The recent strike by Joint Health Sector Union (JOHESU) of AKTH opened a Pandora box of old cankerworms that is set to change the health landscape forever
When in 2008, former President Umaru Musa Yar’adua nominated Professor Dora Akunyili (both now deceased) as a ministerial nominee, doctors across Nigeria threw away their stethoscopes and readied for a show down with the new government. Their grudge was “Why should the government appoint a pharmacologist to man the health ministry?” As fate would have it, Akunyili was assigned the information ministry, and a ‘rightful’ medical doctor became the health minister in the person of Dr. Babatunde Osotimehin.
Whether it was the fury of the doctors that made the government to make Akunyili an information minister or that had been its earliest resolve remains a mystery. But the reality is that since Nigeria’s independence in 1960, medical doctors had mostly been the ministers of the health ministry of the country. Even the current minister of health, Isaac Folorunso Adewole is a professor of gynaecology and obstetrics while the minister of state, Dr. Osagie E. Ehanire, is a surgeon.
According to Abubakar Tukur, a medical lab scientist, doctors have also pocketed virtually all the directorships and HODs of the health ministry. And as usual, the Chief Medical Directors of all hospitals in Nigeria are always doctors, including heads of any headship positions.
But as it is today, it seems the medical doctors have bitten more than they can chew as other allied medical professionals, notably the Joint Health Sector Union (JOHESU) and Assembly of Healthcare Professional Association (AHPA), have rolled up their sleeves to grab from the jaws of the doctors what rightfully belongs to them.
Residents of the ancient Kano city who had no inkling that the local chapter Joint Health Sector Union (JOHESU) in Aminu Kano Teaching Hosptial will embark on a warning strike on January 11, 2016 were caught unaware when they attended the hospital for one ailment or the other to meet the doors of the hospital firmly closed. The strike, which the union said was a warning, lasted till January 14, 2016.
Even though the unionists had had a long list of demands including inadequate facilities, shortage of manpower, request for autonomy and non-payment of skipping emoluments, the last stroke that broke the proverbial camel’s back is what JOHESU’s local chairman, Comarade Adamu Musa Sarki said, “was when the hospital management began deducting our members’ salaries starting from September 2015 to date.”
In civil service, skipping exist where for example, a civil servant on level 9 will skip level 10 to move to go to 11 or skip from 10 to 12. This, Comrade Sarki said, is legally approved by the laws of the land. “But because doctors had been collecting very big fees and their entry point is different from ours, they had no skipping,” the union chairman added.
The least amount an average non-medical doctor takes off with is a salary of about N60,000.00 while his medical doctor counterpart zooms off with a mouthwatering salary of N174,000.00. A non-medical doctor health staff can only rise in the health sector to become a Director of Administration where he/she can pocket N470,000.00 monthly, while a doctor at his peak can fetch home a handsome monthly package of N1,200,000.00.
Even these bumper salaries to the doctors are not enough, say other health workers. In order to become even with other civil servants who skips, doctors went on a strike for over 100 days recently to demand their inclusion in the scheme. It took the intervention of a National Assembly committee and the Kano Emirate Palace to pacify the doctors of AKTH to return to their places of work after a deal was struck with them that allowed them to enjoy skipping.
Crux of Clash
Here is where the problems cropped in. According to JOHESU’s chairman even though the government approved skipping for doctors, “it didn’t say all of them should be moved. According to the government, skipping is going to affect them at the entry point; not that everybody should be moved among them. But the hospital management moved all the doctors from one grade to another across board.”
He also added that when the government gave the approval, it couldn’t release funds for it. And because there was no money in the hospital, the management of AKTH said it will only pay 25 percent of the new increase. And so when JOHESU sensed that the payment of the 25 percent to doctors could affect its members, it raised alarms. But the NASS committee and the emir’s palace intervention together with the promise of the management of the AKTH that the payments will not affect their salaries, “we allowed our members to compute the payments,” Sarki added.
But alas! The feared monster eventually reared its ugly head. The management of AKTH began payment of the 25 percent in September 2015. And by October 2015, staff of the hospital have begun complaining of one missing allowance or the other. These include allowances such as call duty, shift duty and teaching allowances. JOHESU drew the attention of the hospital’s management to the anomaly. When nothing changed, they went for the warning strike.
