Stakeholders in the medical profession express concern over what would be the fate of patients following the decision of the Lagos State government to sack 788 doctors under its employ in the face of a national dearth of qualified doctors
It has been described in some quarters as ‘the nuclear option’. Last week’s decision of the Lagos State government to sack 788 doctors in its employ, replacing them with fresh 373, is one move that is viewed in some quarters as cutting the nose to spite the face. Saheed Babajide, president, Association of Resident Doctors, Lagos State University Teaching Hospital, LASUTH, Ikeja, did not mince words when he described the action as the height of tyranny of power by the government. He also used words such as “undemocratic” and “unfortunate” to describe it, adding that the government’s action amounted to chasing shadows.
Whereas those may be partisan views coming from one of the leaders of the striking doctors, Babajide, however, hit the bull’s-eye when he queried the government’s claim of employing 373 doctors, insisting that the sector lacked the luxury of having such spare personnel readily available. “It is not possible for government to recruit 373 doctors at a go. I am sure that the number is less than that. Besides, most of the recruits are largely from NYSC. These are just new graduates. In the practice of medicine, you have different categories such as the professors, consultants, medical officers, registrars and the house officers. How are they going to replace them?” he queried.
This point was equally not lost on David Oke, a professor and chief medical director, LASUTH, who complained in one of the dailies that following the state government’s action, the hospital had lost many of its best doctors. Should the situation persist, Oke is already envisaging some problems in the delivery of health services in the public hospitals. “This sack, at least in my hospital, means that I have lost a lot of my doctors. It means that we have lost many of our good hands. It is going to affect services and it means that to an extent, it is going to affect the teaching of residents and students in the medical school. But we are putting up contingency plans, such as making a list of consultants, lecturers who were affected by the strike,” he said.
And Oke sure has good reasons to be worried. It is indeed no secret that the public health care system in the country lacks adequate manpower. This fact is corroborated by recent statistics from the Medical and Dental Council of Nigeria, MDCN, the body that maintains the register of doctors in the country. According to the council, the total number of registered doctors in practice within Nigeria, a nation of over 160 million people, is currently 22,000. Out of this, 12,821 are in the private practice, while 9,179 are distributed between the federal government and the 36 states. Out of the 9,179 doctors, 6,138 are in the federal government employ while 3,041 doctors are shared by the 36 states of the federation.
When viewed from this perspective, it will be seen that the sack of 788 doctors under the Lagos State employ does not in any way help the poor manpower configuration in the health sector. The severity of the situation is better appreciated when one considers the fact that many of the sacked doctors had got many years of experience in the medical profession, which the newly employed ones obviously lack. There is the fear that the absence of these experienced hands could lead to tragedy in the hospitals. “There are so many medical cases that the younger ones would need the help of the older and more experienced doctors to handle. But since most of them have been sacked the few remaining ones would be stretched beyond the limit. This is a recipe for disaster,” says a consultant at LASUTH who pleaded anonymity.
Jide Idris, Lagos State commissioner for health, is equally not oblivious of the dangers ahead. Idris, while conceding that the mass sack was not an end to strike in the sector, says: “What we are addressing now is the emergency services. We have the responsibility of providing health care and that is our priority now. The hospitals are not totally paralysed as some doctors are still working. We still have over 1,000 doctors in service, including the new ones. As at yesterday (last week Tuesday), the new doctors had their orientation and are currently being deployed to the various hospitals. We have plans to recruit more as a good number of doctors from other states have signified interest to work with us.”
Explaining the rationale for the state government’s action, Idris said it was borne out of the need to bring sanity to the work ethics of the civil service. He also said that the state government had done everything to accede to the demands of the striking doctors. The doctors’ demands, which had been a cause of dispute for three years, included the reduction of the tax rate and the full implementation of the Consolidated Medical Salary Scale, CONMESS, which had been implemented by the federal government. CONMESS is the universal scale of remuneration for all doctors in Nigeria regardless of location or employer. It is a wage structure put in place to curb brain drain and correct wage disparity in the health sector.
