Nigerian doctors, under the umbrella of the National Association of Resident Doctors, NARD, have been on strike following the failure of the Federal Government to meet their demands. Resident doctors make up the bulk of the doctors in Nigeria’s tertiary hospitals, and when the NARD goes on strike, activities are crippled in such hospitals.
The doctors, amongst other issues, are demanding the immediate payment of the 2023 Medical Residency Training Fund, MRTF, tangible steps on the “upward review” of the Consolidated Medical Salary Structure (CONMESS) and payment of all salary arrears owed its members from 2015. The National President of the association, Dr Emeka Orji spoke to Newspot in an interview on several issues bordering on NARD negotiations with the government. Excerpts!
The Federal Ministry of Health says it has commenced the implementation of the ‘no work no pay’ policy. How did your Association react to it?
The truth is that our members reacted to it negatively, and I did not know why or how a government ministry that is saddled with the responsibility of resolving issues in the health sector would enter into an agreement with an association like NARD with time lines to many of the demands and renege on that agreement. And when the association now reacts, after consultations, when we now react by way of a strike, the same ministry that reneged on the agreement that caused the strike will come and punish us for going on strike. I am not sure that is what the Trade Dispute Act envisaged, that the government will have an agreement with an association, renege on the agreement, and the association reacts, you punish them for reacting; that is against the principle of natural justice. Because he who must come to equity must come in clean hands, and so, we are hoping that they will look at it again and do the needful because that is not going to help anybody. If anything, it will eventually aggravate the situation we have on our hands because they are not willing to resolve the issues.
If you look at the memo critically, you will see that they even enumerated the issues without telling us one after the other which one they have resolved and how they have resolved it, which means that they know the issues, but they are yet to attend to them.
The implementation of the ‘no work no pay’ policy implies that striking doctors may face financial consequences. What is the way forward?
Our members have already envisaged this, and you need to realise that we are professionals. The government should do well to address the issues; that is our major focus. Our focus is on the demand we are making; the medical residency training fund 2023, the keeping arrears, and a host of other things, which we believe the government can quickly address. So if they are able to address it, then we will begin to talk about coming back to work, but if they refuse to address those things and they are talking about no work, no pay, it is actually not going to help anybody.
The circular suggests that the government is holding striking doctors responsible for any likely escalation of the situation. How do you respond to this accusation, and what message would you like to convey to the government regarding the doctors’ grievances?
I don’t know the circular you are referring to where the government is holding us responsible for the escalation of the crisis. We are the ones actually holding them responsible. In some of our previous releases following the issuance of that memo, we felt that it was going to anger our members all the more, and that was actually what happened because you can see now that on Saturday, we had National Executive Council, NEC, meeting, and our members directed that we proceed on a daily nationwide protest with effect from Wednesday.
But ever since that notice came out, we are aware that even the government is reaching out to resolve the issues. We hope that that happens before Wednesday. The government has invited us to a meeting again tomorrow. We are hoping that the meeting will be fruitful because, essentially, everybody wants a solution to this. The essence of the association raising the alarm or even going on strike is to resolve issues. And in this case, many of those issues don’t necessarily have to do with us per se. It has to do with the system. We want the system to work. That is why we are calling for any form of avenue that the government can use to recruit and replace doctors and nurses that left the system. Because we believe that it is only when that happens that the system can function effectively, so that is what we are agitating for, in addition to other important things.
If the government addresses them, of course the urgent one can quickly be addressed, and they give us hope as to when the other ones will be done, we will come back. What our members simply don’t want is a situation whereby we keep working. You see a doctor doing the work of 30 people; there is no way the person will cope.
The ongoing strike has raised concerns about the impact on patient care and public health. How is NARD addressing these concerns?
Even during the time we were working, patient care has been affected by this inadequacy of numbers; we are talking about the inappropriate number of doctors and nurses in the hospital. Patients come there, and they spend the whole day in the hospital, and they don’t get to see their doctors. They come to the emergency department with trauma in emergency cases, and we don’t have enough doctors to treat them, and many of them die. This has been the case for some time now.
Already the patients are suffering because of these issues that we are demanding the government to resolve. Secondly, we have said this repeatedly, doctors are human beings; we are Nigerians. We also have needs. We have families to take care of. And so if the government is not giving us what we believe is our entitlement in terms of remuneration and training funds, of course, we are going to make demands of the government to do those things. Essentially you journalists use to refer us to our Hippocratic oath. If you read that oath critically now, you will see that provision was made and stated clearly that we have to be able to take care of our own health and needs in order to be able to deliver health services of the highest standard to our patients. And so, if doctors are not well taken care of, how exactly will they be in a good frame of mind to treat their patients? A hungry doctor is a dangerous doctor. And so we don’t want to have an army of hungry doctors in Nigeria treating patients; things will definitely go wrong. That is why we are clamouring for all these changes to be made.
