BARRING a change in the current frosty relationship between Nigerian doctors and the federal government, medical practitioners under the aegis of National Association of Resident Doctors of Nigeria (NARD) will proceed on strike on April, 1, 2021, to protest failure of federal government to pay house officers working in federal tertiary institutions across the nation.
Notice of the impending strike was contained in a communique issued at the end of extraordinary national executive council (NEC) meeting of NARD on Saturday, March 28, 2021.
The NEC observed that its earlier ultimatum given to the federal government during a January meeting would expire by midnight on the 31st of March, 2021, “with no significant achievement.”
It said though it supported the central placement of house officers by the federal government, failure of the government to pay house officers for three months had made them pass through pains.
The ICIR had on March 14 reported how rift between the Nigerian Medical and Dental Council of Nigeria (MDCN) and chief medical directors of public tertiary hospitals in the country denied house officers undergoing housemanship programme in the hospitals of their three months’ salaries.
Okorie Venatus, the doctor who collapsed after reportedly working for 72 hours at the University of Port Harcourt Teaching Hospital early this month, is among the doctors who are being owned by the government. He told The ICIR that he had not been paid a dime as emolument since January 1, 2021 by the government.
Further findings by our reporter revealed that only 19 out of 42 tertiary hospitals have paid house officers working for them, despite directive by a committee set up by the Speaker of the House of Representative Femi Gbajabiamila that all the doctors be paid without delay – at a meeting that took place at the House of Representatives between March 10 and March 12, 2021.
House officers are graduates of medical schools who are employed to be further trained for a period of one year. The process, known as housemanship, enables the interns to acquire more practical knowledge by working in hospitals and getting paid. The housemanship programme is required to enable the doctors to participate in the compulsory one-year National Youth Service Corps (NYSC) programme. Experience garnered during the housemanship helps the practitioners to excel in places of their primary assignment.
Speaking with The ICIR on failure of the government to pay the doctors after the directive of the Gbajabiamila’s committee, chairman of House Committee on Health Care Service Yusuf Sununu, said he had not got an update from government and the doctors on what had transpired so far.
He said he would reach out to the leadership of NARD and MDCN. “I don’t have report on current situation. Our agreement is that NARD and MDCN should update us. If I haven’t seen update, I can’t comment.
“I’ve been trying my best. When I came, I met a lot of problems. Even the arrears, we fought it out. This one, we had a meeting and we agreed that they would update us. I’ve not heard from them,” the lawmaker added.
He noted that if the update showed that the issue had not been resolved, the parties would be summoned and the agreement would be reviewed.
Delay in payment caused by change in operation – Health Ministry
Director of hospital services at the Federal Ministry Health Adebimpe Adebiyi told The ICIR that the issue of non-payment “is just a teething problem” caused by transition from one system to another.
She said the delay was caused by central placement of the house officers, which was approved in 2017 and 2018. The first fund was released for the programme this year, after it was taken over by the federal government from chief executives of federal hospitals, she stated.
“There is a transition. It has been worked out between MDCN and the hospitals. The Ministry of Finance removed the money from the GITMIS platform of the hospitals. It is being worked out. As I speak, they are working over the weekend,” Adebiyi, a doctor, said.
When told how painful it was for workers not to receive salaries for three months, she said, “nobody likes it. I was with NARD (leadership) in my office on Thursday till about almost 9pm. We were in Ministry of Labour together, with the Committee of CMDs and the MDCN, Budget Office, Accountant-General and others. Some things will just happen without you planning for it. It is because of the transition.”
Efforts to reach registrar of MDCN Tajudeen Sanusi proved abortive, as his phone number was not reachable all through Saturday, March 27 and Sunday, March 28 when this report was being filed. He did not also respond to a text message sent to him, seeking his reaction to the new development.
The ICIR had reported him parrying questions over the issue in an earlier report published on the matter on March 14, 2021. After much prevarication, he had said: “Don’t force words into my mouth. MDCN did not say ‘transfer this to us.’ There were problems, government wanted to resolve these problems; that was why they said MDCN should take over. MDCN taking over is not that they give us money. No, our own is to scrutinise the list and forward to the Accountant-General Office” where he said further action would be taken on the interns’ payment.
Sanusi’s response was with regard to how the federal government took over the placement and payment of the house officers from hospitals managements in the country – the major reason for the current face-off.
“There are quotas allotted to these people. You see, if you have a quota of 40 and you go and employ 80, what do you want me to do? That is the situation. You have a quota of 40, you’re employing 80. The quotas were allotted based on available human and material resources, and they have no right to adjust the quota themselves, unless they invite Council for re-accreditation. Let us get things right in our society. People should not indulge themselves in acts of illegality, trying to legitimize the act of illegality. No. our Council will never allow that. That is just it. “
He had argued that the hospitals were taking more house officers than quotas allocated to them by the MDCN.
