By Dr Adamu Askira
Resident Doctors make up the largest medical manpower in our tertiary health institutions. They undergo rigorous training in various specialties of medicine in an intensive program that encompasses robust research and effective state-of-art specialist health services delivery. These patriots are the only source of specialist medical care to teeming Nigerians who can’t afford care abroad and can’t access care in our expensive private facilities.
The current strike by the Nigerian Association of Resident Doctors (NARD) has been as a result of the government’s insincerity in implementing agreed actionable series of memoranda. Therefore, out of sheer passion to ensure the right things are done so that Nigerians attain effective healthcare, the Resident Doctors speak to the people in authority with the only language they understand; Strike. One clear fact is the Resident Doctors were forced to embark on this action by those in government. Naturally, doctors hate embarking on strike!
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Let me shed light on just a few reasons for the action.
Firstly, is the dearth of medical manpower due to unnecessary bureaucratic bottlenecks. Despite the few available doctors, we have in the country with a doctor to population ratio at 1: 7000, many hospitals find it difficult to recruit or replace doctors. This has made the work burden on the available doctors to be unbearably high resulting in physician burnout and limited care to a limited number of people needing care. Many doctors are leaving the country to other climes where they can do their job with satisfaction. As a result, the hospitals are depleted but find it difficult to employ new staff because of bureaucratic processes that involve the Budget Office of the Federation, Office of the Head of Civil Service of the Federation, the Federal Character Commission as well as the Federal Ministry of Health. These MDAs, I dare say, deliberately create delays, which result in administrative lethargy, malpractices and corruption. It takes an average of 8-12 months for a lucky hospital to finally obtain a waiver for recruitment or replacement of medical staff. In some cases, the hospitals would be forced to consider candidates from some directors and politicians if at all they want the processes to be expedited, otherwise, it would be outrightly rejected or at best delayed and the required number slashed. In their efforts to keep services running, the hospitals resort to employing young doctors on a month-to-month basis without regular monthly salaries and any certainty for regularisation. Thus, casualising the medical profession and rendering the young doctors frustrated and dejected. In some instances, the Resident Doctors were recruited but the process of migration to IPPIS would take eternity due to other deliberately created bottlenecks of revalidation of already acquired recruitment waivers. These Residents Doctors would spend several months working without salaries and no hopes of arrears.
Secondly, the Medical Residency Training Programme is cost-intensive and requires a lot of updates and revision courses at various levels. Therefore, the Medical Residency Training Fund (MRTF) was created to be paid annually to each eligible Resident Doctor. For the year 2021, it was discovered that the fund was not even captured in the budget. It took the earlier strike by NARD for the fund to be captured in the supplementary budget. It took the second strike for the FG to realise that the fund was not captured in the 2022 budget. Therefore, if NARD had not gone on strike, many agencies of government wouldn’t have done their duties because the beneficiaries are the Resident Doctors and there is no 10 per cent kickback! So, the strike is key in keeping the government to implement the funds for the MRT programme. What a shame!
Another reason for the strike is the non-payment of arrears of salaries for 2014, 2015, and 2016. Also, there is the non-payment of minimum wage consequential adjustment and COVID-19 hazard allowances to some medical and healthcare workers. Similarly, is the non-payment of death in service compensation for healthcare workers who contracted various deadly infectious diseases and died in service. The FG claimed to have deposited billions to insurance companies, but the health workers are yet to benefit from such monies. It must have been consumed by some family, friends and fans of those in the corridors of power.
Why has the strike lingered for so long? That is the bone of contention. Ordinarily, the Resident doctor’s strike doesn’t take more than days because they are conscious of the sufferings Nigerians go through. They comfortably enter agreement and understanding to resolve the impasse. This strike is unfortunately long because the Minister of Labour who is constitutionally responsible for mediation and conciliation during industrial disputes took it upon himself to make this the longest NARD strike. In the very first week of the strike, Mr. Ngige rushed to the media and told Nigerians that he would not negotiate with the Resident Doctors because they were unreasonable. He then went to the Medical Elders the following week and finally ended up in the Industrial Court. The court gave one month for hearing. All these could have been sorted out in the very first week of the strike if Mr. Ngige was up and about in his responsibility. If he wasn’t ready to do the job he was appointed to do, he should have quietly resigned rather than toy with the health and lives of Nigerians. The President of NMA waded in at this point with the good intention to bring the impasse to an end. With the kind interventions of the NMA President, Mr. Ngige agreed to fix a day for the first conciliation meeting when the strike had entered the third week with many Nigerians already suffering the devastating effects of the strike. Though the matter was in court, out of respect to the NMA President and care for the sufferings of innocent Nigerians, the NARD leadership attended the conciliation meeting that lasted for two days. Mr. Ngige told the meeting that President Buhari had directed the removal of all technicalities to expedite resolution. That statement made both NMA and NARD leaderships to open a new leaf of trust and enter another discussion. After all the issues were discussed, the NARD leaders reluctantly agreed on some of the new timelines out of respect for President Buhari and the NMA president. However, at the time of signing the new MoU, Mr. Ngige told them, behind closed doors, that the August salary would not be paid to them. That was the point when the NARD president rightly told them it would be difficult for him to use the new MoU to convince his members if they would not receive their August salary under any disguise. It was very instructive to note that the president, who had directed for the removal of all negative technicalities would not also invoke genuine clemency for the patriotic Resident Doctors that have obliged the first conciliation meeting. This is happening at a time when the government is willing to give amnesty, rehabilitate and reintegrate the so-called repentant terrorists! Why is it so difficult to be considerate with the patriotic Resident Doctors?
This action of insincerity triggered the NMA NEC to give the government 21 days’ notice to solve all issues of dispute with all her affiliates. The deadline is September 18, 2021.
So which way forward?
As for the current NARD strike, the government has to come out clean with a respectable representative that the doctors would trust to enter a genuine conciliation. The Vice President, Professor Yemi Osinbajo is a good option. However, all their entitlements including their August salary must be paid without further delay. A country that gives amnesty to terrorists and bandits should not have any difficulty in giving clemency to patriotic doctors who chose to serve Nigerians in Nigeria rather than travel out for greener pastures. Honestly, those that deserve the ‘no work no pay’ are those in the MDAs that reneged on the April MoA and Mr. Ngige who abandoned his constitutional responsibilities, certainly not the patriotic Resident Doctors!!!
The Nigerian health sector requires a deliberate and sincere overhaul with all the stakeholders involved. The process of recruitment of health care workers must be a seamless one devoid of unnecessary bottlenecks. We need to have a robust and truly working health system with state-of-art facilities. The conditions of service for the health workers must be reviewed upwards with an attractive and competitive package. Health, education and security are the three most important bedrock for a sustainable economy. Any government that is not palpably fixing these three sectors has no business in our democratic economy.
Dr Askira is a former NARD president.
