Unending industrial actions in the health sector occasioned by poor staff welfare, salary, and the government’s inability to faithfully implement agreements among others, have done more harm to the health of Nigerians than any epidemic. Stakeholders maintain that these incessant actions may worsen the parlous condition of the sector if not curbed. CHUKWUMA MUANYA writes.

Several studies have shown that frequent healthcare workers’ strikes result in the closure of public health institutions, which in turn deprives Nigerians of access to quality healthcare services.

Public health institutions in the country are afflicted with numerous challenges, such as inadequate manpower, underfunding, poor management, poor infrastructures, poorly remunerated and motivated workforce, the misconception of what the healthcare job entails, brain drain, unfavourable working conditions and inter-professional rivalry.

Others include disparity in salaries, allowances and promotion of workers in the health sector and failure of the government to honour agreements earlier reached with health workers, among others.

Successive governments’ failure to effectively resolve these issues has contributed immensely to the continuing industrial unrest in the sector. For the duration of the strike actions in public hospitals, Nigerians are at the receiving end and those who cannot afford treatment abroad or in private hospitals within the country either endure their ailments or resort to traditional or herbal medicines, while some invariably lose their lives. The most vulnerable people in this situation are pregnant women, people with chronic ailments, and parents of under-five children.

In recent times, strikes in the health sector have become like a marathon between doctors under the aegis of the Nigerian Association of Resident Doctors (NARD), and the Joint Health Sector Unions (JOHESU), comprising all other health workers other than medical doctors.

The Guardian investigation revealed that poor staff welfare, salary and management and government’s inability to implement agreements are the common causes of healthcare worker strikes. These strikes resulted in the disruption to service delivery and training programmes, increased morbidity and mortality of patients and loss of confidence in the hospitals and the healthcare professions.

Stakeholders recommend that the Federal Government respects agreements made with associations and the management of healthcare institutions, implement the National Health Act, and ensure that only leaders and managers who are formally trained are appointed to healthcare management positions.

Unfortunately, even with the ugly scenario, series of strikes are brewing in the health sector. NARD had on November 29, 2023 threatened a nationwide strike to commence this month if the ‘one-for-one replacement policy’ was not enforced, as the Enugu State University Teaching Hospital (ESUTH) chapter downed tools on December 1, 2023.

President, of NARD, Dr. Dele Abdullahi, said if the Federal Government fails not meet their demands by January 2024, the union could not guarantee industrial harmony in the sector any longer.

On how Nigeria curb frequent strike actions in the health sector, Abdullahi said: “First I wish to reiterate that strikes by unions are never to punish the government but a last-gasp attempt to attract the attention of government and get the government to fulfill most times what they promised. We hate to go on strike, but most times government leaves us no other choice.”

Abdulllahi said that strikes are mostly due to the negligence of the government to ensure that crucial things are done in the healthcare sector, the pervasive attitude of the government to the welfare of healthcare workers, the insensitivity of the government to the trials and problems of health workers, and its insincerity in carrying out documented agreements.

He further explained: “To make a clear example, the story that our hospitals are short-staffed is known to all, the last executive year paid lip service over and over to it, set up a committee on brain drain only to ignore all the recommendations of the committee, dwelled mostly on blame games to no practical solution.”

The physician said this current government is eight months old and NARD is yet to see a practical approach to solving the issue, a Memorandum of Understanding (MoU) stating that a circular to ease manpower shortage brought out on June 5, 2023, and signed, but the government has reneged on the agreement.

“When government officials have a mindset that seems to say ‘regardless of whatever paperwork is signed, we can always decide not to adhere to it,’ then negotiation becomes difficult and there is a lack of trust between the union and government. Hence, the need to down the tools, however, how painfully, to get the government to do what they promised and to see the problems affecting their own agencies,” he said.

On the major demands of doctors that if they get, there will be assurances of industrial harmony and higher chances of not running off to UK and other developed nations for greener pastures, Abdullahi said: “This is a little bit tricky as I can’t say categorically that if these measures are put in place no doctor will leave our shores again. Doctors leave for different reasons but if we are talking about the identified push factors for the mass exodus then I can tell you.”

The NARD president stated that the government needs to improve the working conditions and increase massively, the staffing of all health institutions to make service delivery more efficient and conducive for the members of staff.

Abdullahi said the remuneration of healthcare workers should be made commensurate to the economic reality, increment should not just be arbitrary like you are giving a child candy to stop crying, the remuneration should be seen to ensure the basic amenities for the livelihood of the healthcare worker is ensured.

