The unending rift between doctors and health workers is at the heart of the distraction and disruption that has characterised the Nigerian health sector. PATIENCE IVIE IHEJIRIKA writes on how government can end this and ensure stability in the sector.
The end to incessant strike in the Nigeria health sector may not be in sight, as the lingering crisis that has bedeviled the sector, following the rift between doctors and other health workers has not been addressed.
Indeed, the situation is becomes more worrisome as the Joint Health Sector Union (JOHESU) remains resolute in its demand for pay parity with doctors.
Health workers, including pharmacists, nurses and medical laboratory scientists have repeatedly decried what they described as delay tactics and deliberate foot-dragging of the federal government in approving the adjustment of Consolidated Health Salary Scale (CONHESS) as was done for medical doctors’ Consolidated Medical Salary Scale (CONMESS) since January 2014.
The aggrieved health personnel under the aegis of JOHESU and Assembly of Healthcare Professional Associations (AHP) had on September 29, 2017 suspended a 10-day old strike after a meeting with the minister of Labour and Employment, Dr. Chris Ngige.
However, JOHESU on 18th of April, 2018, resumed the strike but restricted it to only federal health institutions.
According to the JOHESU National Chairman, Comrade Biobelemoye Josiah, the strike was inevitable since government has not shown enough commitment to tow the part of honour and meet their demands, especially, the core demanding for the upward adjustment of CONHESS salary structure as agreed in the Memorandum of Terms of Settlement signed with the union members on 30th September, 2017.
Just as patients, especially the poor ones who cannot afford to go to private hospitals or travel abroad for medication, were hoping that the strike will be called-off soon, the union extended the strike to states and local government areas, from midnight of Wednesday, May 9th, 2018.
Josiah again said that the union was left with no other option than to direct states and local government areas to join the strike while accusing the Federal Ministry of Health of thwarting all efforts at reaching an amicable settlement of the issues of their demands.
He said, “It is six months as at today and government did not see the reason to fulfill its own bargain. We also gave government 21-day ultimatum as at February this year, and they did not also seize that opportunity to do the needful so as to avert the strike action.
“We, for the sake of Nigerians, gave another ultimatum for 30 working days, yet the government did not do any tangible thing.
“Even when we narrowed our demand to just one which is the adjustment of COHESS for health workers, and if we can achieve that, we can then give the government sometime to fulfill other demands, which are revamping the infrastructure in the tertiary health institutions and report of the inter-ministerial sub-committee on critical matters in the health sector.
“Others are Enhancement of Entry Point (EEP) for medical laboratory scientists and Radiographers and payment of backlog of arrears.
“Even when we narrowed our demand like I said, to the implementation of adjusted CONHESS salary structure, government still fails to fulfill its own side of the bargain. So we have no other choice than to embark on the strike.”
“After three rounds of meetings held on Thursday, 26th April, 2nd and 7th May respectively, at the instance of the Minister of Labour and Employment to find a way forward, the Federal Ministry of Health is thwarting all efforts at reaching an amicable settlement of the issues of our demands, especially the upward adjustment of COHNESS salary structure.
“CONHESS review is the upward adjustment of the CONHESS Salary table on-line with the same principles used in adjusting the CONMESS table for medical doctors who work with use in the health team.
“Our own demand for the adjustment of CONHESS that affects over 85 per cent of the workforce nationwide has been frustrated, and part of the reason for this is that the minister of health as well as the minister of state for Health are both medical doctors, while the minster of Labour and Employment, who should be neutral umpire in trade disputes is equally a medical doctor.
Meanwhile, the Nigeria Medical Association (NMA), has warned the federal government against acceding to JOHESU’s demand while threatening to also resume strike should government ignore their warning.
The warning was contained in a statement jointly signed by the NMA President and Secretary General, Dr. Francis Faduyile and Dr. Olumuyiwa Odusote respectively.
According to the association, the warning was informed by the extension of ongoing strike by JOHESU to states and local government areas.
They said “NMA wishes to draw the attention of the federal government to our correspondence of April 21, 2014 on the above, in which we reminded government of the collective bargaining agreement we had with the Federal Government of Nigeria in January 2014.
