How to curtail frequent health workers’ strikes, by Amibor

Dr. Kingsley Chiedu Amibor, a public health specialist/health educator and National Chairman, Association of Hospital and Administrative Pharmacists of Nigeria (AHAPN), in this interview with CHUKWUMA MUANYA, offered solutions on how to avert growing apathy about vaccines and curtail frequent strikes by resident doctors and other health workers, among other issues.

What is your take on the belief that frequent strikes by health workers is worsening the COVID-19 fight and state of health care delivery in the country?
Of a truth, the Nigerian healthcare sector has witnessed incessant strike actions over the years and this does not seem to be abating. Hardly a year passes without threats and reports of one union or the other embarking on one strike action or the other.

Frequent healthcare workers’ strikes result in closure of public health institutions that in turn deprives Nigerians access to quality healthcare services. Public health institutions in Nigeria are afflicted with numerous challenges, such as inadequate manpower, underfunding, poor management, poor infrastructures, poorly remunerated and motivated workforce, misconception of what the healthcare job entails, brain drain, unfavourable working conditions and inter-professional rivalry.

Others include disparity in salaries, allowances and promotion of workers in the health sector and failure of government to honour agreements earlier reached with health workers, among others.

Successive governments’ failure to effectively resolve these issues has contributed immensely to the continuing industrial unrest in the sector. For the duration of the strike actions in public hospitals, Nigerians are at the receiving end and those who cannot afford treatment abroad or in private hospitals within the country either endure their ailments or resort to traditional or herbal medicines, while some invariably lose their lives.

So, what are the other impacts?
Many elites, rather seek health care services in foreign countries, but this has reduced drastically because of the COVID-19 lockdown restrictions.

The COVID-19 pandemic has exposed further, the shortcomings in the healthcare sector in Nigeria, even as healthcare personnel, led by the Nigerian Centre for Disease Control (NCDC) battle to control the spread of the coronavirus pandemic. Now more than ever before, the inadequacies in the healthcare sector have become glaring, especially poor staffing and underfunding.

Lack of harmony among healthcare workers had accentuated the condition of the healthcare sector before COVID-19. Some of the challenges enumerated above have formed the basis of most of the strike actions in the past. Unfortunately, they have not been fully addressed by government and have remained unresolved for years.

There are fears in many circles that continued strikes by healthcare workers in this pandemic period will only worsen efforts to curtail spread of COVID-19, and this is quite worrisome, especially when you remember that Nigeria records new cases of infections on daily basis, while mortality figures from the pandemic are also on the rise.

The healthcare workforce in the country has already been stretched to the limit by the pandemic and as such, any further reduction in capacity through strike action will greatly hamper control efforts.

Frequent strike actions have greatly impaired the efficiency of the health delivery system in the country, thereby worsening the country’s poor health indices, which place it close to the bottom in almost all developmental indices when compared with other countries of the world.

What could be done to curtail incessant strikes, especially by resident doctors?
COVID-19 presents an opportunity for Nigeria to reprioritise her health sector, in terms of improved funding, in line with the Abuja Declaration of 2001 by heads of governments in Africa, which advocates for governments to set a target of allocating at least 15 per cent of their annual budgets to improve the health sector.

Unfortunately, this has not been the case in Nigeria till date. Most of the developed countries have very efficient healthcare systems that are well funded and personnel welfare is an issue of priority in those climes. That explains why medical tourism to those countries has thrived greatly until recently when it was slowed down by COVID-19.

Issues like strike action rarely come up for mention in those parts of the world, and why should they, when healthcare personnel are sufficiently motivated, in terms of salaries and allowances. That also explains why brain drain of health personnel has persisted in Nigeria, even with COVID-19.

Strike actions have persisted for so long in Nigeria because government lacks the political will to address the problems once and for all. What happens currently is that government applies different approaches to resolving strike actions by the different groups in the healthcare sector. Essentially, at the centre of the agitations in the sector are wages and improved working conditions.

