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For the Nigerian public health sector long overwhelmed by numerous challenges ranging from perennial under funding, poor remuneration for medical professionals, dilapidated hospitals, clinics, laboratories, dearth of equipment, the prohibitive cost of treatment, incessant strikes to endemic brain drain, the recent ultimatum by the National Association of Resident Doctors, NARD will definitely aggravate an already bad situation and adversely affect the system once respected globally but currently ranked 163 out of 191 countries globally.
And more importantly, for the less privileged patients in society, who can’t afford the exorbitant medical fees charged by private hospitals, another walk out by the doctors will no doubt, not only endanger their lives but capable of sentencing them to untimely passage which makes the threat to down tools dangerous and therefore very imperative that urgent steps be taken by the outgoing President Muhammadu Buhari administration to avert the looming crisis.
As a further action also, since the leadership of the House of Representatives had rubbed minds with officials of the NARD on the burning issue, we demand that the federal authorities through its Ministry of Labour and Employment should approach the leadership of the doctors for urgent dialogue and possible amicable settlement of their grievances, most of which are recurring because the primary purpose of government is the security and welfare of the people.
Recall that the NARD whose members are doctors undertaking training to become specialists/consultants and constitute about 70 per cent of doctors in teaching hospitals and federal medical centres nationwide, recently sent jitters to the spine of inpatients when its leaders handed down a nine-point resolutions to the Minister of Health, Dr. Osagie Ehanire, including an “immediate increment in the Consolidated Medical Salary Scheme, CONMESS structure to the tune of 200 percent of the current gross salary of doctors in addition to the new allowances and payment of revised 2023 Medical Residency Training Fund, MRTF by the Federal Government before May 29 hand-over date. Before now, the association had in January issued an ultimatum to the government to meet its demands but without success.
However, the doctors in a communique issued at the end of their Emergency Extended National Officers’ Committee (NOC), partly reads: “The extended NOC calls for immediate action by the federal government with regards to the upward review of the CONMESS salary structure which has not been done for over ten years now, and to ensure implementation of same before the May 29th hand-over date;
appreciates the Federal Government of Nigeria for the near completion of the payment of 2020 MRTF and the reviewed hazard allowance arrears and encouraged the government to ensure that the few persons yet to be paid are settled forthwith.
Similarly, they called on the government to “expedite action on the processing and payment of the reviewed MRTF for the year 2023 as these funds are meant to offset debts associated with update courses as well as examinations of both the national and West African Postgraduate Colleges, events that have since kicked off for the year” as well as urged “the Federal Government to keep to agreements reached by the stakeholders constituted by the Ministry of Health on the implementation of the MRTF and to expedite action on its payment immediately, as any attempts to do otherwise would only throw the health sector into another series of undesired crises”.
They further maintained that the “extended NOC admonishes the House of Representatives that the obnoxious bill as sponsored by Ganiyu Johnson is a clear definition of modern-day slavery and not in keeping with anything civil and so should be thrown away at this point” even though the “house, however, agreed with him on the palpable dangers of the current menace of brain drain in the health sector and promises to work with government to reverse the trend when the latter is ready to come up with genuine solutions to the problem” warning that any “attempt by the government or any of her agencies to enslave Nigerian medical doctors under any guise would be strongly and vehemently resisted by the association”.
The contentious legislation is seeking an amendment to the Medical and Dental Practitioners Act to stop the migration of Nigerian-trained medical doctors and proposing five years of mandatory service by them upon graduation before they are given full practising licence.
But further lamenting the non-payment of the salary arrears of 2014, 2015 and 2016 to its members as well as the arrears of the consequential adjustment of the national minimum wage, the NARD demanded immediate commencement of payment of all arrears owed “our members by the various state governments, notorious amongst which is the Abia State government,” and the immediate “massive recruitment of clinical staff in the hospitals and the complete abolishment of bureaucratic limitations to the immediate replacement of doctors who leave the system” in addition to several other demands.
We, however, note with serious concern that rather than rise swiftly to intervene and douse the rising tension in the health sector, the minister of Labour and Employment, Dr. Chris Ngige, whose tenure had been largely characterized by incessant strikes including the eight-month action by the Academic Staff Union of Universities, ASUU, elicited to speak to only two of the several legitimate demands by the doctors and in the process gaffed.
