Our Stand on the Current JOHESU Strike and NMA Rejoinder

 

The Honourable Minister of Labour and Employment,

Federal Secretariat,

Abuja

25 April 2018

 

Sir,

We bring you greetings from the entire membership of the Association of Hospital and Administrative Pharmacists of Nigeria (AHAPN).  

 

We are constrained to write this letter stating our stand on the current JOHESU led strike action by healthcare workers in the country and the contemptible, condemnable stand of the Nigerian Medical Association (NMA) against the strike as contained in their rejoinder titled “RE: AN URGENT CALL FOR AN INTERVENTION TO REDRESS ABERATIONS IN HEALTH SERVICE IN NIGERIA.”

 

A lot has been written in the print and electronic media about the merits or otherwise of the strike action by several interest groups. What is coming as a surprise however is the self serving and recalcitrant stand of the Nigerian Medical Association (NMA) against the JOHESU led strike action. The rejoinder concluded with “The NMA wishes to humbly restate her earlier positions as contained in our letter no NMA/PRE/SG/03/0751 dated 21st March, 2014 which ended thus: “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 violate the January and July agreements of 2014 shall result in the resumption of the suspended withdrawal of service of 2014.”  

 

Honourable Minister Sir, we are amazed at the level of half truths and outright falsehood contained in the so called rejoinder, to the point that we are forced to ask the following questions: What does the NMA really want? Whose interest is she really serving? For how long will the NMA continue in this her shameless game of subtle and or outright blackmail of successive Nigerian governments to dance to the tunes of some hawks in their midst? When will the NMA stop defrauding the Nigerian economy in the guise of “maintaining collective agreement reached with the Federal Government?

 

We are not prepared to join issues with the NMA word for word, because that has already been addressed by several other write ups. However, we are appalled by the statement credited to the NMA to the effect that “Ordinarily, we would not have any basis to interfere but for the risk some of the demands pose to the collective bargaining agreement the NMA had with the Federal Government in 2014 and the possible consequent disruption of peace in the health sector.”

 

We are disappointed that the NMA keeps making reference to the so called “collective bargaining agreement the NMA had with the Federal Government in 2014,” an agreement obtained by hoodwinking and deceiving the then President to sign in his visitors room in the early hours of January, 2014, without reading the contents or its cost implications for the Nigerian economy. The same government that signed the NMA document and promised other healthcare workers adjusted salary increase reneged on that promise after losing the elections which they (NMA) promised to support him to win and which he lost eventually. 

 

That singular act of the then government is one of the reasons for the lack of peace that has bedeviled Nigeria’s healthcare sector till today. You cannot be talking about a collective bargaining agreement when only one party (in this case only medical doctors) were in attendance. As an association, we are not opposed to the jumbo salary increase approved for medical doctors in 2014, but we believe that what is good for the goose is good for the gander. We urge the federal government to sign and circularize the salary adjustment agreed with JOHESU members in 2014 without further delay. 

The NMA unwittingly gave the impression of collusion between her and the federal government in their callous and shameless decision to unleash reign of destabilization, chaos and near anarchy in the health sector, an assertion we find difficult to believe. According to the NMA, “We are aware that this group (referring to JOHESU) has vowed that there can never be peace in the health sector until practices unknown to international standards; court judgments, culture/traditions are entranced (sic) in the nation’s public health sector. 

 

They appeared to have succeeded largely in the past until the inception of this government. This government has worked hard to revamp and sustain international best practices and uphold the laws of the federation amidst constitutional provisions.” We see this as another attempt by the NMA to arm twist this government to acquiesce to their nefarious request  

 

We wish to dissociate ourselves from the NMA stand, and completely align ourselves to the stand of JOHESU on all issues raised, including the following:

. Approve and circularize upward review of CONHESS Salary Structure, having done same for medical doctors.

. Appointment of Chief Executive Officers for federal teaching hospitals and federal medical centers and appointment of deputy Chairman Medical Advisory Committee (DCMAC)

. Payment of backlog of arrears as a result of skipping of CONHESS 10

. Employment of more staff to strengthen the health sector

. Release of circulars for reviewed retirement age from 60 to 65 years.

. Implementation of National Industrial Court of Nigeria judgments in favour of JOHESU

. Appointment of non medical consultants.. Review of the Composition of the Boards of Federal Health Institutions (the current scenario is such that 62% of board members are reserved exclusively for medical doctors, in a ministry that boasts of over twelve other health disciplines. It is on record that no single pharmacist was appointed a member of board of any of the over 53 federal tertiary health institutions in the recent exercise) 

 

Honourable Minister Sir, we want to specifically identify with the stand of the Pharmaceutical Society of Nigeria (PSN) on the current crises in the health sector, as contained in her recent letter to the President of the Federal Republic of Nigeria. In particular, we agree with the PSN where she stated that “it is important to draw you down memory lane that contrary to the superiority mentality created in some quarters; pharmacists and doctors entered the public service on the same grade level up till 1991.In Nigeria, pharmacists started on GL 08 Step 2, while doctors entered on GL 08 Step 3 because of the one year difference in the duration of training. 

