Nigerian physicians, under the umbrella of the National Association of Resident Doctors, NARD, have been on strike due to the failure of the Federal Government to meet their demands. Resident doctors constitute the majority of doctors in Nigeria’s tertiary hospitals, and when the NARD goes on strike, operations are paralyzed in these hospitals.
The doctors, among other issues, are demanding the immediate disbursement of the 2023 Medical Residency Training Fund, MRTF, concrete measures on the “upward review” of the Consolidated Medical Salary Structure (CONMESS), and payment of all salary arrears owed to its members from 2015. In an interview with 9JA NEWS, the National President of the association, Dr. Emeka Orji, discussed several issues pertaining to NARD’s negotiations with the government. Excerpts!
The Federal Ministry of Health claims it has initiated the implementation of the ‘no work no pay’ policy. How did your Association respond to this?
The truth is that our members reacted negatively to it, and I am not certain why a government ministry responsible for resolving health sector issues would reach an agreement with an association like NARD, only to renege on that agreement. And when the association reacts by going on strike, the same ministry that breached the agreement punishes us for our reaction. I don’t believe this aligns with the Trade Dispute Act, which does not envision a scenario where the government enters into an agreement with an association, reneges on it, and then punishes the association for reacting. This goes against the principles of natural justice. We hope they reconsider and do what is necessary because this approach will not benefit anyone. In fact, it will further exacerbate the current situation because they are not willing to resolve the issues.
If you carefully examine the memorandum, you will notice that they enumerated the issues without indicating which ones they have resolved and how they have resolved them, indicating that they are aware of the issues but have not yet addressed them.
The implementation of the ‘no work no pay’ policy implies that striking doctors may face financial consequences. What is the way forward?
Our members have already foreseen this, and it is important to realize that we are professionals. The government should address the issues at hand; that is our main focus. Our focus is on the demands we are making: the medical residency training fund 2023, the outstanding arrears, and various other matters that we believe the government can promptly address. If they address these concerns, then we can discuss the possibility of returning to work. However, if they refuse to address these issues and insist on ‘no work, no pay,’ it will not help anyone.
The circular suggests that the government holds striking doctors responsible for any possible escalation of the situation. How do you respond to this accusation, and what message do you want to convey to the government regarding the doctors’ grievances?
I am not aware of the circular you are referring to where the government holds us accountable for the escalation of the crisis. In reality, we are the ones holding them responsible. In some of our previous statements after the issuance of that memo, we felt it would only anger our members further, and that is exactly what happened. As you can see, on Saturday, we had a National Executive Council (NEC) meeting, during which our members directed us to commence a nationwide protest from Wednesday onwards.
However, since that notice was issued, we are aware that the government has been reaching out to resolve the issues. We hope this happens before Wednesday. The government has invited us to another meeting tomorrow. We hope this meeting will be productive because ultimately, everyone wants a solution. The association raising the alarm or going on strike aims to address the issues. In this case, many of the issues do not only concern us. They are systemic issues. We want the system to function. That is why we are calling for any means through which the government can employ and replace doctors and nurses who have left the system. We believe that only when this happens can the system operate effectively. This is what we are advocating for, along with other important matters.
If the government addresses these concerns, particularly the urgent ones, and provides us with a timeline for resolving the other ones, we will return. Our members simply do not want to continue working under circumstances where a single doctor does the work of 30 people; it is impossible for the person to cope.
The ongoing strike has raised concerns about the impact on patient care and public health. How is NARD addressing these concerns?
Even while we were working, patient care suffered due to the lack of adequate numbers; we are referring to the insufficient number of doctors and nurses in hospitals. Patients come to hospitals, spend the entire day, and don’t get to see their doctors. They arrive at the emergency department with urgent cases, and we do not have enough doctors to treat them, leading to many deaths. This has been the case for some time now.
Already, patients are bearing the brunt of the unresolved issues we are demanding the government to address. Furthermore, doctors are human beings; we are Nigerians. We have needs too. We have families to take care of. If the government does not give us what we consider our entitlement in terms of remuneration and training funds, we are obliged to demand these things from the government. Journalists often refer to our Hippocratic Oath. If you critically read that oath, you will realize that it emphasizes the need for doctors to take care of their own health and needs in order to provide the highest standard of healthcare to patients. If doctors are not well taken care of, how can they be in the right frame of mind to treat their patients? A hungry doctor is a dangerous doctor. We do not want a situation where hungry doctors in Nigeria treat patients because that will inevitably lead to disastrous outcomes. This is why we are advocating for these changes to be made.
Some people argue that strikes by medical professionals could harm the doctor-patient relationship and erode public trust in the healthcare system. How does NARD plan to maintain a positive doctor-patient relationship while advocating for its members’ rights?
We actually make efforts towards that, but it seems as if nobody cares. The problem is that Nigerians only become aware when we go on strike. If they knew the events leading up to the strike, they would sympathize with us; it is not an easy situation. We move from one ministry to another, trying to resolve issues, and some government officials intentionally sabotage our efforts. We only resort to agitation when it becomes apparent that we are not making any progress. Unfortunately, that is when we issue ultimatums. And when we issue these ultimatums, we are ignored. Consequently, we have no option but to escalate the situation. It is regrettable.
Looking ahead, we hope the government will be open to listening. Many of these issues can be resolved through negotiations if all parties come to the table in good faith, with the commitment to resolving issues instead of allocating blame or engaging in tantrums during meetings. When individuals carefully analyze our demands, they will see the reason behind our requests. Therefore, there is no reason these concerns cannot be addressed.
What can you say about the death of Lagos doctor, Diaso Vwaere, due to a faulty elevator?
It is unfortunate. It underscores what we have been consistently discussing. If you examine the situation, it is astonishing why young doctors would be accommodated in a 10-story building with a faulty elevator. When you contemplate these issues, you wonder what is happening in our country. Firstly, why would there be only one working elevator in that facility? Why was it allowed to become faulty when it is a 10-story building? Did anyone anticipate that people would traverse from the top floor to the ground without using the elevator? Furthermore, the fact that this complaint was made a long time ago and not adequately addressed demonstrates the decay in the system we are all lamenting. It is not only the federal government; many state governments have completely neglected healthcare systems in their states.
Regrettably, Lagos State used to be one of those states expected to have a higher level of excellence in healthcare delivery due to its available resources. We are ashamed, appalled, and irritated that this doctor needlessly lost her life due to something that could have been avoided. We stand with the zonal Nigeria Medical Association of Lagos State and their medical guild in demanding the prosecution of all those who exhibited incompetence and negligence, resulting in the death of this doctor. This must serve as a deterrent to others.
