Doctors’ strike and the shamelessness of Nigeria’s leadership

There is a very deep and fundamental challenge bedeviling the nation’s leadership at all levels currently. It is the challenge of lack of shame and absolute incompetence. The best demonstration of this shamelessness is the current strike embarked upon by the Nigerian Association of Resident Doctors. The doctors are simply asking for the government to keep its part of an agreement freely entered at the last strike. They are asking for their salaries and allowances and a justified increase in their hazard allowance. What is the response of government through the Minister of Labour, Chris Ngige? A threat to replace the doctors as if there are doctors lying on the shelf to be hired to replace those on strike!

During the run-up to the 2019 elections, the Centre for Social Justice and other institutions interested in the respect, protection, and fulfilment of the right to health prepared a governance and political agenda for health and sought to engage the political parties and candidates on their respective health agenda. Part of the issues raised in that governance agenda were human resources for health and health tourism. However, it appeared the Nigerian voting public were too engrossed with the inanities of politics and refused to look at the agenda and capacities of the contestants, some of whom have now become our lords and masters despite having merely requested to serve us.

What a shame that at a time Nigerian doctors are demanding to be treated with the dignity of humanity, the President, the number one citizen of the Federal Republic of Nigeria, Major General Muhammadu Buhari (retd.), is relaxing in the United Kingdom, in a foreign hospital, paid and well-maintained at the expense of British taxpayers while his health system is mired in crisis. Evidently, the President and his team have a devil may care approach to the health of Nigerians. They are not concerned because they are not involved; at the least sign of a headache or fever, they jet out with Nigerian taxpayers’ money to hospitals in foreign jurisdictions built at the sweat of the citizens of that country. How else do you define shamelessness?

In that agenda for health, we had raised some critical key issues. The availability of trained medical and health professionals and personnel, receiving domestically competitive salaries is one of the indicators of availability of functional public health and health care facilities and services. Health facilities need adequate personnel to deliver effective service. The Basic Health Care Provision Fund established by Section 11 of the National Health Act sets aside 10% of the Fund for the development of human resources for primary health care. Section 41 of the Act is on the development and provision of human resources in the National Health System. It states: “(1) The National Council shall develop policy and guidelines for, and monitor the provision, distribution, development, management and utilisation of human resources within the national health system. (2) The policy and guidelines stated in subsection(1) of this section shall amongst other things, facilitate and advance: (a) the adequate distribution of human resources; (b) the provision of appropriately trained staff at all levels of the National Health System to meet the population’s health care needs; and (c) the effective and efficient utilisation, functioning, management and support of human resources within the National Health System”.

It further provides in Section 43 (d): “The Minister shall make regulations with regard to human resources management within the National Health System in order to: identify shortages of key skills, expertise and competence within the National Health System, and prescribe strategies which are not in conflict with any other existing legislation, for the education and training of health care providers or health workers in the Federation, to make up for any shortfall in respect of any skill; expertise and competence”.

Where are the policies and guidelines developed by the National Council and the minister? Domestically competitive salaries for medical and health personnel are not about the peanuts that the health personnel currently receive. It is not about the refusal to abide by voluntarily entered agreements between government and health professionals. Improving the hazard allowance of persons who may likely lose their life saving others during health emergencies such as COVID-19 should not be treated as a privilege. Questions upon questions arise in this discourse. How else can one demonstrate patriotism, the ability and willingness to serve, if one is ready to give up one’s life that others may live?  How can the government claim a commitment to the realisation of the Sustainable Development Goals related to health or the idea of universal health coverage when the personnel to run the system are treated with contempt and disdain?

How can a poorly exposed and barely educated federal or state legislator who contributes little or nothing to the physical and economic progress of the nation earn 10 times the salary of a person through whom God saves human lives? How can ministers and other members of the executive be driving convoys of vehicles the aggregate price of which will be more that the emoluments of a doctor from the time they graduate and enter public service until they retire? How else can we describe avarice, greed, contempt for human life, wickedness and shamelessness knowing that these facts are true?

The frequency of strikes in the health sector has been high in the last couple of years. The industrial actions have arisen over remuneration, poor working environment, professional rivalry, etc. What has the government done to stem the tide of industrial disputes? The National Health Act in Section 45 states as follows: “(1) Without prejudice to the right of all cadres and all groups of health professionals to demand better conditions of service, health services shall be classified as Essential Service, and subject to the provisions of the relevant law. (2) Pursuant to subsection (1) of this section, industrial disputes in the public sector of health shall be treated seriously and shall, on no account, cause the total disruption of health services delivery in public institutions of health in the Federation or in any part thereof. (3)Where the disruption of health services has occurred in any sector of National Health System, the minister shall apply all reasonable measures to ensure a return to normalcy of any such disruption within 14 days of the occurrence thereof”. Despite these provisions, strikes have been the norm in the sector.

The minister is to apply all reasonable measures for a return to normalcy. Is the threat to sack doctors part of the measures for a return to normalcy? Evidently not. We cannot continue this fumbling and wobbling act at the expense of human lives. No one can replace or recall a lost life. Health is not a sector for gamblers and persons whose creed is politics for the sake of politics, with little or no premium on human life. We cannot continue with greedy persons occupying the corridors of power. Enough of this. Since, the President and his ministers think that we have a wonderful health system, let us increase the decibels of the advocacy for every public official to live or die with the treatment available in Nigeria.