In this interview with LARA ADEJORO, the President of the Nigerian Association of Resident Doctors, Dr Emeka Orji, speaks about the strike embarked on by members of the association and other related issues
Many thought you would shelve your strike as you have been doing since your association started issuing threats for industrial action, why did you proceed on the strike?
We have been shelving the strike for three years now. The last strike we had was around August and September, 2021 and many of the issues we are talking about now were also raised then. When we notify the government that we are going on strike, they will make promises and after some time, they will not fulfil those promises. That was why our members were no longer happy that even with all the multiple threats and engagements, we have yet to resolve these challenges that affect the health sector, our members and Nigerians, leading to massive brain drain in the health sector.
Before this warning strike action, did you have engagements with the government so that things didn’t have to get to this?
We issued ultimatums two times last year because of these issues and nothing was done apart from the fact that, for the Consolidated Medical Salary Structure, they set up a committee at the Federal Ministry of Health last year. The committee met twice and of course, we were not there and we requested that whenever the committee was meeting with our parent body – Nigerian Medical Association, we should also be invited to take part in the discussion so that we will observe what they are doing and we will be opportune to make input before the collective bargaining agreement is arrived at. But since then, that committee has not met. Our members feel this is how the current government will hand over to the incoming government without addressing these germane issues. We are the largest medical workforce in the country, and we have been trying to resolve the issues amicably but unfortunately, the government has not addressed them and that made us give the two weeks ultimatum on April 29. It will interest you to know that there was total silence, no engagements, no discussion, not even a call (from the government) and I was wondering what they were expecting. The essence of an ultimatum is to alert the government and Nigerians that there are challenges. What is supposed to happen is that you wade in as a government, try to initiate discussions, solve the ones you can, give timelines for the other ones you cannot solve immediately before the end of the ultimatum so that by the time the association is having its reviews, we will have something to report to our members. But in this case, there was nothing.
Apart from the increase in CONMESS, what are your other demands?
The very important one is the inadequate manpower, because our members are overstretched. You have one doctor doing the work of so many doctors because the personnel are no longer there, and the hospitals are completely depleted, both in the emergency departments and the clinics and it is affecting the management of patients. That is why we keep saying that we are doing this for Nigerians because they are seeing what we are saying, except you don’t go to hospitals. If you do, you would have noticed what we are talking about. People spend hours in the hospital. So, inadequate manpower should be addressed, and there is already a guideline agreed upon by a committee set up by the Federal Ministry of Health three months ago. Why has the circular not come out? At least, the Chief Medical Directors will begin to replace doctors and nurses that have left. We also have the issue of inadequate infrastructure and we have always said that you cannot address the infrastructure, personnel, welfare and manpower needs in the health sector without improving the budgetary allocation. There is no shortcut. As long as you do not do it, you are not going to have the needed workforce, and the issues will remain.
What are the other demands?
We also talk about the obnoxious bill by Honourable Ganiyu Johnson (a member of the House of Representatives) and we want the bill to be withdrawn. There is no point remaining silent on it. We do not want to be taken by surprise, we will just wake up one day and see that the bill has been passed. We want them to withdraw the bill. They have seen the outcry, not just from doctors but from everybody. Right now, the government is condemning the bill, but the parliament should take a step further by totally withdrawing the bill and addressing the root cause of brain drain which is inadequate remuneration and deplorable welfare packages. Once this is done, people will stay and it will reverse the brain drain trend because many people who have gone out, we are in talks with them and it is not as if they are enjoying themselves. The thing is that the working conditions are good, the facilities are there and the pay is far better, but they are still second-class citizens there. They want to come back home, but when they compare what they are being paid there and what is paid here, they will cope with the stress and remain there. So, if you improve the remuneration; you do not necessarily need to pay what is paid there because we know that the economic conditions are not the same, the revenue conditions are not the same, but we know that even with what Nigeria is getting now in form of revenue, they should be able to improve this significantly and that was why we pegged it at 200 per cent increment in CONMESS.
Some people would think an upward review of your salary by 200 per cent is outrageous, what do you make of that?
We are scientists and we do not base our discussion on rumours. We have said that for you to take us back to where we were in 2009, our studies have shown that taking into consideration the cost of living in 2009, the fuel price, the inflation rate, the exchange rate, then it has to be increased to a minimum of 270 per cent. So, we are being considerate by bringing it down to 200 per cent. What you do during negotiations is that you present your facts, the government will present theirs and you will discuss. The government can come up with their data showing that they need to increase by a percentage different from ours and when we are convinced, then we will take it back to our members and we will discuss.
The Federal Government has described your strike as unnecessary and that the NMA is negotiating with the Federal Government on behalf of all medical bodies. Are you aware of this?
