The Minister of Labour and Employment
RE: AN URGENT CALL FOR AN INTERVENTION TO REDRESS ABERATIONS IN HEALTH SERVICE IN NIGERIA.
Compliments of the Nigerian Medical Association (NMA).
The attention of the NMA has been drawn to the demands by a group with the name Joint Health Sector Unions/ Assembly of Health Care Professionals (JOHESU/AHPA) and their negotiation with the Federal Government. 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 aware that this group has vowed that there can never be peace in the health sector until practices unknown to international standards; court judgments, culture/traditions are entranced 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.
The demands that attracted our attention include but not limited to:
1. ADJUSTMENT OF CONHESS SCALE AS WAS DONE FOR NMA
JOHESU/AHPA has no justification whatsoever to demand for adjustment of salary scale as was done for CONMESS. What JOHESU/AHPA is asking for is equal pay with medical doctors. NMA wishes to remind government that relativity exists between the CONMESS and CONHESS structures. This was signed between the Federal government and the NMA on the 2nd of January, 2014 after more than 22 years claim of distortion was proved statistically to be correct. The proof was predicated on MSS/MSSS for medical doctors and HSS for other health workers as contained in circular 1, of 1991 which gave birth to the two salary structures.
We wish to place on record that JOHESU had approached the Industrial Arbitration Panel and the National Industrial Court of Nigeria (NICN) on pay parity with medical doctors without success. The NICN rightly rejected and DISMISSED the case based on constitutional proviso which recognized equal pay for work of equal value. JOHESU members could not prove if there was an initial agreement on parity or if they are medical doctors doing the same job. For emphasis, the NICN warned that it should not be brought before her again until they prove that they do the same job as medical doctors. This same type of judgment had been handed over to Non Academic/ Administrative staff in the University hence the difference between CONUASS for Academic staff and CONTISS for Non Academic/ Administrative staff in the University. The same scenario is in existence in the Polytechnics, Research Institutions, Colleges of Education etc.
We wish to draw your attention to the report of the technical sub-committee on critical matters in the health sector. NMA wishes to place it on record that JOHESU’s Demand for “Adjustment of CONHESS” (i.e Harmonization/ Removal of Relativity) could not be justified as NO single evidence was provided by JOHESU to JUSTIFY their demand (which was one of the main term of reference for the committee) just as the NMA team was not sufficiently allowed to engage JOHESU in robust debate. NMA had informed you and the FG that there is NO AGREEMENT on this between NMA and JOHESU as we insisted on 2014 agreement signed between NMA and the FG. Consequently, the NMA advised JOHESU to seek for salary review/ increase/ adjustment with a CAVEAT that CONMESS shall get proportionate review/increase/adjustment in line with the FG and NMA signed agreement of 2014.
We bring to your attention the body language of some government officials particularly the head of the Directorate of the Hospital services in the Federal Ministry of Health and one of the Directors in the National Salary, Incomes and Wages Commission (NSIWC). The federal government must investigate why these officials chose to hoodwink government into avoidable financial burden as they are committed to advising government to UNILATERALLY abrogate the relativity agreement of 2014 with obvious consequences. We DID NOT sign any purported final report of the technical sub –committee to the FG as submitted by the Director of the Hospital Services who acted as Chairman. We know that corrupt officers can attach attendance sheets to support “supposedly” signed committee reports with the intent to deceive approving officers of government.
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 N13 Billion Naira for CONHESS and CONMESS respectively.
2. PROFESSIONAL AUTONOMY:
The two common of scenario in the hospitals include:
b. Clinical/Patient care
a. Administrative Autonomy:
This already exist in the sector as staff in many clinical departments do not report through their primary departments to their professional heads of department. This practice already create problems in the clinical departments. For example, some staff proceed on leave without the knowledge of the primary department. Mostly, this lead to avoidable disruption of service to patients.
The NMA wishes to advice that Staff in a department irrespective of the profession should obtain clearance from the primary department before the head of the professional department approves. This may help in reducing the ‘sudden disappearance from duty post syndrome’ being experienced in many core clinical departments.
b. Clinical/ Patient care:
NMA wishes to advice both government and those who may be seeking autonomy that it is the life of Nigerians including all health workers, their family members and others resident in the country. This fight for professional ego should not be extended to this area as it impacts on patient survival. There cannot be two captains in a ship. The crisis in the various departments of Pathology/ Laboratory Medicine in the nation’s hospitals due to professional autonomy being sought by some staff who also work in the various hospital pathology laboratories readily comes to mind.
