Wanted in Nigeria: Better Health Sector Management

By Tonnie Iredia

Several years back, many Nigerians would readily berate any citizen planning to migrate from our shores in search of greener pastures. The proverbial Andrew who in a television jingle, was seen happily checking out of Nigeria was greatly deprecated.

There is doubt if such spirit of patriotism will find same rhythm this time around, when migrating is in vogue. Indeed, in the last 6 years, there have been reports of numerous Nigerian professionals who have migrated or are still migrating to other parts of the world with no one feeling awful about it as before. In the medical profession, no less than 4500 doctors have reportedly left Nigeria to practice in the UK alone.

This figure was recently confirmed by Miranda Newey, Senior Medical Officer of the British General Medical Council. The spike which shows over 400 percent increase when compared with past figures has according to Newey, led to the opening of a bigger clinical assessment centre to test more Nigerian doctors who are anxious to work in the UK.

At home, medical doctors dissatisfied with remuneration and working conditions have gone on strike thrice in the last one year which appears to suggest that many more would be out of the country soon. But Chris Ngige, Nigeria’s Minister of Labour, is not convinced that the problem at hand can be anchored on poor working conditions. Instead, he thinks our doctors are playing God. The Minister, spoke last Thursday at the 2nd Summit of Medical Elders Forum (MEF).

Ngige, himself a medical doctor posited that Nigerian doctors have a propensity to embark on avoidable strikes when their colleagues are in political positions. Whereas Minister Ngige is better placed than an average analyst to have facts to validate his conclusion, it is disturbing that at each strike, there are issues from the last strike which are yet to be settled. Considering that a minister who ordinarily has ample perquisites of office cannot feel what young resident doctors go through in today’s Nigeria, we appeal to him to take a broader view of the problem and be more patient with our doctors.

It is wise to ask certain basic questions before making conclusive statements about workers’ strikes in Nigeria. In the case of doctors, it is necessary to find out why the strikes by the group have risen so sharply in the last couple of years. Is it a case of the medical profession losing its old privileged position in the country?

Why is the trend of strikes by doctors as well as their migration to other parts of the world occurring at a time when two Ministers in charge of Health and that of Labour are all medical doctors? Is it a case of prophets not accorded value at home or have doctors been expecting too much from their colleagues in government who should have come into office as ambassadors of the profession? If strikes are happening when the health sector is manned by doctors, what other options are available to the country? Answers to these questions will help find appropriate solutions for handling the recurring problem? Rather than do that, the nation is continuously fed with a rehash of same problem and same ineffective prescription now and again as if the sector can afford the continuing recycling of health challenges

What has been transparently perceptible by those who have followed the drama in our health sector has been a cat and rat game. Doctors threaten to go on strike on a fixed date which passes without adequate steps taken to abort it. Thereafter, negotiations begin only after the strike had taken a toll on the people. The public is later told that the strike had been suspended on account of a Memorandum of Understanding (MOU) between government and the doctors.

Months after, the doctors resume their strike as the MOU is not proactively implemented to their satisfaction. The next stage sees another set of negotiations between the parties which ends up this time as Memorandum of Action (MOA). What went wrong? Could it be that there was no understanding in the Memorandum of Understanding? Otherwise, why was the understanding breached? Who breached it and what are the consequences for the failure of the agreement? In honest one can only conclude that the agreement was perhaps not intended to be kept in view of the number of times it recurs in our clime, irrespective of which workers are involved, be it ASUU or doctors etc.

A curious segment of the strike story, is the ineffectual verse which blames doctors for the failure of government to meet her own side of the bargain. The story is usually that the doctors provided inaccurate figures which misled government into paying less or more or in fact paying wrong claimants.

Why does the government which recruited doctors rely on figures presented by the doctors for remuneration? Was there no official enlistment figure at the point of engagement? If there was one, could it be that it was not properly documented and kept in the custody of the relevant Human Resources Department? Are submissions made by doctors not expected to be verified before payments are made? Put differently, are doctors in charge of Finance and Administration Departments in government hospitals? If not, why do we need the offices of Chief Medical Director CMD and Directors of Administration in each hospital? It is issues such as this that tend to make the ordinary citizen who is at the receiving end of the adverse effects of strikes blame government for lapses which accentuate unending strikes by doctors in Nigeria.

At other times, the problem is attributed to malfunctioning digital platforms such as GIFMIS or IPPIS procured supposedly to improve the financial payment system. But whereas such platforms perform well with other categories of workers, doctors are usually not that lucky. It is strange that the same technologies which have been resolving public sector financial management problems in parts of the world including African countries often perform worse than analogue platforms in Nigeria.

We urgently need to critically study the reason such digital platforms create omissions in our country’s records. While, all well-meaning Nigerians would wish that neither doctors nor any other professional group finds cause to go on strike in our fragile nation, a strike is better managed than argued. Those who frequently remind doctors of the tenets of the International Labour Organization ILO and provisions of Labour laws on the popular “no work no pay” seem to forget that definition often calls for counter definition. If the consequence of no work is no pay, what is the consequence of no pay – can it be “no pay more work?” Is it not bizarre that an employer who failed to pay workers their salaries and allowances can be the one to publicise the popular no work no pay rule?

These are hard times for the nation and a large chunk of her citizens. It is a time which challenges managerial skills and which reminds us that organizations such as hospitals are not mechanical contraptions but human cooperatives where management must have a human face.

Those who manage resident doctors are telling them to appreciate the nation’s poor economy which accounts for shortfalls in their entitlements; but no one is talking to citizens whose newspaper allowances surpass the full salaries of doctors. Under the circumstance, it is difficult for doctors to comprehend the message that this is not the best time to go on strike. If the template designed by Rivers state where there is no strike, is followed, we will condemn doctors’ strike. For now, we think it should be better managed.

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