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Doctors vs health workers: How rivalry prolongs strikes

The Joint Health Sector Unions (JOHESU) called off its six weeks old strike on Thursday. National Chairman of the union, Comrade Biobelemoye Joy Josiah, said…

The Joint Health Sector Unions (JOHESU) called off its six weeks old strike on Thursday. National Chairman of the union, Comrade Biobelemoye Joy Josiah, said they called off the strike because of the sympathy they have for the suffering Nigerian masses and also to pave way for further negotiations from next Monday.

Findings reveal that the rivalry in the health sector particularly between medical doctors and other allied health professionals under the umbrella of the Joint Health Sector Unions (JOHESU) has not only continued to linger over the years  but also spurs and prolongs industrial actions.

Members of JOHESU include medical laboratory scientists, pharmacists, nurses and midwives, dieticians, health information managers, radiographers and physiotherapists, among others.

The usual muscle flexing between them often leads to industrial actions and counter industrial actions with each party making demands. When government seems poised to grant them, the other party says that it is also entitled to it, or makes new demands, threaten government not to grant the other party, or worse still embark on another cycle of industrial actions.

Patients bear the brunt of the rivalry as each industrial action leaves in its wakes loss of lives, limbs and untold hardships. The supremacy clash between the duo also threaten quality healthcare delivery in Nigeria.

Members of JOHESU have often complained that government shows favoritism or preferential treatment for doctors and has a penchant for appointing them as ministers and into other key positions. 

They call for fairness in entitlements given to them and doctors. They see doctors as wanting to be in charge of virtually all domains in the health sector and also accuse them of thwarting all government’s efforts to be fair to them.  

 “Policy making is a closed system in the Federal Ministry of Health as only medical practitioners are invited, other health professionals are not. Out of 13 directorates, 12 are all headed by medical professionals, so when implementation comes, it becomes difficult because other health professionals are not carried along,” said Comrade Ogbonna Obinna of the Nigerian Union of Allied Health Professionals (NUAHP).

Doctors on the other hand, under the umbrella of the Nigerian Medical Association (NMA), said JOHESU members want to have everything they have in spite of the difference in training and responsibilities. They insist on relativity, saying that it is also what is obtainable in other parts of the world including developed countries.

JOHESU had proceeded on a nationwide strike on April 18 at federal health institutions level, it had before then given government some ultimatums. 

On Wednesday May 9, the union directed states and local governments to join the strike action. 

National Chairman of JOHESU, Comrade Biobelemoye Joy Josiah and Chairman Assembly of Healthcare Professional Associations (AHPA), Dr. Godswill C. Okara, said government has not shown enough commitment to meet their demands, particularly the upward adjustment of Consolidated Health Salary Structure (CONHESS) as agreed in the Memorandum of Terms of Settlement signed on 30th September 2017. 

They maintain that the crux of their clamour has always been restoration of the relativity in the Consolidated Health Salary Structure (CONHESS) and Consolidated Medical Salary Structure (CONMESS) scale which was deliberately distorted with active government collaboration in 2014. 

The unions said their demand for the adjustment of CONHESS which affects over 95% of the health workforce nationwide has been frustrated because the Minister of Health, Professor Isaac Adewole;  Minister of State for Health, Dr Osagie Ehanire, and the Minister of Labour and Employment, Dr Chris Ngige,  are all medical doctors.

They added that the preferential treatment given to medical doctors has remained the major albatross to peaceful coexistence of health practitioners in the health industry in Nigeria.

The next day, the Nigerian Medical Association (NMA) released a statement signed by its president, Dr Francis Faduyile and Secretary-General, Dr Olumuyiwa Odusote, stating that it strongly opposes any adjustment in Consolidated Health Salary Structure (CONHESS) scale that would result in pay parity between doctors and healthcare professionals, adding that it stands with relativity.

