Fashola-OKTODAY makes it 26 days when doctors under the aegis of  the Nigerian Medical  Association (NMA) abandoned  their  patients   in hospitals nationwide  to  protest  against  the  Federal  Government’s  agreement  with  other  allied health professionals  who  are  under  the umbrella  of  the  Joint Health Sector Union (JOHESU). Medical consultants who were supposed to join in the strike, were restricted by a legal case they  filed through  their umbrella  body, Medical and Dental Consultants’  Association  of  Nigeria (MDCAN) at  the National  Industrial Court (NIC).The case has since been adjourned to October because  judges  are  on  recess. Even NMA itself has been dragged to court by JOHESU. 

     But while everyone is awaiting the outcome   of  the legal cases, it seems the Lagos State government  has  found  a soothing  balm  to  the  challenge  of  incessant  strikes in  the  healthcare sector. Today, the tension that usually heralds strikes in the healthcare sector in the state has been significantly  reduced. When  The Guardian visited  some private  hospitals  in the state,  it was  discovered  that  those  hospitals  were  not  crowded by  patients  as it used  to  be during strikes  by  medical  professionals. The situation at the  Lagos  State University  Teaching Hospital (LASUTH) was  as  if  there  was  ongoing strike action in the medical profession. Staff at both  the accident and  medical  emergencies   of  the hospital  were  working. 

   A source who spoke anonymously  at  LASUTH said  locum staff (doctors hired on contract)  by  the  Lagos  State government  have  made  the difference. “Medical consultants along with locum doctors and other healthcare professionals are working. We have been admitting patients. I think the locum  staffing  phenomenon introduced  by  the Lagos  State  government  sometime  ago has  made  the difference,” the source said.  

   Locum staffing was alien to the  medical  profession  in Nigeria until  2012 when  medical  doctors  and the  Lagos  State government  locked  horns  over  the implementation  of  the Consolidated Medical Salary Structure (CONMESS) signed in 2009 between Federal Government and medical  doctors. Medical doctors under the umbrella of the Medical Guild went on strike. Irked by the action, the Lagos State Governor Babatunde Fashola sacked about 788 striking medical doctors. But there was a big void to fill.  To fill that it, the state government recruited locum medical officers, but not without  signing  a  contract with  the contract medical doctors. 

    Details of the terms of contract revealed that the locums are not employees of the state  government  but contract staff that can be fired at will. The terms of operation also revealed  that  they have no right to unionism  or collective bargaining, and they  cannot embark on strikes or any industrial action to seek redress. The only option available to them when they have grievances is mediation. The terms of engagement also reveal that since there is no guaranteed income for them, the locum staff will be paid between N5, 000 to N7, 000 for every four hours worked. The crisis was later  resolved. But unlike what many  observers had  thought, the locum  staff  remained, even while the employed  medical  doctors  returned  to work. 

   According to the Wikipedia, a locum is a person who temporarily fulfills the duties of another. Locum is a global practice. Wikipedia explains: “In the UK, the NHS (National Health Service) on average has 3,500 locum doctors working in hospitals on any given day, with another 15,500 locum general practitioners. Many of these locum hospital doctors are supplied by private agencies through a national framework agreement that the NHS holds with 51 private agencies.”

    Until the ongoing strike, many people  had forgotten  that  locum has become a part  of Lagos State medical practice. Affirming how the  locum staff  practice has become  a soothing  pill to the  strike headache in Lagos, a consultant gynaecologist  with LASUTH, Dr. Paul Adekoya (not his real name) said: “Lagos  State  government  has  tied  our  hands  with  locum staff practice.” He added that  the  contract type  of employment  has been  effective in reducing  the effects  of  the ongoing  nationwide  strike. The state government has since  expanded   the scenario to  other  healthcare  professionals, including  nurses, radiographers among  others. 

    It was learnt that  the Lagos  State  government  decided  to retain the system  to curtail  the  negative  effects   of strikes  in  the  nation’s healthcare system.  Some other  public hospitals  not  owned   by  the Lagos  State  government, it was also gathered,  have  started hiring  locum staff. At the Lagos  University Teaching  Hospital (LUTH), it was discovered that  locum staffing  has been adopted in the recruitment of  gatemen, cleaners  and  non-medical professionals. 

    However, as good  as  the  practice  may seem  in stabilizing  the healthcare system,  there  are fears  in some quarters  that  it may  lead  to unemployment  in  the medical  sector  if continued. “Locum staffing  is  good  for  the  patient, but  bad  for  the  person engaged  as locum staff. Government  may, as  a result   of the  practice, deliberately  refuse  to give  jobs to qualified  medical  person,” Mr. Alex  Akanji, a pharmacist with  the  Lagos  State  government, said. 

   While many people may attribute  the relative stability  in government  hospitals  to  the  locum staffing, a medical  sociologist  with Crawford  University , Dr. John Ayodele,  thinks otherwise. Citing a research that  was conducted in  Canada, he averred  that the  absence  of patients  in private hospitals may be  because Lagos residents  have learnt  how  to  live  in a healthy way. 

    “A research  that  was  done in Canada some  years  ago showed  that when  medical  doctors  go on  strike, there  was a  decrease  in  medical  problems because people  were  proactive; they  were  taking  action  that  would  positively  affect  their  health so that  they would  not see any  need  to  go  hospital,”  Ayodele said