Opinion

Crisis In Nigeria Health Sector: Understanding JOHESU’S Strike Action

By Muyiwa Olayinka

Providing health to the teeming population by Nigerian government, is a social contract that is non negotiable. Quality and affordable health care is critical to sustainable development and progress, because it is the human capital that drives the economy to prosperity.
Health infrastructure ( hospitals, laboratories, health insurance organizations and other ancillaries), are essential for the efficient functioning of a healthcare system and consequently, a productive and prosperous nation.
Provision of healthcare facilities in Nigeria are provided by both the private and public sectors. Private care are expensive compared to public care and affordable to about 10% of the total population..
Public health care provision in Nigeria are categorized into primary health care (PHC), Secondary health care ( General hospital) and Tertiary health care. The local government takes care of PHC, state government for the General hospitals while the Tertiary health care like teaching hospitals, federal medical hospitals are financed by the federal government.
It is trite to say Nigerian health sector is in a comatose state and are largely inefficient. Government at all levels pay lip service to health care delivery in Nigeria. Our health sector are fraught with myriads of challenges that resulted from lack of planning, to policy summersaults, inadequate pay, poor pay, outdated technologies, poor infrastructure sharp disparities in the availability of medical facilities across the country.
The net effect is inadequate medical supplies,resorting to self medication leading to complications and at times, loss of human lives. Poor pay of the medical personnel resulted to countless strikes and down tooling in this critical sector.
Poor remunerations of medical personnel led to the down tooling of JOHESU ( Joint Health Sector Unions) of tertiary health care since April 17, 2018. JOHESU went on strike after giving federal government a 21 day’s ultimatum from February 5 and an additional 30 working days notice on March 5, 2018.
As customary,the federal government did not take the windows of opportunity provided by the union to resolve the nagging knotty issues.
JOHESU comprises of all health workers apart from medical doctors and dentists, while NMA (Nigeria Medical Association) is the umbrella body of medical doctors and dentists.
Medical personnel such as pharmacists, medical laboratory scientists, optometrists, physiotherapists, imaging scientists/ radiographers, and other supporting staffs. in tertiary medical institutions are members. It also include the National Association of Nigeria Nurses and Midwives (NANNM), Medical and Health Workers Union (MHWUN), Senior Staff Association of University Teaching Hospitals, etc.
The implication is the health sectors in federal controlled institutions have been practically paralyzed for more than four weeks. Without these supporting staffs, it is practically impossible for doctors and dentists to offer comprehensive health care.

Why JOHESU’s strike?

NMA and JOHESU were initially on CONTISS (Consolidated Tertiary Institutions Salary Structure I) during President Obasanjo’s government. All medical personnels including the medical doctors and others were remunerated according to pay grades with structured allowances accordingly..
In year 2009, during late President Musa Yar’adua’s government, there was a clamor for salary increment by the medical doctors. In the last quarter of 2009, agreement was reached and the salary scale was moved to CONHESS,(Consolidated Health Salary Structure), approved and implemented in January 2010 for all medical practitioners. The committee set up by the late President agreed that four years later, there would be salary adjustments.
During these period, .there was harmony in the health sector from 2010 to 2013.
In 2014 when the agreement for salary increment was expected to be met, Nigeria had Goodluck Jonathan as the President. With Professor Onyebuchi Chukwu, as the substantive Minister of Health, a new twist was introduced by the the medical doctors.NMA (Nigeria Medical Association) clandestinely moved from CONHESS to CONMESS (Consolidated Medical Salary Structure). With the new arrangement, medical doctors and dentists had a more robust salary scale than CONHESS.
JOHESU was left in the cold!
This is the genesis of the crisis that led to discrepancies in salary structures
JOHESU have tried unsuccessfully to adjust their salary scale accordingly. Collective bargaining JOHESU had with the federal government in 2014 and 2017 were spurned at both times.
In 2016 and 2017 the principle of ‘relativity’ were implemented for doctors.
This created a wide gap between the medical doctors and other health sector workers.
The national chairman of JOHESU, Biobelemoye Joy Josiah accused the federal government of always promptly acceding to the demands of NMA but reluctant in meeting the demands of other health workers.
To buttress his claim, the JOHESU chairman said a medical doctor at Federal Medical Centre Owo collects N286,000 monthly as salary while his colleague in the pharmacy takes home N140,000. In addition, he said a director in the pharmaceutical or laboratory services earns below N500,000 while a doctor earns over N1.2 million. An entry point for a medical doctor is grade level 12 but for a pharmacist it is grade level 9.
The union suspended its last nationwide strike on Sept 30, last year, after signing a memorandum of Terms of Settlement (MOTS) with the federal government.
The MOTS was supposed to be implemented five weeksBut the workers said federal government has failed to act on it six months after.
They had no choice than to resume the strike action this year. Some of JOHESU’s demands are:
Upward adjustment of CONHESS
Settlement of arrears since the last agreement reached
Implementation of court judgements
Upward review of retirement age of health workers from 60 to 65

