As Doctors Go on Strike…

THE HORIZON BY KAYODE KOMOLAFE    kayode.komolafe@thisdaylive.com

It is certainly a measure of the premium placed on the delivery of social goods that the seven-day old strike by doctors has not elicited a sense of emergency on the part of the government and the public alike.

The strike took a turn for the worse on Monday when the National Association of Resident Doctors (NARD) ordered its members in the COVID-19 isolation centres to join the strike. The doctors undergoing residency training to become consultants are estimated to constitute about 40% of doctors in Nigeria. With the population of NARD members in the healthcare delivery system, a labour action embarked by them is expected to have a significant impact on the sector. As an affiliate of the Nigerian Medical Association (NMA), NARD’s action would have consequences on the work of other groups of doctors. It would be illusory to think otherwise in the unfortunate circumstance of the healthcare system. In any case, the NMA has given a moral backing to the strike.

Yet the government is busy threatening to invoke the obnoxious rule of “no work, no pay” to delegitimise the doctor’s exercise of their right to protest. This is despite the battle cry of NARD as espoused by its president, Dr. Uyilawa Okhuaihesuyi. He said: “I know some people may think we are selfish but this strike is about improving the health sector and improving service delivery.” Ultimately, the society bears the brunt as patients remain in pains while others die in the public hospitals.

Instead of mounting pressure on the government to be socially responsible in policy conception and implementation, the segment of the public that can afford it are content with their resort to a private solution to the problem. So in some privileged quarters you hardly notice a feeling that something is seriously amiss, much less a palpable social concern for the seeming collapse of public healthcare system.
This is a tragic trend.

Things cannot be assumed to be normal in a country in which doctors are on strike even for a day!
The demands of NARD are those that should not require a national strike to be met in the first place. This is more so that this country is in the midst of a public health crisis like every other nation.
For those who care about the efficient delivery of public goods by government it must be a national embarrassment that doctors are owed arrears of salaries by a country that is supposed to be battling a pandemic. If that is not sufficiently scandalous, you wonder what else would embarrass the government. A government that is alert to its primary responsibility would not expect doctors to work without pay.

Besides, members of NARD are also demanding an “upward review of the current hazard allowance to 50 per cent of consolidated basic salaries of all health workers and payment of the outstanding COVID-19 inducement allowance especially in state -owned tertiary institutions.” It is incredible that the hazard allowance in contention is N5,000! To imagine that Nigeria is prosecuting the war against COVID-19 by paying a doctor as a frontline worker N5,000 as hazard allowance! NARD also had to fight for insurance for the doctors who are exposed to a disease whose science is not yet fully understood.

Now, critics of the doctors’ strike are wont to invoke the Hippocratic oath taken by this category of medical professionals. Perhaps, such critics should also be reminded of Karl Marx’s materialist argument in The German Ideology that “mankind must first of all eat, drink, have shelter and clothing, before it can pursue politics, science, art , religion, etc…‟ In other words, the well-being of the professional is important as the society expects ethical conduct from him at work. At least, the doctor himself must be healthy and well-nourished before he could ably attend to his patient. In the last one year of COVId-19, dozens of doctors have died of the disease after getting infected with coronavirus in the course of duty. The welfare of the doctor is important for policy as the society invokes the Hippocratic oath.

One of the least reported developments during the national lockdown a year ago was that NARD was protesting amid the public health emergency the lack of Personal Protective Equipment (PPE). Did the authorities expect doctors to work in the isolation centres without adequate protection and according to the universal standards?
A combination of lack of PPE and the absence of insurance for health workers during a pandemic is nothing short of callousness. That’s why the doctors’ demands should be paid a greater attention than the government is doing at the moment.

The government has naturally called for an end of the action to allow issues to be resolved at the negotiating table. Interestingly, Labour Minister Chris Ngige, Health Minster Osagie Ehanire and Minister of state for Health Olorunnimbe Mamora are all doctors. They are quite familiar with the context of the issues in dispute. To be fair to the trio, they have been fairly measured in their official pronouncements on the clearly unacceptable situation in the health sector generally. They seem to be walking a tight rope. Professionally, it is unpardonable for a doctor in government to rationalise the unjust remuneration or non-payment salaries to those who labour to keep the system going for now. But the ministers are also talking like political office holders in a crisis-ridden system.