That is the government’s position. Our position is different and we have communicated the position with facts. If you hear that the NMA is negotiating, what we are saying is that the NMA is not negotiating because negotiation has not happened this year, let them prove us wrong. We know that salary increment is a product of collective bargaining. We have our facts. More attention should be paid to the Ministry of Health. These issues have not been addressed by the ministry and it is squarely their responsibility to address them. It is only when they fail that they can now call on the Ministry of Labour and Employment to intervene. The committee on the upward review of CONMESS was set up by the Ministry of Health, yet that committee has not met this year and they have not come up with a CBA (Collective Bargaining Agreement). What happened was that the government offered the NMA a certain percentage without a CBA. Even if the NMA has accepted what the government is offering, where is the circular on the upward review of the circular?
There was a time you appreciated the Minister of Labour and Employment, Dr Chris Ngige, for his interventions during a programme on the television, but you seem not to align with his recent statements regarding your demands. What would you say went wrong?
Nothing went wrong and that is not strange. We cannot always agree. He has helped us several times in the past. In fact, for many of the issues that would have pushed us to strike, he was able to intervene and resolve them before getting to the stage of a strike. But like I keep saying, we have the Ministry of Health, which is our parent ministry, and we have two ministers there. They should wade in and resolve these issues. It is only when they try and they are not able to resolve them and it is leading to a strike that the Ministry of Labour will be called in and that is why we are also doing this to keep explaining our stand. I believe that by the time we keep talking and Dr Ngige sits down to analyse these issues, he will agree with us.
What do you make of the statement of him saying that you were feeling entitled regarding your demands?
What we make out of it is to continue to explain because that statement is possibly coming from the fact that we have not sat down with him to actually explain what is happening. I am sure that if we have that opportunity to explain and have a genuine dialogue, he will understand that it is not about having a feeling of entitlement and that we are raising germane issues affecting the health sector. Even after that statement that was credited to him, he has also come out to address one of the issues which we raised on the Medical and Dental Practitioners Act (Amendment) Bill, which seeks to compel medical and dental graduates to serve for five years to earn a full licence. He has condemned it publicly. You would ask yourself, how come the Ministry of Health has not done the same? That is why we are insisting that the bill should be withdrawn because it will not help the situation, but it will worsen it.
What happens if the government does not meet your demands after the warning strike?
What happens next will be dependent on what our members give us directives to execute but we know that all options are on the table. Indefinite strike action is on the table, shutdown of all the health facilities in the country and other government institutions are on the table. And we are still going to raise the alarm that the government should address the situation before it gets to that stage. We are not fighting the government. We are only using the instrument available to us to press home our demands. When the issues are resolved, we will not have time to continue to have industrial disharmony.
What do you think the incoming president should do differently to avert a strike in the health sector?
Whatever policy will affect any group of workers should be discussed in the presence of the workers or their representatives, because there may be vital information that we will give to them that they may not know because we are the ones on the ground, we know what is happening. Even with this brain drain, we have always said any solution that the government will bring up should involve us, and it is because we were not involved in that bill that caused that grievous mistake. They should increase the budgetary allocation to health, it will help to improve the infrastructural needs of the hospitals, and they should beam their searchlight and ensure that funds being released are effectively utilised without corruption. They should try to treat their doctors and nurses well. They keep calling us essential service providers but we are not seeing anything that shows that they mean what they say. They should not allow issues to get to workers going on strike before addressing them because usually when that happens, you have a crisis, and the collateral damages are enormous.
As this government winds down, how would you rate its commitment to the health sector and the welfare of health workers, compared to those before it?
The rating of this government has not been done by NARD and it is not in my place to talk about that because I have not received any mandate from our members to rate this government in terms of their activities and achievements in the health sector.
This government is almost out, and some people would say it’s futile to expect it to make any commitment now. Why didn’t you wait for the new government to come in?
We have a government in place, they should not just wind down before May 29, they should still steer the ship of government before the inauguration. As I said earlier, many of these issues can be resolved in days, and if they commit to it, they can resolve many of the issues. For instance, for the circular, it is just to draft it because the resolution has been reached. It is just to draft it. On the Medical Residency Training Fund, we are aware the list has been submitted, the fund was budgeted for, and all that is needed is for them to give instructions for payment to start. On the 200 per cent minimum review of CONMESS, they should finalise with the committee they set up and the stakeholders, including us, and the circular will come out. We know that one or two things will need some days but you have to start; give timelines and we will continue with the next administration. The incoming government can also wade in because they will soon take over, so they are allowed to wade in. We are willing to discuss with them to find a way out of this even before they take over the government.
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