The Minister of Health, Resident doctors and strikes

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Minister and Perm Sec of FMOH

Since resumption of office, the Minister of Health has faced challenges of industrial disharmony in the health sector, largely inherited, all protracted and mostly on issues relating to the payment of doctors. Presently, a strike by the Nigerian Association of Resident Doctors has paralysed tertiary care centres across the country. This has left Professor Onyebuchi Chukwu in a difficult situation, unable to focus on the future of the precarious health sector in Nigeria, he is being forced to fire-fight his way out of these strikes. Complicating matters even more is the fact that Professor Chukwu was himself an ex-president of NARD.

Now things are really getting out of hand…with reports like these in several newspapers…..

PMnews reports that activities in General Hospitals in Lagos State have been paralysed due to the inability of the Lagos State Government to pay the federal wages its doctors are demanding for. 

Doctors’ strike paralyses LAUTECH, Ekiti govt hospitals


From a letter sent round by NARD in Lagos state recently, the key issues being demanded by the National Association of Resident Doctors can be summarised as follows. 
  • They are protesting the non imlementation of the apparently hitherto mandatory one year overseas clinical attachment for resident doctors
  • They are demanding full payment of the January-May arrears of CONMESS within 21 days of the passage of the budget (i.e on or before Friday 19th Aug 2010) apparently agreed by the former Minister of Health and the Federal Government in the circular no SWC/S/04/s.410/ 220, dated 29th Sept 2009.
  • They insist that Ogun, Lagos, Oyo and Ekiti States which say that they cannot afford to implement CONMESS…must do so ..or else…
  • They are angry about the diminishing relativity in wages between doctors and other health workers, and demand that the FMOH should immediately constitute a committee to review wages within the health sector using appropriate and internationally acceptable yardsticks.

Reading between the lines suggests how deep our problems are. We have lost all confidence in our medical training. It is now the case that 50 years after independence, we conclude that a one year “overseas” attachment is critical for our training needs. There is apparently no shame felt or expressed in this statement. The demands by our senators has given credence to every demand for more wages in our country. The concept of federalism in our constitution and the right of state governments and their legislature to determine their wage structures is thrown to the winds whenever convenient….and “relativity”!…why is this so important? Is it important enough to abandon our patients to go on strike.

In the letter written by NARD, to which we are privy, not once is the patient mentioned. Not once are the state of our hospitals mentioned. No statement is made by NARD on what it is offering the Nigerian people. No commitment to serve. No commitment that when the saalaries are paid, that the work will be done. There is no empathy, no compassion – just fire and brimstone….

But then – our government has put us into this quagmire. After 50 years of independence I can bet that our Ministry of Health will join other Ministries in allocating millions of naira to celebratory books, seminars etc. What do we have to celebrate in our health sector. As with all these matters in our dear country, last week, our own Radio Nigeria reported that 2 committees have been inaugurated – one was a presidential committee and the other a ministerial committee.


1. A Presidential Committee to harmonize working relationships among health workers
 The 42 member committee (42!), headed by Justice Bello Abdullahi is to identify the root causes of disharmony among health workers, and professional groups in the sector, and to examine the negative impact of such problems on the healthcare delivery system. This is mandated to check the long standing rivalry and industrial disharmony existing among the professional groups in the sector.


2. A Ministerial Committee for the review of the residency programme in Nigeria.
The 11 member committee is mandated to review the residency programme in Nigeria including examine the proposed one year clinical attachment/training abroad for resident doctors.

The Lagos State Government has come out boldly to say that the package was worked out for federal doctors alone, and that the state government was not part of the agreement reached at the federal level therefore should not be forced to pay – I agree!

Commissioner for Health, Dr. Jide Idris, says that the Lagos State Government could not pay and would not be forced to do so. Idris stated that government would continue to support doctors who did not join the strike and had been working assiduously to meet the demands of the patient, saying that agitation of doctors in its hospitals for increment in salaries had become too frequent and worrisome, saying that they got increases in their salaries early this year. The state government has begun to employ the services of consultants to carry on the work of administering treatment to thousands of patients in the state’s public hospitals, which are generally inconsequential to meet the teeming needs of the people.

As doctors, we should be very careful not to lose the support of our patients, and we must be extremely careful not to use the power we have in society against the people we have sworn to serve. The “patient” must be central to our arguments and sacrosanct in our demands. We lose the patient we lose everything.

