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Why Lagos doctors should not be on strike, by commissioner

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Commissioner for Establishments, Training, and Pensions, Mrs. Ajibola Ponnle

Mrs. Ajibola Ponnle is the Lagos State Commissioner for Establishment, Training, and Pensions. Ponnle in this interview with CHUKWUMA MUANYA said resident doctors in Lagos State should not go on strike because the government has met their core demands.

Why did the state allow resident doctors to go on strike at a time like this?
LAGOS State is a responsible government, and no responsible government or employer will allow its staff goes on strike, especially at a time like this when the state is dealing with the third wave of the COVID-19 pandemic. I have to say that the strike took us all by surprise as it was not in line with established rules of engagement for industrial action. There was no engagement by the State Association of Resident Doctors (ARD) on their intentions to go on strike, especially as Lagos State is not guilty of the complaints cited for the action, with the exception of the circular issued by the Head of Service to remove House Officers and National Youth Service Corps (NYSC) doctors from attracting Grade Levels on the Scheme of Service. We would have expected the State ARD to seek clarifications on the implications of the circular from the Office of Establishments so that they can make an informed decision based on facts on whether to embark on their action.

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What have you done to stop the strike?
We have engaged all stakeholders in the public health sector, in particular – the management team of the Health Service Commission, Ministry of Health, Lagos State University Teaching Hospital, Association of Resident Doctors, Medical Guild, and even the umbrella body, Nigeria Medical Association. At these meetings, we explained the reasons for the removal of House Officers from the Scheme of Service, allayed their fears on the perceived negative impact on the career and remuneration of doctors, and reassured them that all the demands cited had either been addressed or at different stages of completion.

NARD is accusing Federal and State Governments of insensitivity and negligence to their plight. What is your take on this?
It is important to state that the Governor Babajide Sanwo-Olu administration is arguably the most accessible at the highest levels of governance to all unions in the Public Service. The Medical Guild and ARD have enjoyed unfettered access at all levels. We have had cause on several occasions to meet with the executive members of these associations formally and informally to proffer solutions to issues on conditions of service and welfare of their members. This administration has resolved long outstanding issues within the sector in the last two years and we have been able to establish a track record of creative solutions to ensure we bolster the welfare of our health sector workers.

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Has the government met the demands of the striking doctors? If yes or no, why? How?
There are four main demands from the resident doctors in Lagos State:
Their main demand is for the withdrawal of the circular removing house officers and NYSC doctors from the scheme of service.

The National Council on Establishments, which is a body comprising the Head of Service of the Federation, all Heads of Service and the Permanent Secretaries of Establishments of 36 States in the Federation – at its 42nd National Meeting resolved to remove the current status of Internship Programmes in this case horsemanship and also NYSC doctors as posts attracting Grade Levels in the Scheme of Service.

The circular was issued by the Head of State of the Federation in April and by the Head of Service of Lagos State on July 12, 2021. To understand the issue, I need to explain what the Scheme of Service is. The scheme of service defines the career path of all cadres from point of entry into the Public Service to the point of exit. These are permanent and tenured employees in pensionable employment with the State. House Officers have a temporary placement with the Service in an internship position for one year, working under the supervision of fully licensed medical practitioners. They have provisional licences to practise, and the year is compulsory as part of their training to be fully licensed practitioners.

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After successful completion of their housemanship they go on to do their NYSC. It is only after their NYSC that they can apply to the Service to start their career as fully licensed medical practitioners, either as generalists or as resident doctors. So, since both housemanship and NYSC placements are done prior to their entry into full-time careers with the Public Service, it was necessary to correct the anomaly of having them included in the first place, which is what the NCE resolved to do. This was done to ensure there is equity and justice across the board for other cadres (professions) who also have compulsory internships in the Nigeria Public Service. What I am saying in essence is that being a house officer or NYSC doctor has absolutely no implications on the point of entry, career progression, remuneration, or service years, should they apply and be recruited eventually by the Public Service after their internship.

The second demand is the immediate payment of the Medical Residency Training Fund. After a thorough review with the intent of boosting and supporting the capacity development of Resident Doctors in the State, Mr. Governor approved 100 per cent payment for the examination fees even though the Act states that 80 per cent should be funded through the national budgetary allocation to residency training institutions while Residency Training Institutions fund 20 per cent from internally generated funds. So far, payments have been made to Resident Doctors under the Health Service Commission for 2021 exams while the payment to the Resident Doctors under the Lagos State Teaching Hospital is currently being processed.

