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How Nigeria lost nearly 300 working days to hospital strikes in eight years 

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INCESSANT strikes by doctors and other health workers working in Federal Government-run hospitals in Nigeria resulted in loss of about 300 working days between 2013 and 2021, The ICIR reports.

The National Association of Resident Doctors (NARD) ordered 61 per cent of the strikes, findings showed. 

The NARD was responsible for 11 of the 19 industrial actions recorded by the government within the period.

The association went on strike for 154 days out of the total 252 days of strike recorded by the government.

While it is easy to compute the number of days affected by the strikes, it is unlikely that the government can have data for the lives lost during such actions.

 Strikes by health professionals usually come with preventable deaths for households and loss of revenues for the government.

It further weakens the nation’s frail health system, denies the poor access to care, and promotes medical tourism and brain drain.

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Whenever healthcare providers embark on strike, private hospitals usually charge exorbitant fees and are congested.

The rate of self-medication surges, leading to complications of ailments and rising deaths. 

Strikes leave patients stranded at hospitals as only skeletal services are rendered, sometimes through support staff such as corps members, cleaners and the like.

Minister of Labour and Employment, Chris Ngige

The ICIR obtained the data on strikes in the sector from a response to a Freedom of Information Act request sent by the newspaper to the Federal Ministry of Labour and Employment, headed by Chris Ngige, in August.

The request followed incessant industrial actions by workers in the nation’s public hospitals.

The ICIR sought to know the workers’ strike frequency from 2011 to 2021 and the reasons for such actions.

However, rather than comply with the seven-day window provided by the Act for organisations answerable to the law, it took the ministry almost four months to respond to the request—the delay conflicts with the FOI Act.

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Section Four of the Act demands that affected organisations respond to requests within seven days.

The law, however, set out conditions for delaying response to any requests made under the Act, that is if the information requested is at the disposal of another organisation that could better make it available.

Section six of the Act provides a seven-day extension notice to the applicant if the organisation cannot provide the information but has to transfer the request to another institution to make it available.

The ministry had no communication with The ICIR until it responded in its letter dated December 15.

Nigeria has 20 teaching hospitals, 22 federal medical centres, and 13 speciality hospitals where the workers covered by this report work.

The hospitals are distinct from hundreds of others owned and managed by state and local governments, where workers also go on strike at will. 

Osagie Ehanire, Health Minister

According to the government, as of March 2020, there were nearly 75,000 registered doctors in the country.

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They were among those working in public and private health facilities, including others who do not work in hospitals.

Other health workers, namely pharmacists, medical laboratory scientists, nurses, radiographers, dietitians, therapists, health record and information management workers, form the majority of hospital workers.

Why strikes succeed

Professionals working in the sector group themselves into different unions through which they seek their members’ welfare and professional development.

For instance, the health workers group consists of the National Association of Nigeria Nurses and Midwives (NANNM), Association of Medical Scientists Laboratory of Scientists of Nigeria (AMLSN), Assembly of Healthcare Professional Associations, Joint Health Sector Unions (JOHESU), Medical and Health Workers Union of Nigeria (MHWUN), Pharmaceutical Society of Nigeria (PSN), Nigeria Union of Allied Health Care Professionals (NUAHP) among others.

A hospital ward during strike by care givers

The doctors’ groups include the Nigeria Medical Association (NMA), Medical and Dental Consultant Association of Nigeria (MDCAN), National Association of Resident Doctors of Nigeria (NARD) and other associations.

Once the national leaders of the groups decide on strike, members usually obey them.

Workers complain of poor infrastructures in hospitals and poor working conditions. 

Funding for the sector is inadequate as less than five per cent of the national budget goes into the sector.

The ICIR reported how salaries, cost of running offices gulp 73 per cent of the country’s budget for health in 2022.

The workers often accuse the government of insincerity with its promises. They also accuse the government of dragging feet before implementing the agreements reached with its workers. 

In an attempt to compel striking workers back to work, the government usually threatens to sack them. But the parties always end up reaching a truce.

Olorunnimbe Mamora
Minister of state for health, Olorunnimbe Mamora

A significant feature in strikes among the workers is that doctors and other workers alternate the action. Whenever the government meets the demand of a group, the other will protest and make similar requests from the government.

Health workers often object to the leadership of the sector by doctors. They claim that only doctors head most hospitals, the Federal Ministry of Health and virtually its agencies and departments.

