Beyond NMA Strike …Brewing Discontent In Healthcare Sector

Once again, medical practitioners under the aegis of the Nigeria Medical Association, NMA, have withdrawn their services to public health institutions, over favours done to support unions and alleged non-implementation of agreements reached with the Federal Government. And since July 1, this year, patients in hospitals across the nation have their lives hung on a cliff. And many dead.
Among the doctors’ demands are increase in their hazard allowance from N50,000 to N100,000 and restoration of the post of Deputy Chairman, Medical Advisory Committee in Teaching Hospitals. They also faulted the appointment of directors other than doctors, in hospitals, saying such appointments could distort the chain of command in health institutions and also lead to management of patients.
Other demands include skipping of grade level 12 (COMMESS 2) for medical and dental practitioners and the reversal of the title of Consultants for other professionals in the health care system apart from doctors. The NMA also urged the Federal Government to resolve issues related to appointment of Chief Medical Directors and other federal appointments in the health sector.
Addressing Journalists June 15, this year Chairman of the Lagos NMA, Dr. Francis Faduyile had argued: “The position of the Chief Medical Director or Medical Director must continue to be occupied by a medical doctor as contained in the Act establishing tertiary hospitals. This position remains sacrosanct and untouchable.
“Why did they not ask that the post of Vice Chancellor be open to everyone in the University since members of the Academic Senior Staff Union of Universities and the Senior Staff Association of Nigerian Universities are graduates.
“Can you be a Judge of the High Court or Court of Appeal if you are not a lawyer?  Why do they think the hospitals where, lives are saved everyday should sacrifice the established leadership, the position of a chief medical director?
Curiously, most of these issues form part of suit number: NICN/ABJ/177/2014 before the National Industrial Court (NIC) which stopped the Federal Government from implementing the agreement it reached with the Joint Health Sector Union (JOHESU). The Medical and Dental Consultants’ Association of Nieria secured an interim injunction in the suit which joined the Federal Ministry of Health, Federal Ministry of Labour and Attorney General of the federation as defendants.
In granting the interim injunction on June 27, 2014, the presiding Judge, Justice M.M. Esowe restrained the defendants, ‘from implementing, executing, carrying out or giving effect to the decisions, resolutions and agreements that were reached at a meeting, which was held in the Federal Capital Territory (FCT) Abuja between the Joint Health Sector Unions (JOHESU) and Healthcare Professionals Associations (AHPA) on the one part and Secretary to the Government of the Federation (SGF); Minister of Health, Chairman, Salaries, Income and Wages Commission, Head of Service of the Federation, and other top government functionaries of the other part, on June 5, 2014.
The injunction further ordered that “no party shall proceed to do any act in furtherance of any agreement  reached by the parties, which arguments form the kernel or subject matter of this motion before the court.
The same court also barred the Medical Doctors’ Consultant  Association of Nigeria (MDCAN) from embarking on any strike in protest against the said agreement, stating that ‘nobody or party in the case shall embark on any strike until the motion on notice, which is already filed in the court, is heard and determined. The Judge then ruled that the matter be adjourned to July 10, 2014 for hearing and determination of the motion on notice.
President of MDCAN, Dr. Steven Oluwole had deposed to an affidavit challenging the agreement reached between JOHESU and the Federal Government.
MDCAN went to court to challenge the implementation of a circular recently released by government following the agitation of JOHESU, which among others, provides for the approval of consultancy positions for support staff, abolition of Deputy Chairman, Medical Advisory Committee position and appointment of support staff as directors.
Other aspects of the agreement include referral following the Yayale Ahmed Committee; elimination of medical teachers from eligibility for headship of teaching hospitals, and re-interpretation of “medically qualified”, which is a key phrase in the university teaching Hospital Act.
From the fore-going, it is clear that what the medical doctors are striking for is already before a court of competent jurisdiction. Secondly, most of what NMA is asking for have to do with checking privileges of other professionals in the practice and few additions to theirs.
