President, National Association of Resident Doctors, Dr. Jibril Abdullahi
In this interview with TOBI AWORINDE, the President, National Association of Resident Doctors, Dr. Jibril Abdullahi, blames bureaucracy and bad leadership and not medical doctors for the crisis in the health sector
In what areas are you making progress in your negotiations with the Federal Government?
The issues, on which the National Association of Resident Doctors is negotiating with the Federal Government, can be categorised into two: We have issues relating to clinical governance —that is, the way the hospitals and practice is run in the and secondly, we have issues relating to the welfare of medical doctors. I can add a third group: The issue relating to the training of postgraduate doctors in Nigeria. On the issue of clinical governance, these are areas that border on the position of consultants in the health care sector, the office of the deputy chairman, Medical Advisory Committee, the position of directors – these are issues strictly related to the demands by the Nigerian Medical Association. By extension, they are the demands of all doctors. On some of these areas, there have been some remarkable achievements in the agreements made.
Which of the issues have not been resolved?
One major issue is that of welfare. This is pertaining to the issue of relative difference in the basic salary of doctors and other health workers; this is called relativity in salaries, emolument and allowances. Nigerian doctors have, over the past 22 years, been asking for a restoration of the prior salary structure. This salary structure is called the Medical Salary Structure/Medical Salary Superstructure. This existed between 1991 and 1996, and the motivation for this salary structure in 1991 was the extent to which Nigerian doctors were leaving the country en masse to other countries. Another factor we have observed is that at that time, even the professors of medicine that had retired in Nigeria went to other countries to work for about five to 10 years. This means that the Nigerian doctors were not properly remunerated and, therefore, at retirement, they still had some issues to settle. That is one of the motivations that made the then military government to come up with the MSS/MSSS. But between 1995 and 1998, when the Federal Government started doing what they called harmonisation of salaries, the salaries of doctors were suddenly slashed and doctors became disadvantaged. And this has been an issue on the front burner of discussions with the Federal Government for the past 22 years.
Between December 2013 and January 3, 2014, an agreement was reached and a circular was brought out by the government. This circular was brought out only to reflect the appropriate difference in the basic salary of doctors, pharmacists, nurses and clinical laboratory scientists. It was supposed to take effect from January 2014. The arrears of about 22 years was about N270bn. As the NMA, we admitted that we knew what the country was going through. Therefore, we were not going to add to it. We agreed to let that one go. We decided to start afresh from January. This is one of the issues we keep going back and forth on. Eventually, we and government reached an agreement. They told us, “We don’t have (enough) money in this year’s budget, so we’ll pay some of it now and pay the remaining next year. It will be appropriately captured in the 2015 budget.”
What is the latest development on the skipping of grade levels?
Skipping of grade levels was hitherto enjoyed by other health workers and was known to be illegal until a court of law said they could continue skipping for the time being, while negotiations were on. We had a fair agreement with the government and we’re waiting for them to fulfill it. Hitherto, they (health workers) had reached an agreement (with government), but for now, we’re waiting for them to fulfill it.
Which of the NMA’s demands relates particularly to NARD?
On the issue of clinical governance, which, like I said earlier, are issues relating to training of resident doctors, we have two points. First, we are asking for uniformity in the terms of employment, because there is so much difference in the terms. Our conclusion with that uniformity list pertains to employment. A template was brought out and we were all in agreement, except for a few areas, which we have corrected. There is also the issue of funding the residency training programme, which, we believe, is one of the motivations for government. We are still waiting for that as well. These are some of the issues on clinical governance for residency training that resulted in the strike.
Has an agreement been reached on the issue of life insurance for doctors?
The issue of life insurance came up suddenly because of this Ebola outbreak. All of us realised that all health workers, not just doctors, are the primary people exposed to it. Therefore, they stand the risk of losing their lives. Money in insurance is supposed to be a package, where premium is paid and one’s next of kin would be the one to access the insurance money after one must have passed away. Insurance for doctors is strictly motivated because of the fact that Nigerian doctors receive N5, 000 per month as the amount of money for the risk taken while working, which you and I know is not sufficient enough to pay for any insurance premium. This is one of the issues. So far, we have had a reasonable discussion with the Senate President (David Mark), who was acting on behalf of the President (Goodluck Jonathan) during our discussion. We think we will make headway on that.
One major issue that has come to the fore is inadequate health insurance for Nigerians. What has been discussed on this?
On health insurance for Nigerians, the reason why this is not an issue for the NMA is simply because even from the Act that established the National Health Insurance Scheme, the target coverage for the NHIS is 30 per cent. If a programme target provides health insurance cover for 30 per cent of the population, you and I know that 30 per cent is definitely a failure. That is why we felt the need for government to concentrate on seeing how it can improve the insurance coverage for other people. For now, it is the formal sector that is covered. Definitely, you know that a vast majority of Nigerians are not in the formal sector. Precisely, it is people in the public sector, not even in the private sector, that are the primary beneficiaries of the scheme. So, we feel the community health insurance model, which the government has demonstrated, should be expanded to accommodate other Nigerians because, as health care workers, we see the problem every day. Patients in need of services come into government hospitals but these services cannot be rendered free of charge. This is what we talked about and we hope the government is going to look into that. These are the issues the government said we should partner on; how there are possible modalities or means through which funds will be raised to provide this community health insurance coverage. We have suggested some and we’re hoping that at the end of the day, when we start sitting down to look at all those issues, they will be considered.
There appeared to be an inconsistency as to whether resident doctors were sacked or suspended indefinitely. What was the correct situation of things?