History of strikes since 2013

The NUAHP proceeded on strike on August 16, 2013. The group sought the abolition of the office of Deputy Chairman, Medical Advisory Committee introduced by the government. The strike lasted for seven days.

On October 21, the same year, NARD went on strike over non-payment of July-October salaries and other allowances owed its members. The action lasted for ten days.

JOHESU embarked on strike three months after – on January 20, 2014. The group based its action on the non-promotion of its members on CONHESS 14-15 as directors. The strike lasted for three days.

The NUAHP resumed the strike it suspended earlier, on October 16, over the failure of the government to implement the Memorandum-of-Understanding signed with the association on August 20, 2013. It took the government and the association 16 days to resolve the impasse. 

The JOHESU, again, went on strike on November 12, 2014. The group demanded the adjustment of salaries for its members as the government did for the Nigerian Medical Association earlier that year. The ministry did not provide the number of days the strike lasted.

Doctors protest while on strike in Nigeria

The group yet embarked on another strike that month, demanding the skipping of arrears and other issues. The strike lasted for seven days.

The NARD embarked on another strike on June 1, 2015. The association protested skipping arrears, other benefits for its members, and other issues. The strike lasted for 25 days.

On June 15, the same year, NMA scaled-down services to ask for full implementation of Consolidated Medical Salary Structure (CONMESS) for its members. The time the strike lasted is not available.

Just a week after NMA made its demand, JOHESU suspended services over non-payment of skipping salary arrears to its members in Federal Tertiary Institution, among other demands. It took the government and the group seven days to resolve the crisis.

After its ultimatum on inclusion into the IPPIS expired on July 27, 2016, NARD proceeded on strike. The action lasted for seven days.

Meanwhile, MHWUN protested the delay in releasing its members’ 2015 promotion interview results and consequently downed tools on October 19, 2016. The group called off the strike after two weeks.

Again, NMA and NARD jointly scaled-down services on September 4, 2017, following the failure of the government to meet NARD’s demand on skipping. The strike lasted for nine days.

JOHESU on strike

Between April and May 2018, JOHESU members suspended work over a trade dispute on the upward adjustment of CONHESS. The action lasted for 44 days.

On May 15, 2020, NARD embarked on a five-day strike over the universal implementation of the Medical Residency Training Act in all federal and state hospitals. The action also sought to ensure pay parity among doctors of equal cadre. 

The association, again, embarked on a 10-day industrial action in September 2020 over the non-implementation of agreements it had with the government.

The NARD again scaled-down work for nine days between March 31 and April 8 this year over the failure of the government to pay house officers.

The association resumed its strike on April 12 over the government failure to pay hazard allowances to its members at the frontline of the COVID-19 pandemic. The group said it embarked on the strike also to protest the dismissal and reduction of wages of its members by the Kaduna State government. The strike lasted for ten days.

The longest of all the strikes within the period under study was the action by NARD on August 2. It lasted for 62 days. The association declared the strike over government failure to pay house officers’ salaries and the non-recruitment of house officers.

Unions embark on fewer strikes under Buhari

But for NARD, the sector witnessed fewer industrial crises under President Muhammadu Buhari than his predecessor.

In 2014, the then Minister of Labour and Productivity Emeka Wogu said health care providers embarked on strike more than 40 times in the first nine months of that year.

“The health sector has witnessed a lot of unrest and strikes in the past few months. The sector has had no fewer than 40 strikes this year. It is worthy to note that the health sector is of the essential services and vital to the whole economy. It is the engine on which economic growth and development is built,” he said.

President, others seek care abroad; health care providers opt for greener pastures during strikes

President Muhammadu Buhari

Many officials of government and health care providers often travel abroad for treatment, whether hospitals function or not.

In May 2018, The ICIR reported how President Muhammadu Buhari beat the record set by the late former President Umar Yar’Adua in medical tourism. 

He has sought care abroad after the report was published.

In October, The ICIR reported how the country lost nearly 9,000 doctors to the United Kingdom and other nations within two years.

In August, this newspaper also reported how hundreds of doctors thronged a recruitment venue in Abuja, hoping to work in Saudi Arabia. The firm needed only seven doctors. 

Challenges in Nigeria’s health sector have remained as the country parades some of the worst health indices globally.

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