How did it get to this full blown crisis in our health sector?


The simmering crisis in our public health care sector has now become a disaster as staff working in hospitals managed directly by the Federal Government have closed shop. If you have been following us on twitter you would have seen as more states joined strikes, all most on a daily basis. The Guardian reports that medical personnel are not only striking, but actually gathering at the gates of teaching hospitals and federal medical centers and turning back patients. They are turning back sick Nigerians! What does it take to act like this? How did it get to this in our country? The answer – money. The reason given – “withdrawal of teaching allowance and discrepancies in the Consolidated Health Workers Salary Structure (CONHESS)“….Apparently all staff from Grade 7 were previously paid a “teaching allowance” whether they taught or not. Now this has been withdrawn and being paid only to those who show that their job description actually includes teaching! Makes sense I hear you say, but who approved the global payment in the first place? This is how our country is run.

For daring to to do this, the workers, under the umbrella of Joint Health Sector Unions (JOHESU), have made a call to the presidency to relieve the Minister of Health, Professor Chukwu Onyebuchi Chukwu, of his appointment. Our Minister who was reported to be in Lagos early this week trying to negotiate with the workers had earlier issued a ‘No work no pay’ circular to the striking workers.

Meanwhile in the various states, the industrial actions by doctors has continued unabated as they insist on the N800,000.00 being paid their colleagues at the Federal level under the new “CONMESS” scheme. Colleagues in Enugu state announced a “total and indefinite withdrawal of services with effect from Monday, February 21, 2011 adding that “all doctors working in the federal institutions in Enugu State will join the total withdrawal of services with effect from Monday, February 28, 2011.”

Our government has not got its priorities right! It cannot expect professionals to compromise on the appropriateness of  their earning when it is extremely wasteful in its own spending with our Presidency employing a total of 133 aides including six physicians (two senior special assistants and four special assistants) who attend to the health needs of the president, the vice president and the first lady. They include two chief physicians to the president and vice president, two personal physicians to the President and the vice president, an assistant personal physician to the president, and a personal physician to the first lady as reported in 234Next.

Most of our states are not any better as they embark on white elephant projects. Having not thought strategically about their health workforce they are being caught out. As reported in 234Next, below is the picture of a hospital, apparently built by Nkoyo Ibori, wife of our beloved former governor of Delta State, James Ibori. Mrs. Ibori was recently jailed by a British court for defrauding the people of Delta State while her husband is  in Dubai fighting extradition to the United Kingdom to face corruption charges. Where she got the money to build this “hospital”, which she in all humility named after herself is less of a scandal than the state it finds itself now, overgrown with weeds, and infested with rats.

Just when you would hope for a robust response from the Minister of Health to the crises, making a strong case to the Nigerian people articulating the scenarios to our president, communicating his vision to the country, the Nigerian Compass reports that the Minister is “begging” health workers to return to work. I am guessing that this time begging will not be enough.

We need to turn this argument around. It cannot only be about salaries, but also has to include the services delivered. Our government will do well to communicate to the Nigerian people what exactly our doctors are employed to do. How many surgeries are our surgeons expected to do in a week? How many patients should they see on a working day? When does work actually start in a teaching hospital in Nigeria? How is their performance managed, what performance indicators can we use to measure this.

We absolutely need to change the argument to win it for the patients. If the argument remains one only of renumeration, the answer will always be “more!”, but even if we do change the argument and our government remains as profligate as it is….then arguing will not matter!

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Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (, which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

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