Frequent strikes by medical doctors have become a recurring decimal in Nigeria. This trend is seen as a contributory factor to the weakness of our healthcare system. Most worrisome is that an end to this national quagmire appears not to be in sight. On Thursday, April 1, 2021, the National Association of Resident Doctors (NARD) embarked on yet another indefinite strike. The resident doctors commenced the strike just a few moments after signing an agreement with the Federal Government at the office of the Minister of Labour and Employment, Senator Chris Ngige.
Ngige had invited both parties to a conciliation meeting, following a Notice of Trade Dispute sent to his office by NARD. The heated meeting which lasted for about seven hours, extensively and exhaustively deliberated on all the issues raised by the aggrieved doctors, including the non-payment of salaries of some house officers, non-recruitment of house officers and non-payment of National Minimum Wage arrears and hazard allowances. The doctors also demanded for the abolition of the bench fees for doctors undergoing training in other hospitals.
At the end of the marathon conciliation meeting, both parties signed the MOA, which extracted commitments from each party. Ngige assured that the government side will do everything contained in the MOA, which provided timelines for implementation, adding that they would reconvene in one month’s time to look at the assignments given, to know who performed and who has not performed. On the other hand, the leadership of NARD led by Dr Uyilawa Okhuaihesuyi, promised to go and educate their members on the agreement they reached with government, with a view to averting the impending strike already slated for April 1, 2021.
Painfully, the doctors did not live up to their words. Rather, they pulled out their members from the line of a duty for a devastating national strike, to the utmost dismay and chagrin of Nigerians. Note that this is the second time NARD is embarking on an illegal strike in the last six months. We used illegal here in the sense that the Labour Act makes it unlawful for a union or association to proceed with an industrial action once a labour dispute has been apprehended as done by the Labour Minister.
But to what extent has the government met the demands of the striking doctors? Indeed , investigation shows that some of the demands have been met 100 percent while others are work in progress. For instance, the Medical Residency Training Programme at the time it was muted in 2019, had hiccups, forcing the government to go to the National Assembly for increased appropriation. When COVID-19 struck last year and the budget was sent back for redrafting, the fund was missing and had come in via a supplementary appropriation, under the COVID-19 budget. About N20 billion was approved and released. It was one of the releases made 100 percent by the Federal Ministry of Finance. Other budgetary allocations under the COVID-19 budget were released 50 percent. The total sum of N4 billion was paid as Residency Training Fund (RTF) directly to NARD members to cover examination fees, books, journals, amongst others.
The non-payment of house officers, which triggered the latest industrial dispute involves three categories of people. First, you have the category of house officers who fall within the quota of Medical and Dental Council (MDCN) accreditation for the medical institutions. MDCN accredits each institution and gives you an allocation based on your needs, bed space and other parameters taken into account. This category has been paid.
Next comprises the overflow of the MDCN accreditation quota and the third category, consists of those who were recruited from January to March. Housemanship is just for 12 calendar months. But this was tackled on the table as the quota was waived by the Federal Government and the MDCN and office of Accountant General of the Federation (OAGF) directed to pay everybody.
With regards to the issue of insurance for doctors, it is in public domain that in March last year, the Federal Government spent N9.3 billion to do Group Life Insurance for Health workers and others. The money was paid to 13 insurance companies. Claims should emanate from the next of kin of the deceased. NARD and the teaching hospitals have severally been told to send in names and make claims for those who have lost their lives. It is an insurance that is for one year. Even now, the new process is ongoing so that it becomes a continuous thing.
I gathered that during the last conciliation meeting before the doctors embarked on strike, Ngige again told them to make their claims. Inside sources at the meeting quoted the Minister as saying that “If you have a premium and you don’t make a claim, nobody will pay you. You have to make a claim, get it in through the Federal Ministry of Health and send it to the office of the Head of Service and from there to the insurance companies, so that these people will be paid. There is also additional insurance from PTF, especially for those working inside the COVID-19 isolation centres.” NARD was asked to assist as insurance claims forms sent to Federal Teaching Hospitals and Medical centres are yet to be returned since December 2020. The period of cover is April 2020 to April 2021. The payments on the insurance are made through processing of your claims.
Furthermore, there is an insurance compensation for injuries, diseases and even death in the course of work under the Employee Compensation Act of the Nigeria Social Insurance Trust Fund (NSIFT). Doctors insured under it also make claims and they are verified and paid .
Moreover, the MOA clearly stated that the N5, 000 hazard allowance for doctors will be reviewed in five weeks while the payment of bench fees for doctors undergoing training would be abolished. Recall that a special N32 billion COVID-19 allowance was paid to all doctors in Federal tertiary and secondary health institutions in 2020.
The Federal Executive Council (FEC} also approved the central placement of all would be interns in Federal tertiary institutions to ensure that medical graduates do not roam the streets for up to 12 months, waiting for spaces for housemanship.
But, what bothers me is that despite this effort by government, NARD prefers frequent strike as the only weapon for engaging the Government on their demands. This is obviously not in the interest of 80 percent of Nigerians who are bearing the brunt of the strike, as stated by Senator Ngige. It is also not in the interest of the already traumatized Nigerian health system.
Most worrisome is that NARD embarked on this latest strike against the letters and spirit of the MOA that they signed with the Government, which I learnt, addressed their demands to a very large extent. Quoting the Labour Minister, “Some of the timelines are immediate, some in one week and some, two weeks. The farthest of them is in three weeks and the meeting agreed to reconvene after four weeks.”
Lastly, the accusation of hate speech that the Nigerian Medical Association (NMA) made against Ngige while reacting to his interview last Friday on Channels Television is both laughable and unfortunate. NMA claimed that Ngige said doctors pay for their training abroad. This is a mischievous interpretation of the Minister’s interview that I personally watched on Channels Television. By the way, the statement by the minister was merely an aside. The anchor of the programme, Seun Akinbaloye asked the Minister about the efforts of the government in training and welfare of medical personnel. Ngige stated that government was doing its best and drew a comparison with UK and US, explaining that nobody pays anything to residents over there but rather residents pay to train themselves. But here, Nigerian government pays for some aspects of the training, such as books, examination fees and others.
The attempt to misinterpret the figurative use of the word “nobody” representing government is sheer mischief by the NMA. The Minister was only saying that governments all over the world do not involve themselves in paying residents on training and hence, do not pay them anything, but of course, they are paid by respective hospitals where they undergo residency training based on contracts entered into. This is unlike Nigeria where the Government pays even for books, accommodation and examination fees.
I equally don’t understand how the statement constitutes a hate speech as claimed by the NMA President, Dr Innocent Ujah. Maybe a definition from Cambridge Dictionary will suffice here. Cambridge Dictionary defined Hate speech “as public speech that expresses hate or encourages violence towards a person or group based on something such as race, religion, sex or sexual orientation.” Dr Ujah please answer, “In which category does the statement by Ngige fall here? If there is anybody attempting to escalate the crisis in the health sector, it is definitely not Ngige, as claimed by NMA.
In conclusion, I will implore NMA to stop faltering, sit up and address herself on how to stem the tide of frequent illegal strikes of their junior colleagues, such as the indefinite strike that they embarked on from 8am April 1, 2021.
Nzomiwu, journalist and public affairs analyst writes from Abuja
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