Granted, working conditions are difficult in many of our settings, and granted our Senators have lost all touch with reality by their demands, but must we follow them in this blind pursuit of self destruction.
Finally this issue of “relativity”. Are we really better than the nurses and pharmacists etc…think about it!

In all that has been written in the press and even in the letter circulated by NARD, Professor Chukwu is de
scribed as a man with uncommon integrity in his public and private life“. I could not agree more. We must give him the opportunity to build a better future for our health sector rather than spend the last 8 months of his tenure negotiating salaries.

http://www.nigeriahealthwatch.com/

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 (www.epiafric.com), 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.

Discussion12 Comments

  1. Thanks very much for your patient-centred analysis. One may sympathise with the desire for better wages, but I have always, during these strikes, wondered how doctors in state-owned hospitals feel about their patients.

  2. It is so important that you took on the issue of the strikes from this perspective.
    It’s sad that this can happen and so frequently in a sector where an oath is taken to put life first….what happened to intergrity and sheer dogged loyalty in spite of circumstance? The doctors want 1yr overseas training on the governments’ bill? That’s laughable in the global village that we now live in. We can suggest several viable and more effective alternatives to that.
    On the relative superiority of doctors to nurses and pharmacists….hmmmm!!
    We must be careful not to become insensitive and loose our natural care for human life in a struggle for luxury and self exaltation.
    I don’t have the heart to be a doctor, but I hold them in high esteem, because I see them as Gods’ arms extended on earth to heal mankind…what a priveledge….what an irony.
    I believe passion and compassion should be uppermost in the heart of every doctor. Not self.
    If the main course being championed here were patient-centered like you said, sure they’ll have a louder, more convincing and unified voice…
    Like you say, Hard questions…Honest answers…?

  3. Dear Chikwe,
    apt piece on a troublesome issue. A few tit bit of history may be useful ( I recently exchanged this with fellow members of the Medical & Dental council of Nigeria):
    – in 1981, the NARD supported by the NMA fought for and secured call duty allowance for all doctors in all states in Nigeria under a democratically elected Govt with Shagari as president. To ensure that the deal was nationa-wide and not affected by the federated-structure debate, we the negotiators ensured that the historic deal (no doctor had ever been paid overtime or oncall pay before 1981), even though started with the Federal Govt got the approval of the whole states through the National Council of States. CONMESS should be put through the same council for the states to agree. The Federal and State govt need to harmonise how the extra budgetary need will be met.

    – at the 49th meeting of the National Council of Health (NCH) in Jalingo, Taraba state in 2007, the Cross River State Ministry submitted a memo, that was unanimously adopted and left for the FMOH to take to the Federal Executive Council. The memo was on harmonisation of doctors salary across the country, and across govts (federal & state). That every doctor of equivalent grade ( consultant, Snr Reg, CMO, etc) should earn the same basic pay irrespective of whether they are employed by Fed or State govt, and irrespective of where they live ( sokoto or Port Harcourt, Maiduguri or Lagos). As with other countries, doctors who work in Lagos or Abuja can earn additional weighted allowance for the extra cost of living in these cities (e.g. London weighting allowance in the UK). By so doing, pay will cease to be the main determinant of which employer doctors decide to work for, and it will eliminate the internal Brain Drain of doctors streaming to Teaching Hospitals & Federal Medical Centres thereby constantly denuding state hospitals of doctors. Also, other attributes like clean & green cities, security of life and family, and quality of schools, etc, will become more important than pay in doctors choice of where to work. Imagine what that will do for healthy competition amongst states as they work to make themselves atrractive for doctors and other workers!.
    For, If viable states like Lagos cannot pay CONMESS spare a thought for the other non viable 35 states and FCT.

    – In discussions with current NMA leadership we suggest that it is about time doctors also take action that is seeing as fighting paients cause: When did doctors in Nigeria go on strike for lack of investment in healthcare, poor facilkiuties, high mortality from preventable conditions, etc. It is instructive that The NMA has been hijacked to the extent that we now have resident doctors as NMA Chairmen. The senior doctors who would temper exuberance with caution and use experience to ‘put patients first’ now stay away from NMA meetings and elections!. A new direction is urgently needed to save our profession from public odium.