NARD had warned the government of impending strike early March
NARD had, on 7th March, 2021, informed health minister Osagie Ehanire, in a letter with reference number NARD/8G/2020-2021/070321/366, of the ‘unjust delay’ of salaries of its members on the GIFMIS platform for over three months, which it said had left them in agony.
In the letter titled “RE-NOTICE OF IMPENDING DANGER IN THE HEALTH SECTOR” and signed by president and secretary-general of the group Uyilawa Okhuaihesuyi and Jerry Isogun respectively, NARD listed some of its grievances to include non-payment of minimum wage and other salary arrears to its members nationwide, and nonpayment of medical residency funding for 2019, 2020 and 2021.
NARD said in the letter that 50 percent hazard allowance for all health workers was not implemented by the government, while it called for abolition of bench fee payment, which it said had brought untold hardship for the training of resident doctors.
The group posited that the federal government had failed to meet all the agreements in the Memorandum of Terms of Settlement signed with it on 21 April, 2020.
“We wish to remind you that some of these issues have lingered on for so long and had culminated in a nationwide industrial action on 14th September, 2020 which was later suspended to give room to further negotiations and possible settlement. In furtherance to the above, the NEC unanimously resolved to proceed on a recess to reappraise the outcomes of meetings on Tuesday 9th March 2021, following which industrial harmony cannot be guaranteed,” part of the letter reads.
Why April 1 strike may be unavoidable
The doctors lamented the ‘suffering’ of their members in GIFMIS platform whom they said had not been paid for four months due to delay in biometric capturing by IPPIS.
The group also said that despite efforts to review hazard allowance of health workers in the country, it had remained N5,000 monthly.
“The NEC also observed that despite the efforts of NARD, the erroneously paid 2020 Medical Residency Training Fund (MRTF) to non-resident doctors is yet to be addressed. Alos, the 2019 and some of 2020 and 2021 MRTF are yet to be paid.
“The NEC noted the non-payment of the arrears of salary shortfall dating back to 2014 to our members across the country, including state-owned tertiary institutions. The NEC observed that up till now, none of our members have benefitted from the death-in-service insurance scheme, despite our constant engagement with the relevant stakeholders, with the data of our colleagues who died in service in the nation…”
NARD also lamented the rate of brain drain of medical practitioners in the country, as it blamed it on lack of employment in hospitals, poor remuneration and poor conditions of service.
The NEC resolved that NARD should proceed on a total and indefinite strike on the 1st of April, 2020 by 8am, if the government failed to pay all salaries owned the doctors, including March salaries before the end of work on March 31, 2021. It also demanded an upward review of the current hazard allowance to 50 percent of consolidated basic salaries of all health workers and payment of the outstanding COVID-19 inducement allowance, especially in public tertiary health institutions.
Others demands included: payment of death-in-service insurance for all health worker who died as a result of COVID-19 infection or other infectious in the country; immediate payment of 2019, the balance of 2020 and 2021 Medical Residency Training Funds to the doctors, including those under state government payroll; and immediate review of the act regulating post-graduate medical training in the country.
NARD had embarked on strike in June 2020 over lack of personal protective equipment (PPE) and poor welfare for its members in the midst of the nation’s fight against COVID-19. The group also proceeded on a similar action in September 2020 over unpaid allowances.
President of NARD Uyilawa Okhuaihesuyi said there were about 15,000 resident doctors in Nigeria as at March 2021. Resident doctors are medical practitioners who have finished their housemanship, National Youth Service Corps and are working to specialise in a specific area of medicine.
The MDCN regulates the activities of medical profession in the country but does not have data on the professionals on its website. However, NMA said on its website that it had over 40,000 members from 36 states in the country and the federal capital territory – with about 19,000 in the diaspora.
However, an official of government in a report in 2020 said there were 74,543 registered medical doctors in the country. The population of doctors in Nigeria serves over 200 million people in the country. Doctor-to-patient ratio is 1: 2753, which translates to 36.6 medical doctors per 100,000 persons in Nigeria.
In January 2020, the federal government said the country needed about 300,000 doctors to meet the doctor-patient ratio of 1:600 recommended by the World Health Organization.
In 2018, The ICIR reported how an average of 12 Nigerian medical doctors got registered in the United Kingdom weekly, a development that highlighted brain drain of the practitioners in the country.
NMA had, in May 2019, said 2,000 medical doctors left Nigeria annually for greener pastures.