They also cited the need for immediate massive recruitment of resident doctors. In 2020, Lagos State recruited 350 healthcare professionals into the service through Health Service Commission and Lagos University Teaching Hospital (LASUTH). This year, we have started the recruitment of 400 healthcare professionals. This will include at least 150 doctors, which is the current deficit identified, that will improve the doctor-patient ratio. The process will cover practitioners across the healthcare spectrum, including consultants, medical officers, dental officers, house officers, pharmacists, and nurses.

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Finally, they are demanding the commencement of residential quarters. The State Government is quite aware of this, and Mr. Governor recognizes the vital role accommodation for resident doctors within the hospital complex plays in ensuring proper care for patients, safety/wellbeing of doctors, and even for the accreditation of Residency Training Institutions.

As we all know, construction does not happen overnight. The Ministry of Health has done a lot of work in this area and has earmarked portions of land within LASUTH and General Hospital, Gbagada for the construction of Doctors’ Quarters for Resident Doctors. Preparations for the building are on, with the completion of architectural designs and approvals to build from the Ministry of Works and Infrastructure. We are at the stage of procurement compliance before mobilization of contractors to site. The Ministry of Health will execute the projects.

However, in the interim, some buildings around the hospitals have been rented from landlords for the use of the doctors. So, again, this is work-in-progress and advancing at the right pace, considering the amount of work required for such projects.

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Why should the doctors call off the strike, as you are demanding?
The administration of Mr. Babajide Olusola Sanwo-Olu has prioritised the health sector, in line with the THEMES Agenda – the six-pillar development plan that drives the administration’s projects and policies; health belongs to the second pillar – and we ensure we run an open-door policy for the associations to discuss their concerns. We believe we have built trust over the last two years, as shown by the number of long outstanding issues we have resolved and the Medical Guild and Association of Resident Doctors is very aware of this. They are also engaged in the plans that are underway to provide a holistic approach to resolving the pervading crises in this sector. We have appealed to them to keep the big picture in mind, look at the commitment Mr. Governor has made in the sector over the last two years, despite the harsh global economic climate, and use this as an assurance of the administration’s resolve to find a lasting solution to the incessant industrial action that the sector is known for.

We are, therefore, calling on the leaders of Lagos State ARD to reason, temperance, and the compassion that the profession is known for, bearing in mind that the country is in the middle of the third wave of the COVID -19 pandemic with Lagos as the epicentre. We continue to appeal to them to return to work in order for us to save the lives of Lagosians and move the sector forward.

Are you in support of a work-no-pay policy?
We don’t have any plan to implement the “no work no pay” policy; rather, we are adopting the continuous engagement approach with relevant stakeholders in the public health sector to ensure the suspension of the strike.

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The resident doctors are saying that they will not call off the strike until their demands are met. What is your take on this?
This administration over the past two years has prioritised the welfare of public health workers and will continue to do so. Every demand raised by the State ARD has either been met or is in the process of being met.

Apart from the initiatives mentioned earlier, Mr. Governor increased the salaries of doctors, with the introduction of what we creatively called Retention Allowance approved in September 2020 in a year where there was a global economic recession and many states could not afford to pay salaries. This further showcases Mr. Governor’s commitment to this sector, despite obvious challenges in a very difficult year for the State with unprecedented events that competed for resources.

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With the series of engagements by various stakeholders, including senior colleagues of the striking doctors, we had hoped they would by now have suspended the strike as all their concerns have been addressed and resolved.

What do you think is the way forward for stopping frequent strikes in the health sector?
No war is won on the battlefield. The State ARD Exco categorically stated that their members largely believed that diplomacy and continuous engagement are key to proffering lasting solutions to disputes and not strikes. We hope they will adhere to their members’ wishes.

Apart from this, Mr. Governor continues to champion efforts in infrastructural, process, and governance reforms and has directed us to start the process of developing a holistic roadmap for a sustainable people strategy for the health sector in Lagos. With all the plans underway to reform this sector, we hope that the striking doctors will not add to the delays in ensuring we all work together to chart a new course for Healthcare in Lagos State.

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