    Joseph Ana

  4. Dear Chikwe,
    apt piece on a troublesome issue. A few tit bit of history may be useful ( I recently exchanged this with fellow members of the Medical & Dental council of Nigeria):
    – in 1981, the NARD supported by the NMA fought for and secured call duty allowance for all doctors in all states in Nigeria under a democratically elected Govt with Shagari as president. To ensure that the deal was nationa-wide and not affected by the federated-structure debate, we the negotiators ensured that the historic deal (no doctor had ever been paid overtime or oncall pay before 1981), even though started with the Federal Govt got the approval of the whole states through the National Council of States. CONMESS should be put through the same council for the states to agree. The Federal and State govt need to harmonise how the extra budgetary need will be met.

    – at the 49th meeting of the National Council of Health (NCH) in Jalingo, Taraba state in 2007, the Cross River State Ministry submitted a memo, that was unanimously adopted and left for the FMOH to take to the Federal Executive Council. The memo was on harmonisation of doctors salary across the country, and across govts (federal & state). That every doctor of equivalent grade ( consultant, Snr Reg, CMO, etc) should earn the same basic pay irrespective of whether they are employed by Fed or State govt, and irrespective of where they live ( sokoto or Port Harcourt, Maiduguri or Lagos). As with other countries, doctors who work in Lagos or Abuja can earn additional weighted allowance for the extra cost of living in these cities (e.g. London weighting allowance in the UK). By so doing, pay will cease to be the main determinant of which employer doctors decide to work for, and it will eliminate the internal Brain Drain of doctors streaming to Teaching Hospitals & Federal Medical Centres thereby constantly denuding state hospitals of doctors. Also, other attributes like clean & green cities, security of life and family, and quality of schools, etc, will become more important than pay in doctors choice of where to work. Imagine what that will do for healthy competition amongst states as they work to make themselves atrractive for doctors and other workers!.
    For, If viable states like Lagos cannot pay CONMESS spare a thought for the other non viable 35 states and FCT.

    – In discussions with current NMA leadership we suggest that it is about time doctors also take action that is seeing as fighting paients cause: When did doctors in Nigeria go on strike for lack of investment in healthcare, poor facilkiuties, high mortality from preventable conditions, etc. It is instructive that The NMA has been hijacked to the extent that we now have resident doctors as NMA Chairmen. The senior doctors who would temper exuberance with caution and use experience to ‘put patients first’ now stay away from NMA meetings and elections!. A new direction is urgently needed to save our profession from public odium.

    Joseph Ana

  5. apt piece on a troublesome issue.
    – in 1981, the NARD supported by the NMA fought for and secured call duty allowance for all doctors in all states in Nigeria under a democratically elected Govt with Shagari as president. To ensure that the deal was nationa-wide and not affected by the federated-structure debate, we the negotiators ensured that the historic deal (no doctor had ever been paid overtime or oncall pay before 1981), even though started with the Federal Govt got the approval of the whole states through the National Council of States. CONMESS should be put through the same council for the states to agree. The Federal and State govt need to harmonise how the extra budgetary need will be met.
    – at the 49th meeting of the National Council of Health (NCH) in Jalingo, Taraba state in 2007, the Cross River State Ministry submitted a memo, that was unanimously adopted and left for the FMOH to take to the Federal Executive Council. The memo was on harmonisation of doctors salary across the country, and across govts (federal & state). That every doctor of equivalent grade ( consultant, Snr Reg, CMO, etc) should earn the same basic pay irrespective of whether they are employed by Fed or State govt, and irrespective of where they live ( sokoto or Port Harcourt, Maiduguri or Lagos). As with other countries, doctors who work in Lagos or Abuja can earn additional weighted allowance for the extra cost of living in these cities (e.g. London weighting allowance in the UK). By so doing, pay will cease to be the main determinant of which employer doctors decide to work for, and it will eliminate the internal Brain Drain of doctors streaming to Teaching Hospitals & Federal Medical Centres thereby constantly denuding state hospitals of doctors. Also, other attributes like clean & green cities, security of life and family, and quality of schools, etc, will become more important than pay in doctors choice of where to work. Imagine what that will do for healthy competition amongst states as they work to make themselves atrractive for doctors and other workers!.
    For, If viable states like Lagos cannot pay CONMESS spare a thought for the other non viable 35 states and FCT.

    – In discussions with current NMA leadership we suggest that it is about time doctors also take action that is seeing as fighting paients cause: When did doctors in Nigeria go on strike for lack of investment in healthcare, poor facilkiuties, high mortality from preventable conditions, etc. It is instructive that The NMA has been hijacked to the extent that we now have resident doctors as NMA Chairmen. The senior doctors who would temper exuberance with caution and use experience to ‘put patients first’ now stay away from NMA meetings and elections!. A new direction is urgently needed to save our profession from public odium.

