One of the most difficult social crises besetting life in Nigeria is its broken down healthcare system. Meagre remuneration, chronic shortage of personnel and deficient equipment combine to make healthcare burdensome and expensive when available. So, the system reels on the edge of anarchy at every point. For the past month, the health workers’ unions have embarked on a strike over working conditions. With the government still figuring a way out of the chaos, there is a sinking feeling that a lasting solution is a long way off.
Citing the non-implementation of a 2017 agreement it entered into with the Federal Government, the Joint Health Sector Union, which comprises health professionals other than medical doctors, declared an industrial action on April 17. Central to their demands is pay relativity with medical doctors. JOHESU president, Joseph Biobelemoye, said the Federal Government signed two memoranda of terms of settlement with it in September 2017. In 1991, the Federal Government had introduced the Medical Salary Scale, which improved the remuneration of doctors to the exclusion of other health workers. After much agitation, the government introduced CONMESS (for doctors) and CONHESS (for the others).
The exclusive salary packages distorted the equilibrium in the civil service, more so in the health sector. JOHESU members claim that the difference between a medical doctor, and say, a pharmacist, at the point of entry into the civil service, is now approximately N1.2 million per annum. This has triggered incessant strikes by JOHESU members. Conversely, the Nigerian Medical Association argues against pay parity with other health professionals. To the NMA, the role of chief medical director in public hospitals should be reserved for its members. To press home their point, they too go on strike anytime the government makes a move to restore equilibrium.
These are knotty issues. However, the government, in a bid to satisfy some interests, imprudently inflicted it on itself by entering into all manner of exclusive agreements that it does not care to implement. Nonetheless, JOHESU’s other demands include the upward review of the retirement age from 60 to 65 years, employment of additional professionals, implementation of court judgements and approval of consultancy cadre for them.
Out of these demands, the one that deserves a critical review is the drive by pharmacists, nurses and laboratory technicians to become consultants. For instance, the National Health Service – Britain’s widely-acclaimed public health system – established the role of consultant pharmacists in 2005. To qualify for the job, an NHS trustee said, “A consultant post must incorporate certain elements, such as expert clinical practice, education and training, audit and research, and it needs to consider issues that may be outside of the post-holder’s immediate place of practice but relevant to the wider profession.”
As expected, the public is paying a huge price because of the strike. Although doctors are on duty, public hospital wards are virtually empty across the country. The few who can afford it choose private hospitals. The elite travel overseas for medical treatment. Since President Muhammadu Buhari assumed office in May 2015, he has travelled for medical treatment in the United Kingdom five times. For the downtrodden, they resort to spiritual homes and unorthodox health practitioners.
However, it is dangerous to leave the strike unresolved. Before the industrial action, the national health system had been near comatose. Apart from Lassa fever and other diseases, Ebola is raging again in the DR Congo. Data compiled by multilateral agencies state that 2,300 children below age five die daily in the country. These organisations estimate that 145 women of childbearing age also die daily. In 2016, the World Health Organisation put Nigeria’s life expectancy at 55 and 56 for males and females respectively. In Cuba, it is 79.1 (76.9 for males, females 81.4).
This is why medical tourism costs Nigeria over $1 billion annually, according to the Minister of State, Health, Osagie Ehanire. The personnel crisis is as appalling, with about 19,000 of the over 40,000 medical doctors that trained locally travelling abroad to practise. The NMA says 70 per cent of doctors practise in the urban centres. In contrast, Cuba, which has been groaning under economic sanctions by America, operates a first-class medical system. At its core are well-trained personnel, who operate in every household. The surplus personnel are deployed overseas on medical missions; this fetches Cuba an income of $2.5 billion annually, the authorities say.
Therefore, we need a fresh approach to address this mess. Reforms in parts of the European Union have simplified hospital management, separating administrative duties from core medical duties. Trained hospital administrators could be appointed as chief executive officers of these public hospitals, while medical doctors take charge of the medicine aspect. Although doctors there kick against this, Britain’s NHS has found a way to accommodate nursing consultants.
JOHESU and the NMA ought to review the use of industrial actions as a weapon to negotiate better pay; it should not be employed recklessly. In the 70-year history of the NHS, the Royal Council of Nursing – a 270,000 strong organisation – voted to go on strike for the first time in May 2017. Although junior doctors in the NHS embarked on industrial actions over pay six times in 2016, five of those strikes lasted just two days, between 8am and 5pm.
To save the system, the solution lies in setting up an independent panel of reputable professionals to proffer holistic solutions. The panel has to examine the global best practices in different climes before submitting its recommendations to the government, principally because medical practice and administration are changing rapidly in most parts of the world. It is imperative for the panel to trace the root cause of the loss of cohesion in the health sector, with a view to restoring the amity between doctors and the other health care professionals.
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