This is weakening quality of clinical laboratory reports which significantly lead to clinical mismanagement of patients resulting in avoidable disability or outright death. This demand vigorously seek to remove the safety valve provided by the pathologist. This may not be known to some government officials overtly and covertly supporting these laboratory workers because they have no knowledge of the clinical implications of the demands they are encouraging government to accept. Nigeria is not an island unto itself in the health industry.
Globally, the clinical/ medical team is led by a physician. The Federal Government through the Yayale Ahmed Committee on professional harmony in the health sector has confirmed this as cited in their report to government. The NMA shall, on behalf of innocent Nigerians at the mercy of the negative implications of clinical/ patient care autonomy, irreversibly resist this if government concede to this devilish demand.
3. APPOINTMENT OF OTHER HEALTH PROFESSIONALS AS CONSULTANT/ PAYMENT OF SPECIALIST ALLOWANCE
Having gone through various circulars and court judgments, there is no place it was stated that other professionals should be appointed as consultants in a hospital setting.
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. The table below clarifies the relationship between some specialties in medicine and the staff that work with them
ALLIED HEALTH WORKER/PARAMEDICS
Medical lab technologists (Scientist)
Medical lab Technician
The consultant cadre that JOHESU/AHPA dreams of is the type that will empower them to be in charge of clinical care of the patient, a situation which will definitely create distortion in the chain of care for the patient which is dangerous to the health and safety of Nigerians. The University College Hospital, Ibadan experience is still fresh in our memory where a purported consultant nurse stopped the surgeon from reviewing the wound of a patient the surgeon operated on the previous day. This could have led to litigation against the surgeon and the government if the wound had broken down and the knowledge of the cause was known to the patient.
The demand for consultant position gathered momentum when specialist allowance was approved for medical consultants in CONMESS 2009. Unfortunately the same allowance was approved in CONHESS even when there is no scheme of service supporting the appointment of other health workers as consultant in Public Service in Nigeria. The Judgment of NICN in 2013 pronounced that…. “any future appointment to such positions (consultant) is at the discretion of the ministry.” The post of consultant for other health workers is not recognized by the scheme of service of the Federation or any hospital board of management.
JOHESU/AHPA has always falsely claimed that circular Ref No. SMH/491/S.2/VOL 11.221 of 29th March, 1976 from the Federal Ministry of Health authorized consultant status for other health professionals. We have gone through that circular along with the circular from the National University Commission (NUC) signed by Professor Jubril Aminu, the executive Secretary, on the same matter. There is no place in the circular where approval was given.
We reject this demand. Government should avoid accepting demands that could lead to avoidable deaths of Nigerians. Clinical or patient care practice has international standard.
4. SKIPPING Of CONHESS 10 AND PAYMENT OF ARREARS IN COMPLIANCE WITH NATIONAL INDUSTRIAL COURT OF NIGERIA JUDGMENT
5. HEADSHIP OF DEPARTMENT/ UNITS IN HOSPITALS
This will lead to administrative and clinical chaos
This is not supported and therefore rejected.
6. APPOINTMENT OF CMDs/MDs OF TERTIARY HOSPITALS IN ACCORDANCE WITH THE EXTANT LAWS
There is a subsisting law. The term ‘medically qualified has been interpreted by the NICN to mean medical doctors. Various circulars of government is clear on who is medically qualified.
7. RETIREMENT AGE
We support and accept this demand. Government is reminded that the implementation of the white paper on Onosode report of 1981 as accepted by the Federal Government in 1982 becomes inevitable. The Federal Government accepted the same conditions of service operated in the universities for university teaching hospitals by placing the health institutions in category B as the universities (ref. Views of the Government of the Federation on the Report of the Presidential Commission on Parastatals published by the National Assembly Press, 1982, Lagos).
Therefore, the Federal Government should extend the retirement age and retirement benefits obtainable in the university to the teaching hospitals, specialist hospitals and Federal Medical Centres. This does not need to go to the National Council on Establishment as the cycle has been completed. Asking health workers to re-apply is tantamount to asking them to start all over again on an issue settled in 1982. That will be unfair and discriminatory.