Aderemi Ibirogba, commissioner for information, expectedly threw his weight behind his colleagues in the health ministry, arguing that the termination of the service of the striking doctor was borne out of public interest. He added that normalcy is gradually coming back to the state’s health sector since the decision was taken. “We had a situation in which people who needed treatment were not being given the treatment because some doctors had refused to work. So we had to get rid of them and employ new ones. Before the sack, we had 1,474 doctors. We sacked 788 and employed 373. And right now, we have 1,059 doctors working,” Ibirogba said.
Adesegun Ogunlewe, head of service, Lagos State government, explained that the doctors were axed for their refusal to answer the queries served on them for being absent from work without leave and for not adhering to the rules and regulations guiding strikes and industrial action. This was in reference to the three days’ warning strike the doctors had embarked on which had elicited a query from the government. Ogunlewe was categorical that the strike was illegal, noting that doctors gave the government 24 hours notice as against the normal 14 days’ notice “which is the time-tested and statute-bound processes and procedure for the declaration of industrial dispute.”
Understandably, the action of the Lagos State government did not go down well with the state doctors under the umbrella of the Medical Guild and the Nigerian Medical Association, NMA, which had all along thrown its support behind the Medical Guild. In fact, all through the crisis the NMA had threatened to instruct all medical practitioners within the state to shut down their services, a move that would have been disastrous for patients. Already there were reports of patients suffering greatly and, in some cases dying, due to the closure of the state hospitals since the onset of the strike.
But it was the sack of the doctors that however compelled Osahon Enabulele, national president, NMA, to leave Abuja for Lagos last week. All his spirited attempts to meet with Governor Babatunde Fashola to resolve the crisis however proved abortive as at press time. Temiye Edamisan, state president of NMA, described the government’s action as draconian and undemocratic. He also hinted that the NMA would likely join the dispute. “The government has indeed abused its power of hiring and firing. It shows that they view us as slaves,” he observed. This was also the submission of Olumuyiwa Odusote, chairman of the Medical Guild, who castigated the government’s action and described it as irresponsible. He also accused the government of a plot to privatise some specific health care services in state hospitals. “The government has already privatised the laboratory, diagnostic and pharmacy services within the hospital. Perhaps, they also want to privatise consultancy services. It shows that the government is not responsive to the plight of its workers. If the government was responsive, it would not have taken such approach,” he said.
The striking doctors had also taken their matter before the National Industrial Court, Ikoyi, Lagos. They rushed to the court after they were served a query and compelled to face a disciplinary panel for embarking on a three-day warning strike from April 11 to 13. The case, which was scheduled for last week Wednesday, had given the doctors some measure of hope after they were axed earlier on Monday. But their hope was dashed when the presiding judge, Justice Benedict Kanyip, did not show up due to illness. The case was rescheduled by the court registrars to May 16.
As the crisis continues to rage, some stakeholders have renewed calls for the government and the doctors to reach a middle ground. The Association of General and Private Medical Practitioners of Nigeria, AGPMPN, has been at the vanguard of this call. Anthony Omolala, national president, AGPMPN, last week, reiterated his call for a truce between both sides, noting that such an outcome would save lives. “I am disturbed by the happening in the health sector in Lagos State. The employer/employee relationship is now sour. Both sides must at this junction find a palpable solution. Lives are involved and no one has the ability to give one,” he said.
AGPMPN’s call is similar to that of the Pharmaceutical Society of Nigeria, PSN, which enjoined both sides to sheathe their swords. “As a body we are compelled to call on the Lagos State government and the leadership of the striking doctors to give constructive dialogue a chance in the reality of the recent face-off between the contending parties in the last few days,” said Azubuike Okwor, national president, PSN.
The face-off between the Lagos State government and its doctors over the implementation of CONMESS has over the years led to a number of strikes in the health sector, which have had devastating consequences for many patients. Between August and November 2010, as well as between February and April 2011, Lagos State doctors embarked on strike actions to protest the failure of the government to implement the salary structure. Following the three-month strike in 2011, the state government partially consented to the doctors’ demand by implementing CONMESS but it however allegedly dropped the doctors from their steps in each grade, a move doctors in Lagos found unpalatable.