What is actually the grievance of health workers against medical doctors and the Federal Ministry of Health?
In 2018, members of the Joint Healthcare Sector Unions of Nigeria (JOHESU) went on strike to press home their demands for increase in basic salary for members as was implemented for medical doctors. The negotiations started well and at a point, rather than government acquiescing to their demands, it suddenly turned around and threatened striking workers with “no work, no pay clause.

The strike was forcibly called off and till today, workers that went on strike during that period (April and May 2018) have not been paid their salaries. Since then, several other unions have embarked on strike actions without their members suffering the fate of JOHESU members in 2018.

For instance, members of the Academic Staff Union of Universities (ASUU) went on strike for several months recently, but were fully paid their salaries and allowances during the period. Resident doctors just called off their strike not long ago, you could see that government officials at different levels were running helter skelter to meet their demands, including speedy passage of a supplementary budget to meet their needs.

I do not have anything against payment of resident doctors whatever is due to them, after all a workman is worthy of his wages. My concern is that all healthcare workers should be treated with equity and I am using this opportunity to once again call on government to pay the outstanding April and May 2018 salaries of JOHESU members.

Other categories of workers, including pharmacists that practice in university and polytechnic clinics did not benefit from the enhanced hazard allowance paid out recently to all categories of healthcare workers. I am calling on the relevant agencies of government to urgently redress this lopsided payment of allowances to healthcare workers.

Another factor that has sustained the strike situation in the healthcare sector has been the existing different salary structures. I have always advocated for a single spine salary structure for healthcare professionals in the country.

How can this anomaly be addressed?
In nearly all countries of the world, medical doctors are highest paid in the healthcare sector. Again, I do not have anything against that, when you consider the length and duration of their training. Pharmacists are supposed to be next to the medical doctors, again when you consider the length and duration of the pharmacists training programme, which has since seen the Doctor of Pharmacy Degree (PharmD) becoming the benchmark for Pharmacy practice in Nigeria and elsewhere in the world. Other professionals can now fit into the single spine salary structure, based on agreed or set parameters.

When this is done, you will find that it will drastically eliminate agitations for salary increase by any group in the sector, because once the arrangement comes into play, any future increase in salary will cut across the various professional groups, so the question of you increased for Mr. A, come and increase for me would no longer arise.

As a matter of fact, this was the prevailing situation in the healthcare sector in Nigeria until the military government in 1985 or thereabout felt otherwise and introduced different salary structures in the once-peaceful sector. Since then, peace has eluded the sector, and I am advocating for a return to the status quo as lasting peace in the sector.

There is need for health authorities to tackle the identified causes of strikes in the sector. Training of personnel in health management, interpersonal and leadership skills will help to build capacity and position them to offer inter-professional leadership, which is missing in most health institutions.

Additionally, the Ministry of Health should carry all healthcare professionals along in matters concerning the various professions, instead of the current arrangement where it invites only selected unions and professions to conferences and training programmes.

Finally, I wish to touch on appointment of minister of Health. The office is political, no doubt, but healthcare workers have been agitating about it because for a long time, both ministers of Health and minister of State Health have virtually come from one professional group. While I am not opposed to appointment of minister from any particular group, the office should be rotated among the different professional groups that make up the healthcare sector.

That way, you give a sense of belonging to all the professional groups and reduce bickering and disharmony that has characterised the sector for so long.

There is need to upgrade and modernise our hospitals, in line with international best practice. State-of-the-art equipment that can aid in rapid diagnosis should be made available. Hospital management should provide the enabling environment for pharmacists to engage in compounding or outright production of medicines right inside the hospitals, as is the case elsewhere, as this has the potential to reduce dependence on foreign made drugs and conserve scarce foreign exchange for the country. Working conditions should be improved upon and infrastructural provisions to enhance service delivery.

When these interventions are put in place, I strongly believe strike actions in Nigeria’s healthcare sector will be reduced to the barest minimum.