As it is now, the federal ministry of health waded into the matter and the warring parties were invited to a negotiation table where a truce was called. When a call was put through to JOHESU’s chairman, he acknowledged that the January 2016 salary payment was made full without deduction of any allowance but was quick to add that “we still have other demands that must be met by the hospital management”.
JOHESU’s demands are two-pronged: administrative and financial. The financial aspects include the expansion of the Accident and Emergency ward, increase in manpower, skipping, promotion and allowance arrears, and so on. These they believe could be rectified once the federal government’s implement the 2016’s budget.
The administrative aspect regards the situation where the doctors have taken over the whole sphere of the health sectors.
Ostensibly, referring to the stance the Nigerian Medical Association (NMA), the umbrella body of medical doctors in Nigeria, took that former President Goodluck Jonathan must appoint their members as ministers of the health ministry, farolaks, a user on Nairaland.com, wrote, “At the height of the last ministerial nomination and screening, the Nigeria Medical Association (NMA) had taken a parochial and insulting position that one of its own must be appointed at the helm of the Federal Ministry of Health (FMOH) because according to it, this was a global practice. The NMA went further to threaten the then Acting President that it would ground the health sector if its position was not adhered to.”
“It is important to state that,” folaks continue, “the headship of the Health Sector is not vested in medical doctors contrary to the claims of the NMA. In the United States of America (USA), Kathleen Sebelius was sworn in as the 21st Secretary of Department of Health and Human Services (equivalent to our own Minister of Health) on April 28th, 2009. She is a former Governor of Kansas State, holds a Bachelor Decree of Arts and Masters in Public Administration. Donna Shalala and Tommy Thompson were health ministers in Bill Clinton’s and G.W. Bush’s administrations respectively. They are neither medical doctors nor healthcare professionals.
“In the United Kingdom (U.K), the immediate past Secretary of Health was Rt. Honourable Andy Burnham who holds a Master of Arts (MA) Decree in English Language. In Japan Akira Nagatsuma who was appointed in 2009 as Minister of Health, is not a Medical Doctor. In India the Minister of Health, Mr. Ghulan Azad is not a medical doctor, he holds a M.Sc. Decree in Zoology.”
According to folaks, these are countries Nigerians travel to, in large numbers, for medical attention while the Nigerian healthcare service has been ranked 192 out of 198 countries by the World Health Organization under the leadership of medical doctors.
Coming back home to Africa, folaks mentioned Botswana which been rated by the World Health Organization to have the best national healthcare service. Accoring to the writer, the then Minister of Health in Botswana was an Accountant who took over from Mrs. Motsumi, a Nurse, who was Health Minister from 2003-2009.
“Earlier on,” folaks continues, “Mrs. Phumaphi, a Nurse, was the Minister of Health from 1989-2002. It is noteworthy that since her independence in 1966, no medical doctor has been appointed Health Minister in Botswana.”
And in Nigeria, he emphasised that the tenure of many non-Medical Doctors at the helm of Federal Ministry of Health witnessed stability and harmony. He listed the leadership of late Aminu Kano, Admiral Patrick Koshoni, Admiral Jubril Ayinla, Prince Julius Adelusi-Adeluyi, Prof A. B. C. Nwosu and lately Prof Eyitayo Lambo.
Folaks concluded by saying, “the general perception on why doctors want to continue to be Minister of Health is to maintain the hegemony of an unjust entry level in the civil service and discriminatory salary scales which they always get when doctors are Ministers of Health.”
But Dr. Agwaza Maxwell Dagba with the username DrObum counters on the same forum thus: “There are three directors in a teaching hospital – Director of Administration (DA), Head of Clinical Services (HOCS, also known as Chairman, Medical Advisory Committe – CMAC), and the Chief Medical Director, who is the Chief Executive. The DA handles purely administrative matters, while the CMAC handles issues related to patient care. The CMD, of course, is their superior and serves as the CEO. This ensures that patient care is not sacrificed on the altar of administrative issues and vice versa. There are assistant directors in areas such as nursing, finance, works, and so on.” According to DrObum, this arrangement will create a clear chain of command within the hospital.