Abdullahi said facilities require massive upgrades for more efficient working and better job satisfaction, stressing that “you can’t train healthcare workers in a field, and we don’t even have the basic structure for them to work and compete with their colleagues from other spheres. The list is endless as it includes security in our communities and all but the above should encompass what my union stands for,” he said.

On how to address the frequent strike actions, an obstetrician and gynaecologist and medical director, at Optimal Specialist Hospital, Gbaja Street, Surulere, Lagos, said: “Strike actions are the last resort when the government fails to honour agreements after repeated negotiations. At our end, this leadership, through robust collaboration will work to envisage, present and solve challenges well ahead of time. However, if antecedents are anything to go by, the most important solution to incessant strike actions in the health sector will be a show of commitment from the government, especially by increasing funding to the sector and also honouring their promises and agreements with health workers.”

A specialist in Internal Medicine at Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH), Bauchi, Bauchi State, Dr Dare Godiya Ishaya, said: “The issue of medical tourism outside the shores of this country is very unfortunate. The latest World Health Organisation survey ranks Nigeria’s healthcare system as the fourth-worst in the world, and this can be attributed to poor funding. Our annual budgetary allocation to health has consistently fallen short of the 15 per cent agreed by African countries at the Abuja Declaration in April 2001 (20 years ago). This continual lack of investment in the sector has resulted in a deplorable state of the healthcare system in terms of health infrastructure such as medical equipment and reusable materials, and remuneration to health workers in terms of salaries, wages and allowances.

“Poor health infrastructure has made it impossible for the sector to grow and compete with the standard of healthcare available in other countries. Paltry remuneration to healthcare workers who on the other hand led to the massive efflux of our best brains (brain drain) to other countries in search of greener pastures.”

A public health specialist/health educator and former National Chairman of Association of Hospital and Administrative Pharmacists of Nigeria (AHAPN), Dr. Kingsley Chiedu Amibor, said in nearly all countries of the world, medical doctors are the highest paid in the healthcare sector. “Again, I do not have anything against that, when you consider the length and duration of their training. Pharmacists are supposed to be next to the medical doctors, again when you consider the length and duration of the pharmacist’s training programme, which has since seen the Doctor of Pharmacy Degree (PharmD) becoming the benchmark for Pharmacy practice in Nigeria and elsewhere in the world. Other professionals can now fit into the single spine salary structure, based on agreed or set parameters.

“When this is done, you will find that it will drastically eliminate agitations for salary increase by any group in the sector because once the arrangement comes into play, any future salary increase will cut across the various professional groups, so the question of you increased for Mr. A, come and increase for me would no longer arise.

“As a matter of fact, this was the prevailing situation in the healthcare sector in Nigeria until the military government in 1985 or thereabout felt otherwise and introduced different salary structures in the once-peaceful sector. Since then, peace has eluded the sector, and I am advocating for a return to the status quo as lasting peace in the sector,” Amibor said.

He said there is a need for health authorities to tackle the identified causes of strikes in the sector. Amibor said training of personnel in health management, interpersonal and leadership skills would help to build capacity and position them to offer inter-professional leadership, which is missing in most health institutions.

“There is a need to upgrade and modernise our hospitals, in line with international best practices. State-of-the-art equipment that can aid in rapid diagnosis should be made available. Hospital management should provide the enabling environment for pharmacists to engage in compounding or outright production of medicines right inside the hospitals, as is the case elsewhere, as this has the potential to reduce dependence on foreign-made drugs and conserve scarce foreign exchange for the country. Working conditions should be improved upon and infrastructural provisions to enhance service delivery. When these interventions are put in place, I strongly believe strike actions in Nigeria’s healthcare sector will be reduced to the barest minimum,” Amibor said.

The Guardian investigation was corroborated by a study published in Human Resources for Health titled, “Healthcare workers’ industrial action in Nigeria: a cross-sectional survey of Nigerian physicians.”

The study shows that healthcare workers’ strikes were common across the nation—but the majority occurred in the southern regions. There were no public healthcare workers in the country who had not embarked on one or more episodes of industrial action during the period under review with its attendant consequences. This, the researchers believe, is both disruptive and detrimental to the healthcare system in Nigeria. Furthermore, the majority of the strike actions were initiated by physicians, who also lead the healthcare facilities, thus, undermining indirectly, what they are mandated to lead and maintain.