The recent demand by resident doctors for a 200 per cent increase in their gross salary has, once again, brought the issue of the working condition of medical doctors in Nigeria to the front burner. The resident doctors hinged their demand on the dwindling economic situation in the country. This includes the low value of the naira and its damaging effects on the cost of living in the country.
They lamented that despite several engagements with the government to upwardly review their Consolidated Medical Salary Structure (CONMESS), last reviewed over 10 years ago, government has failed to address the issue. They have therefore given government two-week ultimatum to address their demands or they might not guarantee industrial harmony in the sector nationwide.
Apart from the demand for salary increase, the doctors also demanded immediate payment of the 2023 Medical Residency Training Fund (MRTF); commencement of payment of all salary arrears owed to doctors in 2014, 2015 and 2016; immediate massive recruitment of clinical staff in the hospitals and complete abolishment of bureaucratic limitations to the immediate replacement of doctors who left the system. Others are immediate infrastructural development in our various hospitals without further delay; 15 per cent budgetary allocation to health; and a review of hazard allowance by all the state governments and private tertiary health institutions where residency training is done.
Government feels the 200 per cent demand by the doctors is on the high side. It has reportedly offered 25 per cent increment. The doctors disagreed, saying the Federal Government could afford their demand. The National Association of Resident Doctors (NARD) National President, Emeka Orji, told a national television recently that things were getting worse and there was no increment in their take-home pay.
We think the 200 per cent demand by the doctors could be negotiated. Both the government and the doctors should come to the negotiating table in good faith and arrive at an amicable solution. Constant resort to strikes is never a solution to any problem.
The problem is that the Federal Government has not been showing good faith in its agreement with many unions. It reneged, for instance, on many of its agreements with the Academic Staff Union of Universities (ASUU), prompting the union to embark on long strikes that crippled activities in the universities. Resident doctors have had cause to also embark on strikes because of the failure of the government to keep to its agreement with the union. In June 2020, when COVID-19 was ravaging the whole world, the NARD embarked on a nationwide strike after the expiration of their 14-day ultimatum to the Federal Government. The strike affected all the federal and state hospitals. Part of the grievances of the doctors was that there was no life insurance or death-in-service benefit for their families. They also complained about ridiculous hazard allowances, non-payment of arrears of salaries owed them in federal and state tertiary health institutions and the non-implementation of the Medical Residency Training Act in federal and state hospitals. Since then, the doctors have had cause to embark on strikes for one reason or the other. In April 2021, the government and the striking doctors endorsed a Memorandum of Action (MOA). The doctors suspended their week-long strike then. But government reneged on its agreement with the doctors.
Today, these same issues have not been fully resolved. It is obvious that the government has neglected the health sector over the years. Budget allocation to the sector has hovered around an average of five per cent despite the 2001 agreement by African countries in Abuja that 15 per cent of each country’s annual budget be allocated to health. This year, the budgetary allocation to health is 5.7 per cent.
Besides, doctors’ take-home pay hardly takes them home. This has resulted in exodus of medical personnel to different parts of the world. Thousands of Nigerian doctors make waves in the United States, United Kingdom, Australia, Canada, United Arab Emirates, Kuwait, Saudi Arabia and many other countries. Experts estimate that nine in 10 doctors consider work opportunities abroad. This is despite billions of dollars spent to train these doctors. The result is that doctor-patient ratio stands at about 1:5,000 in Nigeria as against 1:600 recommended by the World Health Organisation (WHO).
What is required now is the spirit of give and take. There is need for dialogue between the doctors and the government. The government should keep faith with the existing agreement with the doctors. People should be able to trust the government whenever it makes promises.
The strike ultimatum, which expires on May 13, should be addressed. This is because any strike now will tell on the poor masses who cannot afford the cost of private hospitals. Those already on admission in public hospitals may be discharged if there is strike. We cannot continue to toy with our health system. This is the time to chart a new course.