 

This was the pattern till the Olikoye Kuti leadership in the Federal Ministry of Health got the military administration of Gen. Ibrahim Babangida to approve the Medical Salary Scale (MSS) a discriminatory salary wage in favour of medical doctors in public service. The MSS obviously disrupted the equilibrium of public sector wages as it became the basis for other doctoral players request for exclusive wages in the health sector.”

 

We make bold to state Sir, that therein marked the genesis of the protracted crisis in the health sector which has defied successive governments ever since. Former President Olusegun Obasanjo came in with the Consolidated Tertiary Health Institutions Salary Structure (CONTISS) which effectively narrowed the huge gap in wage bill among all workers in the health sector, including medical doctors. That arrangement brought some reprieve to the sector. 

 

Peace has eluded the healthcare sector in Nigeria since 1991 because our medical doctors have refused to accept collaboration as a necessary working tool for harmony in the sector, as is the case in every other country in the world. 

 

All of us in the hospital setting attend to the same patient at different points of care. Granted that the medical doctor sees the patient first, but then that is by virtue of his training which involves making a diagnosis, among others. There are specific roles for other healthcare workers as part of the care process. The pharmacist ensures that the right medication is given to the right patient with the right diagnosis at the right cost, also by virtue of his training. The nurse comes in at a point with nursing care, the medical laboratory scientist conducts tests to assist the doctor in making a diagnosis. Ditto for other healthcare professionals. 

 

There is no tertiary hospital anywhere in the world where a patient just walks in, sees the medical doctor only and walks out without undergoing the care process and then claims to have been attended to in a hospital. Every professional has a defined role to play in the care process, this is what obtains in developed countries; this explains why medical tourism is high in those countries, because of their near excellence standards. 

 

Back home in Nigeria, the medical doctors insist on running a one man show, from heading clinical services, heading laboratory services, radiology, pathology and if they have their way, pharmacy and nursing services. This is why the health sector in Nigeria has refused to move forward. Medical doctors have held successive governments in Nigeria to ransom, abandoning their Hippocratic Oath and insisting on heading hospitals and every department in the Federal Ministry of Health. They threaten strike action with or without provocation not minding their Hippocratic Oath and leave Nigerians to die in their thousands just to massage their ego and insatiable urge for money. 

 

They have largely succeeded because successive governments have refused to call their bluff even at the expense of the lives of ordinary Nigerians. The disparity in wage bill between medical doctors and other healthcare professionals has assumed monstrous proportion and is not obtainable anywhere else including the military, judiciary, universities and research institutes.

 

Way Forward 

Honourable minister Sir, it is obvious that the health sector in Nigeria cannot continue the way it is going for much longer. Drastic approach is needed to sanitize the sector and bring in lasting peace. 

 

i. As a lasting solution, we are advocating  harmonization of the wage bill of workers in the health care sector such that there will be a unified or consolidated salary structure where every health professional will enter the scale based on their duration of training, with higher steps reserved for those disciplines with longer duration of training. This is also the stand of the Pharmaceutical Society of Nigeria and other professional associations.

 

ii. It is ridiculous and unheard of that one professional body should dictate the salary of her members and those of other professionals in that sector. As an association, we will not accept salaries and allowances dictated for us by the NMA.

 

iii. We are asking that the federal government appoints pharmacists as members of boards of federal tertiary health institutions as was done for other health professionals in the spirit of equity.

 

iv. Government should call the bluff of the NMA for once and implement reforms in the health sector that favour the ultimate good of the Nigerian people and that will usher in lasting peace and tranquility in the sector. Government must never panic nor be in a hurry to dance to the tunes of NMA at the least threat. In other climes including Ghana, their governments always call the bluff of medical associations whenever they threaten strike action, by employing Asian trained doctors to replace them. And of course they have always recapitulated. Nigerian government is encouraged to employ the same tactics. 

 

Conclusion

There is a saying that only a fool will keep doing the same thing every time and expect a different result or outcome. The macabre dance in Nigeria’s health care sector has lasted for too long. Enough is enough. It is time for the sector to move forward. Government should not hesitate to take the lead. A stitch in time saves nine.

 

Please accept assurances of our esteemed regards.

 

Signed

Pharm. Martins Oyewole MAW                       

National Chairman AHAPN

 

Pharm. Jelili Kilani

National Secretary