Some people argue that strikes by medical professionals could harm the doctor-patient relationship and erode public trust in the healthcare system. How does NARD plan to maintain a positive doctor-patient relationship while advocating for its members’ rights?
Well, we do that a lot, but what we see is that it looks as if nobody cares. And you see, the problem is that even when we are engaging the government on so many issues, Nigerians don’t get to know. It is only when we keep engaging, and nothing is coming out that we will now start agitation. That is the only time people begin to know. If we tell you what we have done to prevent this strike, you will not believe it; people leave with their families and come over to Abuja and move from one office to another.
We are also trying to engage the public to let them know exactly what the issues are and how they can help us.
Assuming the general public decides to be fighting for us and for the survival of the health sector, I can tell you that the Nigerian Association of Resident Doctors, NARD, won’t have any need to be engaging in all these agitations because we see the public fight for us while remaining in the hospitals and work for them. But nobody does that, of course, we don’t have an option but to fight for ourselves and for the survival of the health sector.
NARD has been engaged in negotiations with the government to address various issues. Can you provide an update on the progress of these negotiations? What are the key points?
The major issues remain the 2023 medical residency training fund that has not been paid, which we are hoping that the government will be able to pay so that we can resolve these issues. Then there is this keeping arrears that have lingered for a long time that have not been paid upon several promises. Then, of course, with these biting economic conditions, our members expect that the government will be able to settle all these arrears of salary so that it could help us cushion the effect of the removal of fuel subsidy and the consequent inflation.
Apart from these arrears, there are others, but those ones are being owed to a few of our members who were not paid alongside others. And then, the issue of massive manpower shortage in the hospitals; we want the government to think outside the box and bring up this circular of one-for-one replacement that they have promised us for a long time ago so that the hospitals can have enough manpower to take care of health needs of Nigerians; this will make our members heave a sigh of relief when they have people coming to join the system, and then the current work overload in the system can be addressed. Those are the major issues.
How soon is the strike going end?
You know, whenever we are going for such meetings, we always have hope, just that many times after you go there, you see the body language, you will know that from the beginning that there may not be any plan to even resolve issues. But this time around, we believe and hope earnestly that because of well-meaning Nigerians that have intervened so far, we believe this meeting will be able to yield something that will help us with these issues that we have on our hands.
Some critics argue that strikes are not the most effective way to resolve disputes with the government and may lead to more harm than good. How does NARD justify its decision to resort to a strike, and what alternative approaches have been explored to address your concerns?
As I said before, the general public only gets to know when we go on strike. If they know the events that happened before the strike, they will pity us; believe me, it is not easy. You keep moving from one ministry to the other, trying to resolve issues, and some government functionaries will deliberately scuttle whatever efforts you are making. And when it looked like we had no headway at all, that was only when we first issued an ultimatum. And when we issued this ultimatum, we were ignored. Of course, we had no option but to escalate, and it is quite unfortunate.
Going forward, we want the government to try and listen. You see, most of these issues can be resolved on the negotiation table if people come to the table with good faith, hoping to resolve issues and not to throw blames or throw tantrums in the meeting or even start looking at you as if you are overbearing without critically analysing the demand that we are making. It is like these demands we are making now. When people go through them one by one, they see reason in what we are asking for. So, there is no reason they would not be addressed.
What can you say about the death of Lagos doctor, Diaso Vwaere due to a faulty elevator?
It is unfortunate; it still boils down to what we keep talking about. If you look at the scenario, it is actually why, in God’s name, young doctors will be quartered in a 10 storey-building with a faulty elevator. When you begin to think about some of these things, you wonder what is really going on in this country. To start with, why would you have only one lifter in that place? Why would you allow it to be faulty when you know it is a 10 storey-building? Do you envisage that someone will come from the topmost floor to the ground without using a lift? And to even think that this complaint was made a long time ago and that it was not adequately addressed shows you the decay in the system that we are all complaining about. It still boils down to the fact that it is not only the federal government that we are even talking about; most state governments have completely abandoned the health care system in their states.
Unfortunately, Lagos State used to be one of those States that expect some level of excellence in terms of their health care delivery system because of the resources available to them. So we are ashamed, appalled, and we are annoyed that this doctor will lose her life needlessly for something that could be avoided. We are still calling, and we join our voices with the zonal Nigeria Medical Association of Lagos State, their medical guild, to demand that all the people who, in one way or the other, exhibited incompetence and negligence that has now led to the death of this doctor should be brought to book, so that it will serve as a deterrent to others.
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