For instance, Dr. Ngige accused NARD at the weekend of presenting the government with a fait accompli while denying the doctors’ allegation that their members were not insured. The minister said: “”We signed a memorandum that says NARD will go back to its members to educate them on what has been agreed, the timelines placed on them, with a view not to disturb the industrial milieu in the health sector.
”We also agreed to reconvene after four weeks”
However, the doctors do not appear to have the patience for four weeks for matters to be resolved.
After all, the less patient colleagues of the striking doctors have long voted with their feet. They are in north America, Europe, the Gulf and even other African countries flourishing professionally and well compensated for their labour. A number of them have actually been making waves from their various posts.

During this pandemic, countries with advanced healthcare system have been recruiting doctors and other professionals in the medical workforce from Nigeria. The responses of Nigerian doctors have been instructive despite the obvious risks in working in those places that have been sometime epicentres of COVID-19. The pull in the better organised societies is simply the legitimate pursuit of welfare along with professional fulfilment. The irony of the Nigerian situation is that the very few who can afford medical services abroad sometimes become patients of some of the doctors who emigrated from this country.

A relief of sorts is that the NMA has not embarked on a national strike for some years. This maturity of purpose of NMA , as the parent body of doctors, has lessened the shocks on the system. The past heroic struggles of the professional organisation were meant to prevent the brain of doctors from a country with a poor doctor-patient ratio by international standards. It is hoped that government would pay heed to the patriotic advocacy of NMA to reverse the negative trends in the heath sector and put things on the path of progress.

Meanwhile, the NARD action is just one among the strikes going on in various sectors. The polytechnic teachers have declared a strike because government reneged on agreements. Workers in the judiciary are protesting poor conditions of work and neglect. So the courts are shut down on the basis of the “injunction” caused by the labour action. Meanwhile, the government would require more than legal technicalities to lift the “injunction.”
The NARD strike is symptomatic of the malaise in the sectors in which the government is expected to deliver on public goods for the benefits of the people, the poor in particular. It is the poor that suffer when doctors are not on duty in public hospitals. The few who have the means could have easy access to quality medical attention in private hospitals. The neglect of the welfare of members of NARD is typical of what happens to other categories of the workforce in the healthcare delivery system.

The same dispiriting story of lack of welfare of the workforce is also being told about the education system and the security sector. The condition of the human agents who drive the system is hardly the priority of those in power (who, by the way, take good care of themselves).

The three sectors – health, education and security – have been isolated, in passing, for this reflection because of their primacy in social policy formulation and execution. A government that cannot deliver on public goods in these sectors which are central to human development can as well be deemed to be absent in the lives of the people especially the poor majority. The poor cannot have access to those things classified as public goods (healthcare, education, security etc.) unless government deliberately directs policies for that purpose.

This is also a response to the neo-liberal standard alibi that “government cannot do everything” or that “there are competing needs for government’s limited resources.” Pray, what exactly can government do if it cannot ensure adequate welfare of the medical workforce for hospitals to be properly run, pay teachers’ salaries to give quality education or properly kit and reward policemen sufficiently to protect the society?
Even in the headquarters of global capitalism these public goods still remain the primary purpose of governance. Elections are fought in western countries on the basis how government could deliver on public goods. For instance, in Britain, the country of the patron saint of the Right, Adam Smith, the National Health Service (NHS) is an institution that has defined the character of governance in that country for decades regardless of the party in power. The other day, British Prime Minister Boris Johnson was treated as a COVID-19 patient in an NHS hospital just like other citizens. On his recovery, Johnson showered praises effusively on the NHS staff who cared for him in the most competent fashion. The staff could not have done that if they were owed arrears of salaries like their counterparts in Nigeria. The pundits who instinctively rationalise the indefensible abdication of responsibility by the state are not taking a systemic view of the retrogressive trends. Efficient running of public hospitals and schools and maintaining a security and defence system are basic responsibilities of government.

Those who are in power today enjoyed these public goods at certain stages in their lives.
It is, therefore, immoral for those who are products of quality public schools to now give excuses for government’s failure to run public schools efficiently.
Similarly, it is a matter of social conscience that those whose lives have been saved in their early lives in public hospitals now give lectures on why government cannot run hospitals.
Public hospitals can, of course, be run given an effective health policy.
Doubtless, the welfare of those who labour to make the system work should be the nucleus of a health policy.

QUOTE
“Things cannot be assumed to be normal in a country in which doctors are on strike even for a day”