DrObum also responded to the yearning of JOHESU that their members be promoted to Director Cadre. “Knowing the Nigeria we live in,” DrObum wrote, “no director will be answerable to another within the same ministry or agency. A director, as far as I know, is only answerable to a permanent secretary. Now unless the titles of the CMD, DA and CMAC are changed, what will become of the hospitals when we have, say, 100 other ‘Directors’ walking the corridors of the teaching hospital? And if you make all the CMDs in Nigeria permanent secretaries today, what will become of the Ministry of Health? For surely, such permanent secretaries will only report to the Minister! And how many ministers can we have at once?”
In the view of DrObum, the whole debacle between doctors and other health workers revolves around the quest for salary increase. He added, “How many other government institutions have a hundred Directors within them as will be the case if this request is granted? Now the irony of it is that if this policy is approved, many doctors would also proceed to become directors.” So he asked, “What benefit does it add to the system? None!
“And what does it take away? First, increased wage bills for the government. Secondly: increased anarchy in a system that is already bastardised by unprofessionalism. Thirdly, many ‘directors’ will abscond from their duty posts since they would now be too big to sit in a clinic, laboratory, pharmacy or hospital ward. And who would bear the brunt of it all? Our dear old black oil! Raped, plundered and wasted, but still faithful. Nothing can be more senseless. If people wish to pursue an increase in pay, they are free to do so. But for Pete’s sake, let there be order in the hospital!” DrObum concluded.
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In November 2015, health workers, under the aegis of the Joint Health Sector Unions (JOHESU) and Assembly of Healthcare Professional Association (AHPA) petitioned President Muhammad Buhari over the lope-sided appointments in the Federal Ministry of Health (FMoH) even as they among other things asked for urgent balance in appointments in the interest of peace.
The letter jointly signed by Chairman JOHESU, Comrade Jay Josiah, and Chairman APHA, Dr. Godswill C. Okara, noted, “While Nigeria appears to be on course for a great future, we are worried that the ever-boiling Health Sector appears to be headed for more heated discourse especially against the background of recent appointments in the leadership strata of the Federal Ministry of Health.
“Your Excellency, the appointment of two Medical Doctors as Ministers in Charge of the Federal Ministry of Health equaled the precedence of former President Goodluck Jonathan, GCFR, which unfortunately catalyzed unprecedented dislocation of the component elements of the Health Sector in that dispensation.
“The only ameliorating balm in that discourse (the Old Jonathan Order) was that the Permanent Secretary in Charge of the Federal Ministry of Health were always administrators or non-care providers. Today even that has been taken away because the new Permanent Secretary of the Federal Ministry of Health is also a traditional strong advocate of the interests of only her Medical Doctor colleagues from her time as a Permanent Secretary in the office of the Head of Service of the Federation.
“To compound the woes of all other health workers apart from Doctors which we represent, the Federal Ministry of Labour and Productivity which ordinarily should arbitrate over our welfare demands which the hegemony of Doctors over-bearing leadership truncates at the Federal Ministry of Health is now being headed by yet another Medical Doctor, Dr. Chris Ngige. The obvious fallout of this dangerous but unprecedented structure against the professional destinies of all health workers apart from Doctors can be summarized in the reflected phraseology-calamitous future expectations.
“For a Health Sector where Doctors hitherto reduced a supposed Federal Ministry of Health to a Ministry of Doctor to now be officially and legitimized as home to only Doctors who constitute less than 5% of the workforce at the detriment of the majority of over 95% in our humble opinion Your Excellency, appears to epitomise neglects of the feelings of the gross majority of health workers and will aggravate the volatility in the sector instead of abating it.”
As doctors and other health workers keep on fighting and throwing missiles at themselves, the hospital system rot and the patients suffer. As an African proverb said, “When two elephants fight, it is the grass that suffers.”
Many Nigerians see the warring parties as selfish and ingrates. For example, there are many Nigerians out there without jobs and some with jobs survive on a paltry salary of N5,000. But the least paid health worker goes home with a monthly salary of N60,000 while the top-notch smile to the bank whenever they receive monthly alerts of N1 million and above. Even the non-health workers are still well paid and on time.
The way forward will be for all health workers to sheath their swords and think of ways to make the health sector work. They should know that they are a privileged few milking the purse of the national treasury hard. The doctors should also yield authority to other health workers since nobody knows all. And the government should develop and enforce positive policies that will enhance and further the Nigerian health sector to come out of the woods it is presently in.