8. ABOLITION OF THE POSITION ON DEPUTY CHAIRMAN MEDICAL ADVISORY COMMITTEE (DCMAC)
We reject this demand in its entirety. The position of Deputy CMAC is a creation of the boards of management. The board is empowered to do so by virtue of the teaching hospital Act. The DCMAC became relevant due to the volume of clinical services required to be attended to by the CMAC. The position has helped immensely in the smooth running of the hospitals. Acceding to this request will violate the agreement NMA signed with government in 2014.
9. STAGNATION AND NOMENCLATURE
The NMA is not against any graduate rising to GL 17 (CONHESS 15). However, this should not be done in violation of the teaching hospital Act. Since there is a conflict between the hospital Act and many health professional’s scheme of service, the NMA believes strongly that the nomenclature should be revised in such a way that the graduates amongst them can rise to GL 17 (CONHESS 15).
This will protect the sanctity of the teaching hospital Act. The medical doctors are already using nomenclatures that have no place for directorate cadre but allow them to rise to GL 17 without violating the teaching hospital Act. This approach should be adopted to lay this problem to rest. Any decision that allow multiple appointment of directors in a department must be extended to medical doctors.
1. NMA is totally opposed to salary harmonization as doctors are not prepared to receive the same salary as other health workers. It is not happening anywhere in the world. JOHESU/AHPA has no legal or factual basis to demand for the release of a circular on adjustment of CONHESS as was done for CONMESS as the adjustment was done to partly correct observed distortions in relativity between in CONMESS. The FG should disregard this demand as NMA shall not accept another distortion of the relativity between CONHESS and CONMESS. Circular SWC/S/04/S.176/VOL.11/464 dated 3rd January, 2014 and the precursor agreement of 2nd of January, 2014 must be upheld.
2. The FMOH should as a matter of urgency review the nomenclature of the other health care professionals provided it does not violate the teaching hospital Act but allow them to rise to the peak of their career (GL 17/CONHESS 15)
3. The NMA is opposed to the demand for appointment of non-medically qualified personnel as consultant in hospitals. There is no circular or law or scheme of service that authorized this just as it is against international best practives. The interest of the patient is sancrosant as multiple consultants with opposing instructions would lead to anarchy in clinical care of patients with deadly consequences.
4. There is a subsisting law. The term ‘medically qualified’ has been interpreted by the NICN to mean medical doctors. Various circulars of government are clear on who is medically qualified.
5. The position of Deputy CMAC is a creation of the boards of management recognized by University Teaching Hospitals Act, Cap U15, LFN, 2004. We reject the demand for the abolition in its entirety.
6. The NMA totally and unequivocally support the extension of the retirement age from 60 to 65 years for all health workers except consultants who should retire at 70 years. All health workers should enjoy the same conditions of service as in the university in line with the white paper of 1982 on Onosode Commission report of 1981.
7. Clinical/ medical team is led by a physician. The Federal Government through the Yayale Ahmed Committee on professional harmony in the health sector has confirmed this as cited in their report to government. The NMA shall irreversibly resist any action aimed at changing this international practice.
Honourable Minister Sir, the Nigerian Medical Association is ready to partner with the Federal Government to ensure lasting peace and progress in the health sector. This we shall do relying on international best practices. However, we shall not accept violence, intimidation and outright falsehood reminiscent of JOHESU/APHA’s trade mark. The care and safety of the patients remain our eternal interest.
The NMA wishes to humbly re-state 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. Please take this as a notice Sir.
Thank you Your Excellency,
Long live NMA
Long live Federal Republic of Nigeria.
Dr (Prof.) Mike Ozovehe Ogirima Dr. Yusuf Tanko Sununu
PRESIDENT SECRETARY GENERAL
President of the Senate, Federal Republic of Nigeria
Speaker, House of Representative, Federal Republic of Nigeria
Secretary to the Government of the Federation
Chairman, Senate Committee on Health
Chairman, House committee on Health Institutions
Honourable Minister of Health
Honourable Minister of Finance
Honourable Minister of Budget and National Planning
Honourable Minister of State for Health
Office of the Head of the Civil Service of the Federation
Chairman, National Salaries Income and Wages Commission
Permanent Secretary, FMOH
Head, Department of Hospital Services FMOH
DG, Budget Office of the Federation (BOF)
DG, Department of State Security Service (DSSS)