“The NMA painfully wishes to inform the Federal Government of Nigeria that any award to the non-medically qualified health professionals that violates the January and July agreements of 2014 shall result in the resumption of the suspended withdrawal of services of 2014. Please take this as a notice sir,” they said in the statement.

An organization under the Nigerian Medical Association (NMA), the National Association of Resident Doctors (NARD), said any adjustment in  Consolidated Health Salary Structure (CONHESS) should be matched with corresponding adjustment of Consolidated Medical Salary Structure (CONMESS).

NARD President, Dr. Ugochukwu Chinaka, said they reject pay parity between doctors and Allied Professionals as this would erode relativity and distort emolument hierarchy in the health sector.  

However, JOHESU and its sister organization, the  Assembly of Healthcare Professional Associations (AHPA)  accused Prof Isaac Adewole of fueling the crises, saying there was never a time they asked for parity in payment.

The Federal government on its part through the Federal Ministry of Health had maintained that it is negotiating with JOHESU and not taking sides. 

Aside the general issues between members of JOHESU and medical doctors, each profession under JOHESU also has its demands and grievances against doctors.

These professionals clamour for consultancy positions, directorates, and separate departments. Some of them have gone to court to press their demands and there are many of such rivalry cases in the courts.

For instance, there are lingering problems between pathologists (medical doctors) and the medical laboratory scientists. There are also cases between radiologists (medical doctors) and radiographers. Radiographers said they should not be lumped up with medical doctors and headed by the later in the same department, as radiography is a different and unique discipline.

A few days ago, the Lagos branch of the Nigerian Medical Association expressed displeasure over the creation of the consultant pharmacist cadre and separate directorates for allied health professionals in the Lagos state hospitals, citing some reasons and asked that it be reversed.

Medical lab scientists under the aegis of Association of Medical Laboratory Scientist of Nigeria (ALMSN) have also been calling for the creation of separate departments to enable them practice their profession. They took the case to the National Industrial Court and judgment was given in their favour.

“It has been clearly pronounced by various courts of competent jurisdiction that the era when medical doctors treat other health professionals as ‘errand boys’ and ‘girls’ or ‘slaves’ is gone,  and that every profession, especially Medical Laboratory Science is separate, distinct and autonomous from medicine/surgery; capable of administering, supervising and heading their practice,” said  Toyosi Raheem, Former ALMSN president.

Also, the President of the National Association of Nigerian Nurses and Midwives (NANNM), Comrade Adeniji Abdulrafiu, recently accused medical doctors of sabotaging negotiations between the Federal Government and Joint Health Sector Union (JOHESU) for selfish gains.

Former Chief Medical Director of the University of Benin Teaching Hospital, Prof Eugene Okpere,  said nurses and lab scientists are not supposed  to be paid the same salaries as doctors. He said, “In an airplane, even though there are crew members and engineers guiding the flight, it is the pilot that takes responsibility likewise the doctor takes final responsibility for patients care.”

Prof Ngim Ngim, President of the Medical and Dental Consultants Association of Nigeria, said everyone in the health system has a role and if everyone sticks to their roles there will be no problem or rivalry.

Former chairman Pharmaceutical Society of Nigeria (PSN) Abuja branch, Otote Bridget Aladi, said that in the civil service, not until recently, pharmacists do not get to directorship cadre. “We were made to stop as deputy directors and it took years of long battle before we were able to get that recognition.”

She said there is a limit to which any human being can take anything especially when “you are consistently being discriminated upon, when you are practicing and operating within the same society and economy. You go on rounds, calls and do practically everything the doctor does.”

Pharmacist Otote said, “Even in school, we do almost the same courses. I want it on record that most pharmacists are pharmacists by choice not because they cannot study medicine.

“Most of us are ‘A’ students. A lot of doctors you see around were our classmates and students we beat hands down in class. But where the doctors begin to make it look as if they are special beings or because they are more intelligent than the pharmacists, or see pharmacists as second class citizens, it is most unfair. That is why we are trying to rise up to the challenges and also make our voices heard by the people we serve and by the government,” she said.


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