‘Skipping’ into disaster

Dozens of women were lined for fistula repair surgery at Adeoyo Maternity Hospital in Ibadan. Then yet another strike hit. One started just as another from last year ended. Two more overlapped. Surgeons made special arrangement for their patients, but the women told the hospitals to get lost.
Hospital services are fast becoming a dizzying rollercoaster as strikes shut down services and squeezed patients into despair in swathes widening across the country. Nearly all have one word that’s fast becoming a dirty word in civil service speak: skipping. It is at the heart of ultimatums, warning strikes, work to rule, and full-blown strikes.
For years, staff in public service could skip at least one pay grade, from Grade Level 10 to 12. When salary scale for health workers was adopted as CONHESS, it meant skipping from CONHESS 9 to 11. The argument for doctors considers skipping as compensation for the years spent in school long after their school mates may have entered the workforce.
Those school mates working in the health sector make up JOHESU (Joint Health Sector Unions) – an umbrella group that comprises pharmacists, nurses, technicians and any of at least five groups allied with health care. They have been to court, asking for similar treatment. A National Industrial Court ruling since 2013 came down in their favour, but putting skipping to use meant also a backlog of arrears going back to 2010.
The federal health ministry has appealed the court ruling.
A separate plea called for salary adjustment for every health worker as done for doctors under the umbrella of Nigerian Medical Association. More than a dozen demands, some backed by court ruling, others on the strength of agreement, need implementation.
Skipping needed a circular to get bureaucratic backing throughout public service, but it sparked a strike by Nigerian Union of Allied Healthcare Professionals in May after previous meeting in December failed. It only yielded a verbal commitment for government negotiators to pass demands onto then President Goodluck Jonathan.
By May, it became “obvious that the government had not made any appreciable progress,” the union reasoned. The demands didn’t stop there, and have sharply divided non-doctor staff from doctors in hospitals sorely hampered by inter-professional disharmony.
Health workers designated directors, and having spent more than 15 years are still not promoted from CONHESS 14 to 15, they argue, and are not considered for appointment as chief medical directors to head hospitals.
Hospital heads created a position for DCMAC (a deputy chairman of medical advisory committee) ostensibly to help share clinical and administrative work for hospitals chiefs. But non-doctor health workers call the position “contrary to law” and demanded it be abolished. In addition, they want retirement age extended from 60 to 70, as applicable to counterparts in universities.
Circulars to back implementation of their demands have not been satisfactorily set out. Hospitals have individually cobbled up steps to implement especially skipping, and fallen short of worker expectations. The result is more strikes.
Doctors famously went on strike in the run-up to Nigeria’s dealing with Ebola outbreak last year. Their continued strike throughout the period angered authorities to the point where threats of privatisations became headlines.
Doctors themselves have joined in again, this time over skipping, crippling teaching hospitals and federal medical centres one by one.
FMC Keffi, in the North Central, after three months of strike, said its management wasn’t buldging on extending the benefits of skipping – which other staff had been enjoying for four years – to doctors.
Doctors there were pained to admit that “health conditions of some patients in the hospital, who are supposed to benefit from the ‘skipping,’ have worsened” in the face of stiff resistance from the hospital management, according to Dr Isah Ohyoma, spokesman for resident doctors at FMC Keffi.
In Bauchi, in the North East, Abubakar Tafawa Balewa University Teaching Hospital bumped its services down to skeletal two weeks into a strike by its resident doctors. “Since the strike started, we have been attending to only emergency cases as only house officers and consultants are there to provide services to patients,” said the hospital’s chief medical director, Dr Yusuf Jibrin. “The resident doctors are in the majority, so lots of services have been affected.”
The hospital managements have adopted a common language in the face of strikes: dialogue is ongoing. But workers, from resident doctors to nurses and other allied health staff on strike, insist they will sustain action until their issues are dealt with. Of all their demands, very few directly address patients, quality of service or better care, analysts have said.