Nigeria’s health system teeters on the brink of collapse as doctors once again resort to their favourite pastime of embarking on indefinite strike to settle labour issues. Once again, it is that season when doctors forget the meaning of the Hippocratic oath and abandon ailing patients to their fate; it is also that time when people pray fervently that they or their loved ones should be spared the agony of taking ill, especially for the poor and the downtrodden.
It is deeply troubling that the country has to go through this all over again in a health care delivery system that has failed over the years to live up to its billing. As far back as 1983, the late Sani Abacha, in a coup address to the nation, described the country’s tertiary hospitals as “mere consulting clinics”. Close to 35 years after, the situation has not changed. If anything, it has even gone worse.
Poorly funded and shorn of adequate equipment and personnel, government hospitals that used to be the bedrock of a robust health care system are now referral centres, where patients are sent abroad for ailments that should ordinarily be handled in Nigeria. In 2012, the Nigerian Medical Association claimed that $500 million was spent annually on medical treatment abroad by Nigerians. The most preferred destination has been India, a Third World country like Nigeria that has developed its medical facilities to the level where they are among the most sought after in the world.
Worse still, top government functionaries who have a responsibility to raise the standard of healthcare delivery in the country have no faith in Nigerian hospitals. The President, Muhammadu Buhari, just returned from a 104-day medical sojourn abroad, to treat an undisclosed ailment. A former Vice President, Atiku Abubakar, while in office, once flew abroad for treatment when he had a knee dislocation. So also was the case of a serving senator and former governor, who made a show of building a world-class hospital in his state, only to run abroad immediately he had a minor auto accident in Abuja.
Issues currently canvassed in the current strike by resident doctors are not unfamiliar; they have to do with the welfare and other emoluments of doctors, which had been agreed upon by the Federal Government way back in 2009. It is therefore sad that the government, quite in character, has failed to honour its part of the agreement. This shows a cavalierly government, with little or no consideration for the health of ordinary Nigerians, who are the worst hit by the current resident doctors strike.
In fact, both parties have displayed a lack of good faith in the handling of the current strike, which ought not to have degenerated to this level. Reports have it that the leadership of the National Association of Resident Doctors had an agreement with the Federal Ministry of Health to stay action on the strike as efforts were being made to meet their six-point demand. It was therefore wrong for the doctors to renege on the agreement without waiting to see whether the government would fulfil its promise or not.
It can be presumed that the doctors’ action was predicted on previous experience of the government not respecting the terms of its agreement; but, given the sensitive nature of the duties performed by doctors, the recourse to strike at the slightest provocation can never be tenable. For example, the current strike is just one in a series that had taken place in the past. But have they been able to bring sanity to the Nigerian health sector? The answer is an emphatic no. So why can the doctors not explore other means of conflict resolution?
In other civilised societies, health care is so important that issues are not allowed to degenerate to the stage where strikes become inevitable. When such happens, which is usually rare, it is symbolic, not meant to paralyse the entire system. For instance, when junior doctors embarked on an industrial action in the United Kingdom on January 12, last year, Aljazeera reported that it was the first of its kind in 40 years. Besides, it was not an indefinite strike but an action staggered through January 12, 26 and February 10. Doctors still continued to provide emergency care during the exercise described as a walkout, except the last one, which was planned to be total.
There is no doubt that the right of a doctor to go on strike will always present an ethical dilemma. As workers, doctors, like everybody else, have an indisputable right to protest under unfair labour terms; but as essential duty workers, just like the police and fire fighters, for instance, medical officials’ resort to strike to object to unfavourable working conditions should be under very extreme and exceptional circumstances.
This however should not be an excuse for the government to act irresponsibly. Whenever there is a negotiated agreement, the government should ensure that such agreements are honoured, to enhance its integrity. In other parts of the world, health care is so important that it can determine who wins a presidential election. It is time Nigerians started holding the government to account on the quality of health services provided for citizens.
To start with, government officials should henceforth stop the idea of running abroad whenever they have minor ailments. It has become obvious that they can only develop hospitals at home when they know they have no foreign option. Efforts should also be made to increase the ratio of doctors to patients in the country, currently put at 1:6,400 as against the World Health Organisation’s recommended ratio of 1:600.
A good working environment is essential. When hospitals are well equipped, doctors who are now fleeing the country at the least opportunity will not only stay back but those abroad will return. In the time being, the government has to do everything to ensure that the strike is called off and normal services restored to the hospitals.