RE: AN URGENT CALL FOR AN INTERVENTION TO REDRESS ABERRATIONS IN HEALTH SERVICE IN NIGERIA
The recent letter from the Nigerian Medical Association (NMA) to your office with the above caption refers. The Association of Hospital and Administrative Pharmacists of Nigeria (AHAPN) is the umbrella of all Pharmacists that work in hospitals (government and private) and administrative positions such as Ministry of Health (both State and Federal), regulatory agencies such as NAFDAC, Pharmacists Council of Nigeria (PCN) and others.
Ordinarily, our members are peace loving, law abiding citizens and conscientious healthcare workers highly dedicated to their jobs and patients. Along the line however, our humility has become mistaken for weakness. Over the years, our members have been stagnated in various Teaching Hospitals and Federal Medical Centers, with some of them being stagnated at CONHESS 13 for upwards of 13 years. Yet some others upon promotion are being “promoted” from one CONHESS Level to same CONHESS Level; in some cases with lower take home pay at the end of the day. Our members have been stagnated on same salary since 2004 when government consolidated salaries of healthcare workers.
Our Association all along has been operating under the banner of the Assembly of Healthcare Professional Associations (AHPA), the professional arm of the Joint Health Sector Union of Nigeria (JOHESU), in the absence of an official trade union. Our members heaved a sigh of relief upon being informed of few concessions that JOHESU had extracted from the Federal Government in the course of the ongoing strike action called by JOHESU. To our greatest surprise however, it came to our notice that the Nigerian Medical Association (NMA) is opposed to any form of salary adjustment for other healthcare workers that will not include them.
According to NMA, “the NMA is not opposed to any salary review, adjustment or increase for JOHESU members or any other worker for that matter PROVIDED that the same rate applied to CONHESS is applied to CONMESS to sustain the principle of relativity agreement as signed between the Federal Government and NMA on the 2nd of January, 2014. Consequently, the NMA is again advising JOHESU to seek for salary review/ increase/ adjustment. We are resolute on this advice. The cost implication for adjusting CONHESS and applying the relativity rates to CONMESS after adjusting CONHESS is estimated to be twenty one Billion, seven hundred million (N21.7Billion) Naira only –N8.7 Billion Naira and N13Billion Naira for CONHESS and CONMESS respectively”.
First and foremost, we are shocked to hear that the NMA has taken over the job of the National Salaries Income and Wages Commission (NSIWC) and the Federal Executive Council (FEC) in deciding salary increment for Nigerian workers duly employed by the Federal Government of Nigeria. It is an open secret that the so called agreement reached between the NMA and the then Federal Government on 2nd January, 2014, was obtained under deceit and was highly politically motivated. The then President Goodluck Jonathan was deceived and cajoled into signing an agreement which he never perused, on the first working day of the new year (1st January is always a public holiday in Nigeria) without recourse to the usual negotiating team from Labour and Health. We are aware that the so called agreement was a kind of trade off between the then president and the NMA. A governor of one of the states then took the NMA executive members to Aso Rock and coerced the president to sign the agreement for them, in return for support during the 2015 elections.
The NMA should hide her head in shame for securing salary adjustment through the back door for her members! And they claim to be the leaders of the healthcare team. We wonder at the type of leaders who work against the welfare of other team members. There is no history with previous governments in Nigeria and most advanced countries around the world, where the EXCO of a union will visit an executive president in his house, and right there and then, he will unilaterally approve salary increment for her members without recourse to due process. The same federal government promised other healthcare workers salary increment, only for it to renege after losing the election, thereby worsening the existing feud in the healthcare sector. We are aware that government paid doctors their arrears, with some of them receiving millions of naira as arrears. The NMA then did not compute the cost of the salary increase borne by tax payers to the public.
As if that was not enough, the NMA soon came out again to blackmail the government, this time asking for skipping of one Salary Grade Level for medical doctors, as was approved for CONHESS. Of course they threatened the government with strike action, the government acquiesced and NMA had her way. Again many of her members received millions of naira each as arrears, while they did not bother to compute the cost of the skipping nor inform the Nigerian public accordingly. So effectively, between 2014 and date, the NMA had secured salary increment for her members twice, without other healthcare workers batting an eyelid. Now that JOHESU has managed to secure some form of agreement for salary increase for her members, NMA is crying foul. This attitude of NMA has exposed the insincerity of doctors all along in handling the affairs of the healthcare sector in Nigeria (no wonder the mess in the sector has refused to go away). They keep making reference to some relativity ratio agreed over the years. When they were negotiating for salary increase in 2014, they “forgot” relativity, but now that it is the turn of other healthcare workers, NMA has suddenly remembered relativity.