The role of medical doctors in the industrial strike.

JOHESU accused the medical doctors of always been a stumbling block in getting fair treatment from the federal government. Instead of NMA to be partner in progress, it went ahead to threaten the federal government with a strike action, if demands of JOHESU are met.
A cursory look at the supervisory ministry of health are currently dominated by medical doctors. The minister of health Professor Adewole, is a medical doctor, while another doctor Osagie Ehanire is the junior minister of state for health The minister of Labour that is mediating in the crisis is another medical doctor, Chris Ngige. The top echelon of the ministry are dominated by medical doctors They have so much institutionalized themselves in the ministries to protect their interests.
Successive past ministers of health have been medical doctors except Professor Eyitayo Lambo who left office in 2007. Lambo was a health economist.
The minister of health,Professor Adewole has not shown sincerity and capacity with recent public utterances
He was quoted there was no agreement in 2019, and went further to say the document JOHESU is brandishing as 2014 agreement were minutes of meetings they had with organs of federal government.. In another breadth, he said 14 out of the 15 point demand had been implemented, He also said the health workers are demanding equal pay with the doctors.

Implications of JOHESU strike action

States and local governments had decided to join the strike in solidarity with their colleagues. This is to mount maximum pressure on government to meet JOHESU’s demands.This will add to the pains of Nigerians that badly need healthcare.
It could lead to total collapse of the health sector if this strike action is allowed to drag on unnecessarily.Nigeria was ranked 179 out of 183 nations on mortality and morbidity rates, when it has full complement of all the staff in the health sector. Now that almost 95% of the workforce have withdrawn their services, one can imagine the debilitating and consequential effects.
As the strike continues, patients in critical conditions, pregnant women and nursing mothers and ordinary Nigerians in dire need of healthcare are being denied. Some of them might have been sent to their untimely deaths.
There will be upsurge patronage of private hospitals for those that can afford it. Unfortunately most of these private hospitals are owned by doctors in public service. Invariably ,medical doctors that are seen to be clogs in the settlement of this impasse, would continue to gain from this confusion
NAFDAC, agent of federal government responsible for regulating of foods and drugs have been hampered, simply because of the participation of its workers in the ongoing strike.

The way forward

The President who the buck stops at his table has to wade in to stop this backward trend in the health sector.
President Buhari must show political will to put an end to this strike. His appointees in the ministries are biased and handicapped
Unfortunately, most Nigerian political elites with their families go abroad for medical treatments, they cared less. President Buhari has traveled countless times to United Kingdom for medical treatments
At a time he spent more than 100 days in one of his numerous medical trips. While the strike lasted,, he jetted out of the country to keep an appointment with his doctors..
Well meaning Nigerians pressure and civil society groups in Nigeria have to rise and put pressure on federal government to stop paying lip service to healthcare in Nigeria. The social contract of providing healthcare to Nigerians is a task that must fulfilled by governments at all levels.

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