    Joseph Ana

  6. apt piece on a troublesome issue.
    – in 1981, the NARD supported by the NMA fought for and secured call duty allowance for all doctors in all states in Nigeria under a democratically elected Govt with Shagari as president. To ensure that the deal was nationa-wide and not affected by the federated-structure debate, we the negotiators ensured that the historic deal (no doctor had ever been paid overtime or oncall pay before 1981), even though started with the Federal Govt got the approval of the whole states through the National Council of States. CONMESS should be put through the same council for the states to agree. The Federal and State govt need to harmonise how the extra budgetary need will be met.

    – In discussions with current NMA leadership we suggest that it is about time doctors also take action that is seeing as fighting paients cause: When did doctors in Nigeria go on strike for lack of investment in healthcare, poor facilkiuties, high mortality from preventable conditions, etc. It is instructive that The NMA has been hijacked to the extent that we now have resident doctors as NMA Chairmen. The senior doctors who would temper exuberance with caution and use experience to ‘put patients first’ now stay away from NMA meetings and elections!. A new direction is urgently needed to save our profession from public odium.

    Joseph Ana

  7. Dear Sir,
    I dare say your article obfuscates the facts of the matter at hand.

    The training is mandated by law, it is not a fresh demand and until it is repealed, protesting its non-implementation is not an unreasonable thing to do (even if you find it laughable).

    Secondly, the issue of relative pay is sensitive inasmuch as it reminds all that doctors assume the lead role in the healthcare profession, yet it is quite a logical demand. The principle of relativity is applied in the work distribution, responsibilities and liabilities of the members of the healthcare team, there is no reason why it should not be applied to the wage structure as well.

    It is interesting to read Ngozi talk about ‘integrity’ and ‘sheer dogged loyalty’ and ‘privilege’ and ‘compassion’ in the heart of every doctor!
    Does she mean that doctors are a breed apart? Different from all other Nigerians?
    I am pretty sure doctors have never demanded for a special status or recognition from the people or the government of Nigeria, so we must be careful not to confuse the presumptions of others with the place of doctors in our society.

    Until doctors are the recipients of privileges such as different tax laws, and the likes, let no one make utopian demands on them.

    The last point I wish to make is that it is not the purview of the medical associations to improve the healthcare of this country, as a professional body, they are the enablers and facilitators of record, agreed; but that onerous task resides with the people, through their elected (or anointed) representatives.

    Blaming doctors for not striking for improved medical facilities is an argument that is as puerile as castigating the Police for not protesting their lack of capacity for law enforcement…

    The roles of employee and those of management are as separate as day and night.

    Thank you.

  8. Well, an interesting article… I’ll like to remind all that doctors are human…. we have families to feed, school fees to pay and its not free…. i don’t go to the market with my certificate… in fact, the title gets you a higher bargaining price in the market!!!
    I don’t like the constant blackmail of ”the patient first and our oaths” used on us all the time…
    Many people have professions that directly affect lives but doctors are painted as ”black sheep” whenever we agitate for legitimate rights….
    The sacrifice to study medicine and remain in clinical practice has cost a lot of us so much… we have issues with obtaining loans to buy cars or property, landlords don’t want you because you are not comfortable and they believe you cant pay your rent, you cant put your kids in good schools, etc and you call yourself a doctor…. You don’t even have the time to bond with your family, your spouse hardly sees you, your kids swear not to do medicine because they don’t see mummy and daddy often and are always managing, some have lost their homes, broken marriages because of the odd working hours, occupational exposure to all sorts of diseases first hand…… the list is endless….
    In spite of all this, you are overworked, underpaid and under the constant threat of your employers axe on your head!!!! This is so true with the state employed doctors…. Lagos and Ogun states particularly…They are so dedicated to their jobs, work to the bone, miserable pay, heavy and ridiculous taxes…( you need to see the payslips and you’ll be shocked) and they get no appreciation….. Just more blackmail and victimization
    The politicians that are earning so much for free are not being questioned…..
    Please, all we ask for is the return of the dignity of our profession… its not all about the pay
    @ Ngozi, there is no substitute to overseas training… Medicine is apprenticeship… Its not an Internet based curriculum…. I cannot substitute a human for a mannequin or an on line image…. exposure is key here… Moreover, a lot of disease conditions formerly thought to be limited to the developed world is now seen routinely here in the tropics ….
    As much as its sad being a patient, i actually feel sorry for them….. But as it is, many doctors are already sick emotionally and physically and the sick cannot help the sick!!!!!