“It is also pertinent to once again remind government about the concluding part of our letter no. NMA/PRE/SG/03/0751 of 21st March 2014, which states, “In view of the above, the NMA painfully wishes to inform the Federal Government of Nigeria that any award to the non-medically qualified health professionals that violates the January and July agreements of 2014 shall result in the resumption of the suspended withdrawal of service of 2014.”
They opposed any adjustment in CONHESS salary Scale with resultant pay parity between doctors and healthcare professionals allied to medicine.
The association also maintained its stand against JOHESU’s demand for the appointment of other health workers as consultant with payment of specialist allowance, describing it as a self-centered agitation aimed at ensuring they are in charge of clinical care.
“The demand for Headship of Departments/units in the hospital by members of JOHESU/AHPA will lead to unprecedented chaos in the health sector with ripple effect on the health of Nigerians. We reaffirm our rejection of this demand.
“The NMA reiterates her position on the appointment of CMDs/MDs of tertiary hospitals which is in accordance with the extant law and with emphasis on ‘medically qualified’ as interpreted by the National Industrial Court of Nigeria. Various Circulars of government also refers,” they said.
NMA however said that doctors not against career progression of allied health professionals but will not accept any decision that allows for multiple appointments of directors in a department without such being applicable to medical doctors.
Speaking further, they also expressed full support for the demands of JOHESU/AHPA on skipping of CONHESS 10 and payment of arrears in compliance with National Industrial Court of Nigeria Judgment, and increased retirement age.
However, the federal government on its part, has tried to resolve the issue by setting up a committee to look into it. There have also been series of meetings between the Federal Ministry of Health, Labour and Employment and JOHESU which all ended in deadlock.
In the letter written and signed by the Head, Department of Hospital Services, Dr. J.O Amedu for the Minister of Health, the federal government said; “You will recall that the JOHESU commenced a strike action on the midnight of Tuesday, 17th April 2018 despite all entreaties by the Government for them not to.
“In line with provision of Section 43 of the Trade Dispute Act CAP 18, Law of the Federation of Nigeria (LFN), 2004 and the International Labour Organisation’s principles concerning employers’ right during strike in essential services, the Federal Government has invoked this Provision and is therefore enforcing “No Work, No Pay” law on Unions and Associations who decide to embark on strike without consideration of Government efforts to resolve their request. This directive is the decision of a High Level Body of Government Stakeholders chaired by the Secretary to the Government of the Federation.(SGF).
“I am directed to inform you to stop the April 2018 salary of all JOHESU workers who have defied Government by partaking in the strike. You are also directed to strictly keep the Attendance Register of all staff who are not partaking in the strike. As JOHESU workers in your institution are yet to be captured in the Integrated Payroll and Personnel Information System (IPPIS) platform, you are to implement this directive of government on your GIFMIS platform.”
Due to this directive, the salary of JOHESU members for April has been withheld. Reacting, the National Association of Nigeria Nurses and Midwives (NANNM), has condemned the move, insisting it is not the way out.
President of NANNM, Comrade Abdrafiu Adeniji, who stated this while briefing journalists at the end of the 2018 nurses and midwives week, held in Abuja, said “the April salary of JOHESU members is being withheld, even though they had worked dutifully until early hours of 18th April, 2018.
“According to all regulations, the ‘no work no pay’ is only applicable when an illegal strike is embarked on. An illegal strike means a strike embarked upon without notice to government. The situation we have at hand is for the federal government to look into what it signed and implement the agreement
Adeniji also accused the Federal Ministry of Health of employing measures targeted at frustrating and humiliating the union members rather than simply implementing agreement entered into with JOHESU and obey court order.
He lamented that while other countries are counting their gains and achievements towards attaining universal health coverage, the Nigeria government is doing the opposite.
Sadly while this tussle and indeed the attendant strike continues, poor Nigerians continued to groan in pain as they are left with the sad choice of either patronizing quacks or resign to fate.
Experts have however urged the federal government to find a lasting solution to the crisis, which has characterized the nation’s health sector, forcing patients to patronise private health institutions and herbal medicines.
They also opined that government should take proactive measures to resolving the health sector issues rather than waiting for health workers to embark on industrial action before calling for discussion.
Indeed, the time is long over for government and the critical stakeholders in this all important sector to meet with both JOHESU and NMA with a view to finding lasting solution to issues that have consistently been fueling disharmony in the sector.
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