Lanre Ajayi: Chronicle of Nigerian doctors’ problems with salary
With all due respect for journalism professionals globally, I found the media campaign against the ongoing doctors strike born out of gross ignorance or pretense. Let me first without any prejudice highlight some of inherent doctors problems with an attempt to limit them to issues on remunerations, though there are other problems (i.e on leadership, practice, health care infrastructures etc).
Honestly speaking, doctors have been depriving themselves for over 22 years, before which they were known to be well more remunerated than any other profession in this country-an erroneous belief that still holds till date. Their present struggle is an attempt to correct the implosion that is about to occur as a result of their self-inflicted woes. What are these woes? Let me limit them to renumeration for now.
1. Prior to 90s, doctors were well remunerated: belief or mentality most Nigerians still hold till date.
2. But at a point a former minister of health pushed for a separate salary scale for doctors without recourse to future reviews and legal implications.
3. Doctors lamentation started when a new govt came in and raised minimum wage without proportional adjustment to that of doctors salary scale. What do you expect? Doctors became short-changed, went on strike after negotiations failed. The military junta sacked them and sequelae to that was sending health sector backward 20 yrs. A considerable volume of doctors especially resident doctors fled the country for a greener pasture and invariably contributing immensely to another man’s country health indices. * “A prophet is never honored in his own country”.* Doctors who managed to still remain in the country then ‘begged’ to be returned back to general public salary scale, of course, losing some of their previous benefits to the separate special salary scale, some abandoning residency training for life. This brain drain is the cause of current medical tourism to other country we are expressing now.
4. Since the early to late 90s, doctors have been making attempts to have a special salary package restored as a way of getting better pay. Ironically, this has rather made their remuneration worse than before. *Why?* They were not based on sustainable and immutable principles. At a point they would request to be placed on an old salary scale when a new one seemed not favorable. Minimum wage was raised from 250 naira to 5500 naira in 2000, they were not captured. With metamorphosis of civil service salary scale from HAPISS to HATISS, doctors were never favored nor contented. In fact, to simply put it, they were just simply sidetracked. This was going on and the public kept believing each time doctors went on strike it translates to increase pay. Alas! What an illusion! http://news.biafranigeriaworld.com/archive/ngguardian/2003/mar/03/article14.html
5. To worsen their problems, Obasanjo administration in 2006 consolidated all allowances including some of those that are exclusive to medical practitioners to be paid to all public servants irrespective of your profession, rank or file and abolishing some other allowances like call duty, clinical duty etc. It took another threat of national-wide strike in 2007 to restore their call duty which was initially abolished by the El Rufai led committee on the consolidated salary scale (CONTISS). Two years later, CONTISS was again revised (in 2009) to CONTISS II (Appendix 1).
It is important to note here that metamorphosis of HATISS to CONTISS included obliterating skipping levels 10 & 13 in the previous HATISS thus making CONTISS to end at level 15 instead of level 17 in the old HATISS.
FOR OVER 22 years AND TILL DATE, IT IS ONLY DOCTORS THAT DO NOT SKIP ANY LEVEL WHILE OTHERS DO, AN INJUSTICE DOCTORS ARE ALSO PROTESTING NOW. EVEN DESPITE OBLITERATING THE SKIPPING LEVELS IN THE PRESENT CONTISS, OTHER CIVIL SERVANTS STILL SKIP Level 10 except doctors thereby giving them undue and unfair advantage over doctors in terms of promotion and renumeration. Though initially objected to skipping, NMA now wants doctors to skip after FG HAS REAPPROVED skipping after INITIAL suspension for other health workers under umbrella of JOHESU. This was following National Industrial Court ruling in favor of workers skipping level 10. See http://www.vanguardngr.com/2014/06/fg-bows-health-workers-demand/
6. Unhappy with some other emoluments lost to CONTISS and in an attempt to avoid making same applied to other public servants, doctors agitated for a separate salary scale, Consolidated Medical Salary Scale (CONMESS)(appendix 2)which through strike action was again approved in 2009 via a collective bargaining and a SIGNED agreement with the FG. This was done shortly before government revised CONTISS to CONTISS II (an improved package over the previous CONTISS doctors’ CONMESS was based). The implication of this was a relative higher take home for all workers except doctors.