    Anonymous….

  9. Well, an interesting article… I’ll like to remind all that doctors are human…. we have families to feed, school fees to pay and its not free…. i don’t go to the market with my certificate… in fact, the title gets you a higher bargaining price in the market!!!
    I don’t like the constant blackmail of ”the patient first and our oaths” used on us all the time…
    Many people have professions that directly affect lives but doctors are painted as ”black sheep” whenever we agitate for legitimate rights….
    The sacrifice to study medicine and remain in clinical practice has cost a lot of us so much… we have issues with obtaining loans to buy cars or property, landlords don’t want you because you are not comfortable and they believe you cant pay your rent, you cant put your kids in good schools, etc and you call yourself a doctor…. You don’t even have the time to bond with your family, your spouse hardly sees you, your kids swear not to do medicine because they don’t see mummy and daddy often and are always managing, some have lost their homes, broken marriages because of the odd working hours, occupational exposure to all sorts of diseases first hand…… the list is endless….
    In spite of all this, you are overworked, underpaid and under the constant threat of your employers axe on your head!!!! This is so true with the state employed doctors…. Lagos and Ogun states particularly…They are so dedicated to their jobs, work to the bone, miserable pay, heavy and ridiculous taxes…( you need to see the payslips and you’ll be shocked) and they get no appreciation….. Just more blackmail and victimization
    The politicians that are earning so much for free are not being questioned…..
    Please, all we ask for is the return of the dignity of our profession… its not all about the pay
    @ Ngozi, there is no substitute to overseas training… Medicine is apprenticeship… Its not an Internet based curriculum…. I cannot substitute a human for a mannequin or an on line image…. exposure is key here… Moreover, a lot of disease conditions formerly thought to be limited to the developed world is now seen routinely here in the tropics ….
    As much as its sad being a patient, i actually feel sorry for them….. But as it is, many doctors are already sick emotionally and physically and the sick cannot help the sick!!!!!

    Anonymous….

  10. Well, an interesting article… I’ll like to remind all that doctors are human…. we have families to feed, school fees to pay and its not free…. i don’t go to the market with my certificate… in fact, the title gets you a higher bargaining price in the market!!!
    I don’t like the constant blackmail of ”the patient first and our oaths” used on us all the time…
    Many people have professions that directly affect lives but doctors are painted as ”black sheep” whenever we agitate for legitimate rights….
    The sacrifice to study medicine and remain in clinical practice has cost a lot of us so much… we have issues with obtaining loans to buy cars or property, landlords don’t want you because you are not comfortable and they believe you cant pay your rent, you cant put your kids in good schools, etc and you call yourself a doctor…. You don’t even have the time to bond with your family, your spouse hardly sees you, your kids swear not to do medicine because they don’t see mummy and daddy often and are always managing, some have lost their homes, broken marriages because of the odd working hours, occupational exposure to all sorts of diseases first hand…… the list is endless….
    In spite of all this, you are overworked, underpaid and under the constant threat of your employers axe on your head!!!! This is so true with the state employed doctors…. Lagos and Ogun states particularly…They are so dedicated to their jobs, work to the bone, miserable pay, heavy and ridiculous taxes…( you need to see the payslips and you’ll be shocked) and they get no appreciation….. Just more blackmail and victimization
    The politicians that are earning so much for free are not being questioned…..
    Please, all we ask for is the return of the dignity of our profession… its not all about the pay

  11. @ Ngozi, there is no substitute to overseas training… Medicine is apprenticeship… Its not an Internet based curriculum…. I cannot substitute a human for a mannequin or an on line image…. exposure is key here… Moreover, a lot of disease conditions formerly thought to be limited to the developed world is now seen routinely here in the tropics ….
    As much as its sad being a patient, i actually feel sorry for them….. But as it is, many doctors are already sick emotionally and physically and the sick cannot help the sick!!!!!

    Anonymous….

  12. Dr Abbas L. Ibrahim

    Dear Chikwe,
    I find your piece nauseating as its disgusting.You seem to have missed the point-doctors are only demanding for a living wage.
    The governments,both federal and state have the moral responsibility to arrest the increasing trend of brain-drain within and outside the country.
    We will never get it right on our health system if credits is not given to who is due.

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