According to him, “We (government) have been managing their matter and have given them everything they want, including the residency training programme funds; we are paying them, even when in training, we pay them a full salary, pay them all the allowances and you decided that we have not done enough,” insisting that, “as I said before, you have the option to go. It is left for the education and health ministries to fashion out what they can do.”
It is very disappointing in our view that an apparently enraged minister threw caution to the wind and declared, “So you asked that a bill submitted by a member (House of Representatives) be removed as a condition not to commence strike? That is absurd, adding that
“the entitlements syndrome, the sense of entitlement is too much in this country and as I said earlier, you obey the law you look odd, you apply the law, you look odd or you are a wicked man. I don’t have any apologies for whatever I have done in the management of trade disputes,” Ngige was quoted as saying.
We believe therefore, that this uncompromising posturing of the outgoing Labour and Employment minister is not only unfortunate but will certainly, not advance the course of amicable resolution of the issues raised by the NARD as he seems less concerned about what bleak future awaits the nation’s battered health sector post-May 29 when he alongside other members of the Federal Executive Council, FEC will bow out of office after President Buhari hands over the mantle of leadership to the President-elect, Asiwaju Bola Ahmed Tinubu.
In case, the government may have forgotten, there exist several outstanding welfares and burning contemporary problems bothering professionals and subsequently threatening the continued well-being of the health service delivery in the country which regrettably had been responsible for the increasing medical tourism and brain drain of such medical personnel seeking greener pastures abroad such that whereas Nigeria requires about 363,000 doctors for its over 200million population, only 24,000 licensed doctors are practicing, a figure that is less than 10 per cent of the number needed to meet a World Health Organization, WHO recommendation.
According to the President of the Nigerian Medical Association, NMA, Dr. Uche Rowland, while a country requires a mix of 23 doctors, nurses, and midwives per 10,000 population to deliver essential health services, it was a matter of regret that only one doctor is available to treat 30,000 patients in some Southern states, while in the North, it is one doctor to about 45,000 patients. In other words, due to the migration of Nigerian medical experts, the country is faced with a poor ratio of 4 doctors to 10,000 persons or 1:2500, which falls below the ratio of 1:400 and 600 persons recommended by the WHO.
Regrettably too, the Central Bank of Nigeria, CBN’s balance of payment review in 10 years (2011-2021) showed that medical tourism has cost the nation a whopping sum of $11.01 billion with an average of $ 1 billion yearly spending on tourism according to the Nigerian Sovereign Investment Authority (NSIA), which is 2019 saw the highest overseas health-related expenditure at $2.56 billion – the same year the country budgeted a meagre $757.920 million (N315.62 billion) for the health sector.
Sadly too, that year, as much as 86.3% of the budget was earmarked for recurrent expenditure with just 13.7% allocated for capital expenditure even as the records further indicate that over the years, despite the shortfalls in budgetary allocation to the health sector, an average of 80% had gone to payment of salaries, pension and other overheads costs, while critical investments in facilities and other infrastructural upgrades are largely underfunded.
Regrettably also, with 3.83%, 4.05%, 4.35% of the federal budget allocated to the sector in three years of COVID-19 (2019, 2020 and 2021, respectively), which is a far cry from the 15% agreed on by African leaders and the WHO in 2001, it is quite obvious that government has not demonstrated a genuine commitment to addressing the rot in the health system which explains why Nigeria’s health care is in a deplorable state which requires urgent action.
“Consequently, we, believe strongly that it is only fair and in the national interest that the incoming administrations at the federal and state levels should as a matter of national urgency beginning from the next financial year, substantially increase their budgetary allocation to the health sector in accordance with the global best standard to achieve adequate funding to provide not only new infrastructure and modern equipment but for the training, retraining, and motivation of the workforce through enhanced remuneration in order to reduce widespread brain-drainand lowering of standards in the medical profession”.
Besides, the organized private sector should not rest on its oars but intensify its hitherto robust financial support to the public health sector was demonstrated during the pandemic under the aegis of the Coalition Against COVID-19, CACOVID established to assist the government in combating Coronavirus disease in the country just as we implore the NARD to embrace dialogue and withdraw their earlier ultimatum to the government to allow for meaningful negotiation and amicable resolution of their grievances by the incoming administration.
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