7. To worsen their problems, FG again raised minimum wage from 7500 to 18,000 naira. Again, what do you expect? Doctors went back to the govt for proportional adjustment. Ask me what they got. Eight to nine hundred (800-900) naira ONLY across board! Though this also affected other health workers.
8. It is important to know that immediately they got their separate salary scale (CONMESS) in September 2009, other health workers also agitated thereafter for their own separate scale too, but this time around, precisely in December 2009, a better and improved carbon copy of what was approved to the doctors earlier including specialist allowances, teaching and clinical duties allowances known and considered to be “exclusive” to the doctors was packaged for other health workers under what is now called Consolidated Health Salary Scale (CONHESS). Appendix 3. Even as at present, non-clinical staff (I mean admin staff) working in govt hospitals who are now under the CONHESS are paid these doctors “exclusive” allowances too. What do u think? Doctors had become very angry and restless since then (2009), going back to the govt for adjustment during which an agreement was again reached for proportional adjustment. The bone contention is the RELATIVITY in allowances which to the doctors, has been grossly obliterated.
Let me explain what relativity means in health workers pay. It means RELATIVITY in allowances (not in the basic salary) when compared with others health workers. It is usually doctor:pharmacy:nurse/lab scientist. So the allowance could be in ratio 3:2:1 or any ratio adopted by the country. It is important to note that RELATIVITY has been operational for long in Nigeria prior to a push for a separate salary scale for doctors by a former health minister. Relativity is not peculiar to Nigeria alone but exists in many other countries like UK & US. See appendix 4.
Again, for clarity sake, relativity is not applicable to basic salary but translates to higher gross total pay. For instance, a civil servant working with FRSC (a FG employee) on level 10 and a doctor (in a teaching hospital) on level 10 earn the same basic consolidated basic salary. No difference. No discrimination. National Salaries, Incomes and Wages Commission (NSIWC) ensures this equity at all times! The only difference will be in the allowances each is entitled to. So no doctor earns more basic consolidated salary than any other civil servants in the employment of the government, on the same salary scale level. www.nsiwc.gov.ng
9. JOHESU-NMA saga theory. The rift between doctors and other health worker started when a former health minister pushed for separate salary for doctors leaving out other health worker. Since then, other health workers has been kicking against appointment of a doctor as health minister. Even though this separation was in long run not favorable to the doctor, other health workers has not stopped to capitalized on this to blackmail the government into believing that doctors are the causes of the woes befalling health sector. They have constantly used this weapon to pitch doctors against doctors. In order not to totally digress but to limit this discuss to renumeration issues, recently, since there was no emolument doctors were receiving that other health workers were not receiving, (maybe) other health workers felt that: what now stops them from also being the head of the health institution; be called consultants and exert same power as doctors. A conspiracy, JOHESU (a collation of all other health workers except doctors in the hospital) alien to the health sectors emanates. All these were ongoing underground without the doctors knowledge to the end some legislations were pushed by this coalition,and got them passed to law to usurp the doctors power thereby causing conflict of roles in the hospital at the detriment of the innocent patients. These conflicts though are currently now being challenged at the National Assembly and Law courts by (not NMA per se) MDCAN, an affiliate body to NMA.
10. On realizing “a threat” via a grand conspiracy heralded by JOHESU against their profession, the doctors (irrespective of cadre) then agreed unlike ever before to one last battle which this ongoing strike seems to be addressing among other issues: THE 24 DEMANDS including better health care for the citizenry which appear obviously blind to the public eyes.
11. Let me also state that health professionals are being paid a ridiculous hazard allowance. Before now, workers were being paid 1,666.66 naira as hazard allowance before it was reviewed upward to 5000 naira recently which in no comparison to 30,000-45,000 naira being paid some university staffs as hazard allowance in this same country. Is the government trying to prove that university staffs are at higher risk health-wise than those faced with dreaded diseases on daily basis? I leave the answer to the mind of the readers.
12. No health worker in this country is insured. NMA is asking the government to insure all health professionals. National Health Insurance Scheme (NHIS) that is currently operational is selective in treatment of some diseases only, without comprehensive coverage of diagnosis or treatment of all other ailments. For example, NHIS DOES NOT COVER computed tomographic scan which costs, on an average, about 40,000 naira in my center to access personnels/patients that requires such investigation. How many doctors can afford that with meager pay of 5000 naira (60,000 naira per annum)? Potent and efficacious drugs are not also included in NHIS.
