Strike called off – but challenges prevail


Last week we blogged about the strikes in the health sector. One thing has been obvious over the past few days are the efforts of the Minister for Health to avert the first major crisis in his tenure….Now the strike has been called off.

The Minisiter was hard at work last week…

…negotiating with the NMA as described here

…appearing before the House of Representatives as described here

…and explaining the intricacies as in the press statement below.

The truth is that there are fundamental problems with the way we run our tertiary health institutions. After the 8 wasted years of the Obasanjo regime spent on white elephant projects we now need to really re-evaluate our teaching hospitals. These large institutions, with huge budgets are managed by colleagues with often no managerial experience prior to the appointment. They are managed as huge bureaucracies with no incentives to preform and no consequences for failure. We have refused to do the critical thinking required in order to reform, and we keep throwing more money, more equipment, and more of the same…New MRI machines are not the answer…never have been. You do not need to have an MBA to figure that out.

The Vamed project was the most colossal waste of time, energy and money witnessed by the health sector in my lifetime, and I doubt it has saved a single life.

Several years ago Albert Einstein told us that if you want different results, do not do the same things.

I remember studying the history of the NHS in the UK and the THINKING that has led to the different reforms to maintain the ideals of the founding fathers in 1948 to provide a health service to the citizen – free at the point of care – from the cradle to the gave. It is important to reflect on this as this was the colonial experiment we inherited.

The attempts at reform since 1948 can be summarised as:

1. 1950 – 60: Realisation of finite means despite infinite demands for health careleading to the introduction of a spending ceiling, charges for dental /optical services and prescription charges.

2. 1960 – 62: Introduction of “Hospital Activities Analysis” – to pressure consultants to consider the economics of their practice. The Hospital Plan for England and Wales – first attempt to take comprehensive view introducing national norms for adequate hospital beds e.g. 3.3 acute beds per 1000 population.

3. 1962 – 69: As the NHS is a monopoly supplier of health care for the vast majority of the population, it suffered no consequences of failure and managerial inefficiency was endemic. Management was identified as the fundamental problem for the NHS.

4. 1974: 1st major re-organisation of the NHS. Introduction modern management methods – New layers of management: districts and areas.

5. 1984: The Griffith’s report: The “managerial revolution”. Griffith was Head of “Sainsbury’s”, supermarket chain famed for it’s financial success. A single general manager was introduced at each level of management with real power. A new doctrine of “general management” was introduced using performance indicators. Manager’s salaries were linked to performance.

6. Late 80s: Introduction of the Internal market legitimising seeking value for money within the NHS and introduced accountability for outputs by attempting the introduction of market forces.

7. Early 00s: Collaboration replaces competition. Introduction of targets, performance indicators and league tables.

8. Late 00s: Darzi review leads to the introduction of the “Quality agenda” and polyclinics.

By now you will have noticed my point – every single major reform is around MANAGEMENT.

My thesis – Healths systems are complicated and despite the resources to a country like the UK, they are constantly THINKING about how to make it more efficient. Since we inherited our present system from the British in 1960, nothing has fundamentally changed. The National Health Bill is still stuck at the National Assemble after 5 years. A Tertiary Hospital Commission that could lead to some change in the managerial arrangement of our hospitals is also stuck in the system….

The consequences – Consultants hardly come to work, hospitals hardly generate any income, patients have no confidence in the health services, health care workers are not motivated to provide the service…- A VISCOUS CYCLE

The Honourable Minister has his job cut out for him….and we wish him well. We really do!

Press Statement from the Ministry of Health

Strike Action by Federal Medical Workers
It has come to the notice of the Federal Ministry of Health that Medical Workers in Federal Health Institutions have embarked on a strike action to press home their demands for the implementation of the Monetization Policy of Government. We therefore wish to state as follows:
The current strike by medical / health workers in federal government institutions is very unfortunate because it will inevitably lead to loss of lives and care of patients will be impaired in the least. The strike is based on the demands of the workers for the implementation of the monetization policy of government. The issue is a service wide issue which is being addressed by the Office of the Secretary to the Government of the Federation (SGF). In this regard, it is beyond the Federal Ministry of Health because it affects all Federal Government employees.
Nevertheless, we
hasten to state that given the sensitivity of the issue of health care to our population and citizenry and the negative consequences that would result therefrom, one would expect that this will be the last option that the workers would consider. As it is, lives are being lost right now and the hospitals are left with no choice than to discharge patients, even as new patients are not being attended to. Inevitably, this will affect all and sundry, including the relatives of the striking workers themselves.

Very importantly, it is expected that since it is an issue that affects all federal public servants, (not just health workers alone), health workers would be the last to take this course of action in realization of their noble call to service of humanity.
Thus, the Honourable Minister would like to seize this opportunity to call on the health workers to go back to work in the overriding interest of their patients and most importantly because the office of the SGF is doing its best to address their grievances.
Thank you.
Niyi Ojuolape
Special Assistant (Communications) to the Minister of Health

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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