This is a question better addressed to the Minister of Health or somebody from the ministry. You know there are procedures in civil service. Whether to call it suspension or not is left for the common man in Nigeria and legal experts to say. For me, I don’t want to engage in polemics. But I know that experts are mindful of what is right and wrong. We are working with government to resolve the matter at the highest level, so there’s no problem. We have faith in Mr. President that the right thing will be done.
The Federal Government has repeatedly said resident doctors are not volunteering to assist in managing the Ebola outbreak. Is this true?
The Minister of Health has been angry with us over the strike before it was suspended, and he’s a doctor. But the reality is this: The resident doctors are always the first line of doctors to attend to patients, whether they are on strike or not. I can tell you, in all sincerity and honesty, that there are six to eight resident doctors from the Lagos University Teaching Hopsital, Idi Araba, who participated in the case management of Ebola patients. There are four or five doctors from the Lagos State University Teaching Hospital, Ikeja, who participated in the case management of Ebola patients. There are several other resident doctors, who participated in the areas of surveillance and contact-tracing. Also, the entire membership of officers and some members of the Lagos zone of the NMA participated repeatedly in several corporate enlightenment campaigns through the media or at public gatherings. So, I wonder where that information is coming from. I have the names of the people who participated, but for the sake of their privacy and the risk of stigmatisation, I will not make the list public. We have between 10 and 12 resident doctors from both LUTH and LASUTH that participated in the management of Ebola patients. We certainly know the situation; we are being demonised. That is the basic truth.
With the recent Ebola case in Rivers State, what is the nature of mobilisation with regards to resident doctors?
The problem is that the (doctors’) strike has been suspended. The paradox again is that Ebola is expanding; it has gone to Port Harcourt. We emphasised the need to have a clearly demarcated patients’ floor in the hospital. The truth is, when you have an outbreak, you need to plan well. In the course of people coming to the hospital, one patient can infect others, who then go and transmit it to other parts of the community. This is why there has to be a clear plan of the patients’ floor in the hospital; how the patients will be attended to, in the case of any suspected case. There has to be an adequate laboratory capacity in Port Harcourt. These are the ways in which planning will be used to contain the outbreak in Port Harcourt because, obviously, the performance in Lagos was good enough. We hope it will be used and that the government of Rivers State will do as much as the Lagos State Government did, with help from the Federal Government. We’re hoping for the best. Our members are always prepared to work, provided they are protected.
There was widespread condemnation of the strike by members of public, blaming medical doctors for the current situation in the health sector. Do you agree?
The reality is that Nigerians are unhappy with all leaders. Nigerians are not happy. One thing about Nigerians that I know, having led a group of doctors, is that we like to find fault in our leaders. We are quick to find faults, rather than to commend a good job. In the same vein, Nigerians are quick to find faults in doctors, but they are not quick to commend doctors for their good work. One thing is clear; doctors are not happy about strikes. Our members are not happy when they have to go on strikes for government to respond to simple issues. This is because we are not exempted. Nigerian doctors fall sick; Nigerian doctors die because of strikes. I lost a dear friend during this last strike. He was a doctor, a young consultant, who just finished his residency. The point is, nobody is happy about the strike and, as doctors, we have seen where we’ve erred. Let us all join hands to ensure that Nigeria functions. So, it is not a matter of blaming doctors alone. We should blame each other as citizens of this country so we can collectively move the country forward.
With the obvious animosity brewing between doctors and other health workers, shouldn’t the patient’s wellbeing come first?
Have you ever asked yourself, as a journalist: Does this form of rivalry occur in a private setting? I can give you a simple example. Garki General Hospital is a public-private partnership institution in Abuja, and that institution is run by a doctor. Have you ever heard of any gang-up by cleaners, nurses, lab scientists, pharmacists, to form one group to fight a doctor in that hospital? No. So, why is it that this is happening in the public sector? It is easy to say doctors are to blame. But if you look at it, a conglomeration of an attendant and a pharmacist, who has a PhD, coming together to form one umbrella of several heterogeneous people to fight a common cause, tells you that it is no longer a professional issue. Rather, it is an ego thing. Ordinarily, in professional development, pharmacists would go with their issues on their own; nurses likewise. But you have cleaners, administrative officers, nurses, pharmacists, lab scientists, and what have you, coming together to form a medical health workers’ union. It tells you they fight for the ego. And I wonder why that kind of fight doesn’t take place in the private sector. Why must it take place in the public sector?
I don’t exclusively say there are issues unrelated to how people from both sides of the divide meet each other. We can’t deny that there are problems from this and other sides. But the reality is that everybody must learn to station himself at the level of his profession. That is it. That is when you can work together for the interest of the most important person in the health care sector. But this issue of rivalry comes to play when people want to cut corners. If all these other health workers can work quietly in a private setting — quietly, without rancour— they should do the same thing in the public sector. They are now getting warmed up for a probable strike because they would have heard government is giving something to the NMA. I just hope we are all mature, from both sides, to realise that the common index is the patient. Our focus should be on developing the country. It is not only for the Joint Health Sector Union but also for doctors.
In all sincerity, the problem of frequent strikes by university staff, court workers, doctors, nurses and other bodies in Nigeria is such that, gradually, Nigerians are seeing the flamboyant lifestyles of their political office holders, while they wallow in penury. I’m not talking about today, so people don’t say I am against current government; I am tired of that politicisation. As Nigerians are getting more educated, the middle class is expanding. When the middle class expands, the economy grows. But again, there is a price for it. You have people demanding more accountability and transparency and better governance. This is what happens in Nigeria. It is not only in the health sector where everybody is asking for the best. Our leaders must take a cue from this, so that they know that, now, things are changing.
source: Punch
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