Based on the above,
1. Pride and prestige of an ENVIABLE noble medical profession (rather than calling it ego – which to me is more or less personal) is being defended along monetary and policy line. This is not unexpected given the fact that some lawmakers make millions per month as sitting allowances (highest in the world) whereas civil servants (least paid in the world) suffer in penury. What an inequity! What even amuses me is that the same suffering public is not compelling the govt to do the needful but condemning doctors’ action on ‘insatiable quest for money’. This condemnation is uncalled for because it is born out of lack of adequate information on the basis for their ongoing struggle.
2. It is obvious that the govt cannot be exonerated from the woes befalling the health sector. Apart from being responsible the continuous decay in health care infrastructures, government responses to health workers agitations in past decades have rather being lopsided than being wholistic. Government needs to be carefully decisive, weighs the implications and possible conflicts some remunerations/acts/policy adjustment could portend on other workers and the nation at large. Government must take wholistic approach to renumeration, acts and policy making.
3. While every union has the right to negotiate for improved salary, govt should be weary of the motives behind such moves and its global implications before entering into agreement with such labour union or association. Current NMA strike, to me, seems to be a provoked and reactionary one. I will not be surprised another ‘reactionary’ strike emanating from JOHESU after the NMA’s.
4. While the ongoing doctors strike can be likened to earlier suspended ASUU strike ( based on earlier agreement reached with FG and a need to use a resolve-it-once-and-for-all method,) I do not see an end to this strike soonest unless FG is ready to credit the doctors accounts as it did for ASUU members and other university staff few months ago to correct the injustice of past years based on an earlier reached agreement. Moreover, FG should be sincere with and honour agreement reached with parties.
5. In all fairness to the doctors, FG should without any further delay approve relativity and skipping for all doctors too as it has done for other health workers. What is good for the goose is also good for the ganders.
6. The recent suspension of specialist training in Nigeria and sack of all resident doctors in training is rather retrogressive, myopic and will be counter-productive making the impasse far from getting resolved. While advanced countries are seen strengthening their specialist training, Nigeria should not be seen dragging further back from the current 50 years backward gap difference compared with other countries. I see the suspension and sack as a sign of a clueless government that has no consideration for the unimaginable future implications on the nations health and medical training. Israeli doctors went on strike for 5 months, their government did not sack but saw a need to improve their health system. http://www.haaretz.com/mobile/israeli-doctors-strike-finally-ends-after-five-months-as-landmark-deal-inked-1.380681?v=778881D888022F3290B306C5ADDD25Bĺĺ
7. FG should call for a stakeholders meeting in the health sector with an attempt at resolving the current challenges once and for all while they should be weary of jettisoning the headship of the hospitals from the doctors as it has been operative since independence and in all developed countries.
8. The public and well meaning Nigerians should not be deceived by the propaganda going on in the public against their doctors but should rather rally round and prevail on this government to always honour agreements reached with labour unions and professional associations. This is because we all need a doctor both in health and in sickness. It is the wish of every family to have a member as a doctor and not to castigate such in the face of demanding his/her right to better living.
9. Castigating doctors on the premise of breaking their Hippocratic Oath is also a display of ignorance. The Hippocratic oath was based on the assertion that doctors shall be treated as first class citizens in the society they serve. But is it the same here today? And on this assertion, the oath ends thus: I will leave this operation to be performed by practitioners, specialists in this art….may I enjoy my life and practice my art, respected by all humanity and in all times… I leave the interpretation of this to every reader of this piece.
10. On a final note, FG should for the sake of peace reverse suspension of specialist training in Nigeria, recall all sacked resident doctors and re-enter negotiation table with the NMA whiLe NMA reciprocates by suspending the ongoing strike for the sake of peace. It should be clear to both parties that in such circumstances like this, there can be no victor, no vanquished.
Appendix 1: http://www.nsiwc.gov.ng/Docs/Policy_docs/CONUAS%20II%202009.pdf
Appendix 2: http://medicalworldnigeria.com/files/files/CONMESS_2009.pdf
Appendix 3: http://medicalworldnigeria.com/files/files/CONHESS-2009.pdf
Appendix 4: attached
Lanre Ajayi is a senior specialist registrar and former Editor, Mediscope.