The Healthcare Sector in Nigeria is not the birthright of NMA, healthcare delivery all over the world is a collaborative process, with defined roles for every professional, including doctors, pharmacists, nurses, medical laboratory scientists, physiotherapists, radiographers and so on. No profession should lord it over the others. If a patient visits a hospital and sees the doctor but is not able to access his drugs or medicines, the care would be incomplete. Same goes for laboratory services and all others. We are of the opinion that government for once should call the bluff of NMA and pay healthcare workers the agreed salary increment.
NMA alone does not enjoy monopoly of strike. If NMA can go on strike and paralyze the health sector, other healthcare workers can equally go on strike and achieve same effect, (sadly though) as the current JOHESU declared strike action has demonstrated. The unfortunate aspect of all these is the attendant avoidable loss of human lives, in disregard of their Hippocratic Oath. The NMA has become an anti human organization known for instigating strikes in public health sector and repressing other healthcare professionals through the use of arm twisting tactics in connivance with doctors in government.
So far, JOHESU has never asked the Federal Government to deny NMA what is due to her members. All we are demanding is that what is good for the goose is also good for the gander. It is therefore unimaginable that NMA as a body is losing sleep over legitimate demands by their supposed co-workers. Government should not pay NMA members any additional increment based on this agreement reached with JOHESU, as they have been previously settled. Any attempt to include them in this agreement with JOHESU will be tantamount to encouraging fraud which this government has vowed to eradicate.
On the issue of appointment of other health professionals as consultants/ payment of specialist allowance, the NMA asserted that: “Every professional with the right qualification can self appoint him/herself as a consultant but NOT in a hospital setting. None of the proposed consultants is useful in patient care as physicians may not need their services. There are consultants in various medical specialties that oversee the work of the allied health workers.”
This very stand of the NMA, is one of the reasons why the level of medical tourism is very high in Nigeria. NMA makes reference to international best practice when it concerns their pockets and take home pay. Elsewhere in the world, evidence based, multifaceted, specialist patient care, is the order of the day. Consultant physicians make diagnosis based on evidence from laboratory and other diagnostic tests, consultant clinical pharmacists advice on drug therapy based on pharmaceutical care principles, there is also a place for consultant nurses. So for NMA to claim that “none of the proposed consultants is useful in patient care as physicians may not need their services. There are consultants in various medical specialties that oversee the work of the allied health workers” is at best a fallacy, designed to massage their ego and megalomaniac appetite. It is the patients who need specialist care and attention not doctors or NMA. Every Nigerian, and indeed all human beings have a right to best and highest level of health care which doctors alone cannot and can never provide. In fact, NMA is solely responsible for the rot in the health care delivery system in Nigeria. They are responsible for the low health indices in Nigeria.
The Federal Government should discountenance the NMA and go ahead and appoint duly qualified clinical consultants from other professions, including consultant clinical pharmacists, and post them to hospitals to boost medical practice and encourage medical research. That way, before long, medical tourism will be booted out of Nigeria.
At an emergency meeting of the National Executive Committee of AHAPN to review the current happenings in the healthcare sector, the Association resolved as follows:
- Federal Government should ignore the NMA and honour the agreement reached with JOHESU on salary increase for healthcare workers.
- NMA must be cautioned to stop these unwarranted attacks on other healthcare professionals and stop arrogating to itself powers that it does not have.
- Government should feel free to appoint specialists (consultants) from all professions in the healthcare sector, and spell out their roles to avoid chaos. There should be no discrimination against any profession.
- We insist on the abrogation of office of deputy chairman, medical advisory committee. Where the office is allowed to stay, then it should be rotated among all health care professionals, just like the office of Chairman Medical Advisory Committee (CMAC).
- We commend the NMA’s stand that no professional should be stopped from reaching the peak of their career (CONHESS15).
- We believe strongly that harmonization of salaries of healthcare workers, with payment of specialist allowances for those with additional qualifications, remains the panacea to the feud, disharmony and incessant strikes in the sector. Anything less than this may lead to further chaos and worsen the rivalry in the sector.
- We commend the efforts of the Federal Government in trying to redress the problems of the healthcare sector, but pray that the government will be guided to take decisions that will guarantee long term peace and tranquility in the sector, in the overall best interest of Nigerian patients.
Please accept assurances of our esteemed regards.
TO: The Honourable Minister,
Federal Ministry of Labour and Employment,
3rd October, 2017
Pharm. Martins Oyewole, MAW Pharm. Jelili Kilani
National Chairman National Secretary