Infact, there is a growing bad blood between medical doctors and other healthcare practitioners, which if not checked would cause an even greater danger to the sector. This is because each of the unions has employed the same weapon-industrial action. If demands of JOHESU are met by government, NMA would go on strike, as it has. And if NMA’s demand for increase in hazard allowance is met, JOHESU would demand same and go on strike.
The irony is that both groups need each other to function properly. Infact, the days are far gone when the patient was the doctor’s sole responsibility. The Pharmacists, Laboratory  Scientists, Nurses, Midwives among others complement the doctor’s practice.
So while the medical doctor continues to insist on total control and supremacy of the hospital environment the support staff have grown both professionally and in practice and are now asking for their due. It was in acceptance of some of such demands that government issued the recent circular, the subject of the litigation before the National Industrial Court. So why the NMA strike?
This will indeed not be the last strike even if NMA succeeds in arm-twisting government to do its bidding. Already, another dispute is brewing between the NMA and the Association of Medical Laboratory Scientists of Nigeria (AMLSN) over the Central Bank of Nigeria’s (CBN) circular authorising the Medical Laboratory Science Council of Nigeria (MLSCN) to approve licences for importation of In-Vitro Diagnostics (IVDs).
The new NMA President, Dr. Kayode Obembe, had in an open letter to President Goodluck Jonathan warned that the circular would set a “dangerous trend in the nation’s health sector”.
Describing the CBN circular as dangerous, the NMA said it is completely wrong that one would have to go to the MLSCN to get approval in order to import medical laboratory equipment, arguing, “already, importation of medical products is being regulated by the National Agency for Food, Drug Administration and Control (NAFDAC) and the Standards Organisation of Nigeria (SON).
In a swift reaction to the NMA position, the AMSLN also challenged the doctors’ body to go to court rather than threaten the apex bank to withdraw the circular. President of AMSLN, Godswill Okara told newsmen in Abuja, June 29, 2014, “If NMA feels very strongly about the circular, it should go to court, contest it and see the way it will be floored.”
He too warned that if the CBN should succumb to the NMA pressure and withdraw the circular, his association would challenge the withdrawal in court.
Okara urged the NMA to respect the rule of law, jettison ego-tripping and embrace laudable objectives that would improve the health sector.
“The dog-in-the manager attitude would not help the health sector, neither will the first-born mentality often displayed by the NMA and its members.
Modern healthcare practice is multi-disciplinary and multi-professional in dimension and scope” Okara stated.
“The quest to demand for what it wants and also turn around to dictate what others should be given is to say the least reprehensible and nihilistic” and then said “NMA does not have the exclusive preserve to strike action”.
“The CBN circular, unlike the chauvinistic undertone of everything done by the NMA, is not about the MLSCN or any other professional group, but about the citizens of this country, who spend whopping $1.7 billion annually seeking quality diagnosis and treatment abroad, and who have continued to clamour for reliable medical diagnosis”, Okara explained.
Ordinarily, this issue should not generate any controversy, if not for the bad blood that flows in the veins of the NMA and other support bodies and for which the general society remains victims. In fact, what the CBN did is based on law.
Sections 4e and 19d of the Medical Laboratory Science Council Law Act II, 2003 (Cap M25, LFN 2014) specifically mandates the MLSCN to regulate the production, importation, sales and stocking of diagnostic reagents and chemicals and make rules for the maintenance of good standard of medical laboratory practice and services. This is “with respect to regulation and control of private, including statutory inspection, approval and monitoring of all medical laboratories, including those adjoined to clinics, private and public health institutions”.
This means importation of clinical needs by medical doctors would be subject to approval by the AMLSN and with the existing ‘warfare’ that would not be healthy. That is the crux of the matter.
Doctors must realise that the frequent recourse to strikes negates the wording of the Hippocratic oath they took, just as their constant disruption of services in public health institutions in preference for their private clinics, a disservice to the nation.
My agony is that each time doctors go on strike over issues with rival unions in the health sector; it is not the warring factions that feel the pinch. It is the ordinary patient and indeed society, while they feed fat on the desperation of the helpless with outrageous medical bills for services, sometimes not properly rendered.

Soye Wilson

Pius Anyim Pius, SSF and Prof. Chukwu, Minister of Health

Jamabo