and government officials cannot reach an agreement on how to quickly restore services to public health institutions. Both should reach for their consciences — if they still have any — and restart the hospitals to stop the human misery. There are no saints in this grim saga. Successive governments have made a mess of health services — under-funding and under-equipping hospitals, entrenching corruption and inking agreements with doctors and other professionals that they thereafter fail to honour. Some doctors, on their part, have run public health institutions with glaring inefficiency, antagonized other health workers thereby polarizing the system, and short-changed the public by simultaneously engaging in private practice. When public sector doctors began a “total and indefinite” nationwide strike on Tuesday, all these longstanding combustible elements were in play. Among their 24-point demands were the usual requests for better remuneration and implementation of agreements reached between the Nigerian Medical Association and its affiliates, and the Federal Government. The terms include upgrades of public health facilities, passage of the National Health Bill and universal coverage under the National Health Insurance Scheme. The doctors said their action was to “save the system from anarchy.” While these sound lofty and there can be no excuse for the government’s failure to honour or renegotiate agreements, the sad reality is that Nigerian doctors have over-used and abused the strike weapon. As we have argued in the past, a physician belongs to a special class of professionals; we believe the primary job of a doctor is to save lives and manage the sick. Just as journalists constitute the Fourth Estate of the Realm and soldiers pledge their very lives to defend the Commonwealth, we believe that doctors too have a higher calling that should make them embarrassed to be found staging more work stoppages than railway unionists, petrol tanker drivers or daily paid workers. While the mandatory Hippocratic oath enjoins doctors to save lives, patients die and suffer disabilities and pain when doctors stop work. The strikes have been just too many and their impact, dreadful. The latest was preceded by a three-day “warning strike.” Numerous strikes since year 2000 have led to numerous deaths, while those mostly hit are the low income earners. In a country where 61 per cent of the population are poor, where only 35 per cent have access to adequate sanitation, and life expectancy is only 54 years, the frequent recourse to strikes is cruel and self-centred. Doctors are making some untenable demands. Their earlier insistence on only doctors being made minister is unreasonable. It is a political-cum-administrative post and other countries don’t subscribe to this. Their opposition to health professionals rising to directorship in public hospitals is also odious. Demands such as denying other professionals the title of consultants, should be resolved by the government only in the light of best practices worldwide and in the public interest. Doctors have the right to bargain for rewards, but it is unacceptable to oppose the right of others to receive what an employer is ready to offer them. If doctors from other countries are in Nigeria helping in the terror-torn North; and in Zamfara State where lead poisoning has killed hundreds of children; combating malaria and polio elsewhere, and are mapping strategies to prevent the spread of the deadly Ebola virus, this time, therefore, is not when our own doctors should cripple hospitals with strikes! The primary blame for the mess of course lies with our corrupt, clueless and fickle government that has failed to prioritize health care delivery and implement sensible policies to revamp the rickety system. Even its own National Strategic Health Development Plan 2010-2015 has gone nowhere. Only N264.46 billion was earmarked for health in the 2014 federal budget of N4.69 trillion, even less than the N279.53 billion or 5.7 per cent earmarked from the N4.92 trillion 2013 budget. Worse, about 80 per cent of this is spent on recurrent items, leaving only 20 per cent for infrastructure in a system that has 20 ill-equipped teaching hospitals, 22 Federal Medical Centres and 13 specialist hospitals across the country. The World Health Organisation faulted the 4.6 per cent of Nigeria’s Gross Domestic Product contributed by the health sector in 2011 as incapable of reversing the sorry state of health services in the country. The NMA claimed in 2012 that 5,000 Nigerians travelled abroad each month (mostly to India) for medical treatment, costing the country $500 million annually, with India alone raking in $260 million of this. Like the centre, most of the 36 states also fail to adequately fund health, while the governors, legislators and contractors gorge on the treasury. This trend is unsustainable as the cost in death and human misery is too high. The Minister of Health, Onyebuchi Chukwu, needs to demonstrate more commitment and urgency in tackling the terrible state of health care services. He and President Goodluck Jonathan, who, characteristically, has remained aloof while the populace groans in misery, need all their persuasive skills to bring the recalcitrant doctors and all health professionals, state governors and other stakeholders to the roundtable to break the deadlock. The government should stop the cavalier attitude of reneging on agreements. There should be an emergency programme to bring back many of the estimated 15,000 Nigerian doctors practicing abroad to join the 25,000 at home. With a doctor-to-patient ratio of 1: 6,400 and only about 3,000 doctors produced locally each year, efforts should be made to reach the WHO standard of 1: 600. In the meantime, the NMA should call off this strike and pursue the path of dialogue.
Posted on: Mon, 07 Jul 2014 10:47:16 +0000
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