JOHESU, AHPA Advise Tinubu on Health Sector Reform

Nume  Ekeghe

Health workers under the umbrella of the Joint Health Sector Unions (JOHESU) and Assembly of Healthcare Professional Associations (AHPA) have appealed to President Bola Ahmed Tinubu to avoid the mistakes of his predecessors in his resolve to reposition the country’s health sector by engaging seasoned administrators as heads of the sector.

The unions in a statement signed by the acting National Secretary of JOHESU, Matthew Ajurotu, reasoned that the sad state of health service delivery in the country was the result of the several years of failed administrators dominated by the physicians.

They contended that a shift in paradigm was imperative because most of the previous heads of the health sector allowed sectional and parochial interests to becloud their capabilities in the discharge of their constitutional responsibilities.

Ajurotu said: “The President must allow the reforms shaping Nigeria in the last few days catch up with the health sector because most of his contemporary predecessors have allowed physicians to enjoy an unfortunate usurpation of the authoritative exclusivity of non-physician health workers in Nigeria.”

He alleged that “Physician-Head of Civil Service of the Federation complemented the internal oppressive structures of the Federal Ministry of Health( FMOH) to initiate the annihilation of the major health professions with state machinery.’’

Ajurotu, who was reacting to a recent publication by the Nigeria Medical Association (NMA) and the Nigerian Association of Medical and Dental Academics (NAMDA), alleged that both medical groups were unanimous in taking a position that an adjustment in the Consolidated Health Salary Structure (CONHESS) would amount to a distortion in the relativity of existing CONHESS and Consolidated Medical Salary Structure (CONMESS).

He said, “The CONHESS and CONMESS became salary scales for Non-Physician and Physician cadres in 2009. It is noteworthy that the umbrella groups of physicians in different templates as usual by insinuating that. We wish to clearly state that CONMESS was not reviewed upward, rather an error in translation of the Collective Bargaining Agreement (CBA) that gave rise to CONMESS in 2009 was corrected.

“The JOHESU/AHPA put on record that it is bored stiff with the obvious ignorance of the NMA and the likes of NAMDA as well as other levels of representation of the physician tribe in Nigeria. In very simple evaluation and analysis, facts that are sacred confirm that the CONHESS and CONMESS became salary scales for Non-Physician and Physician cadres in 2009.’’

He explained that prior to the “introduction of discriminatory salary scales in Nigeria especially the era pre-1991 when late Prof. Olikoye Ransome-Kuti under the military regime of Gen. Ibrahim Babangida, imposed the Medical Salary Scale (MSS), the norm was that pharmacists and physicians (medical doctors) entered the civil service on the equivalent of GL 08 for internship and houseman-ship respectively and move to GL 09 after youth service. Other health professionals who are graduates started on GL 08 after youth service, while registered nurses and midwives started on GL 07.’’

Continuing he said, “At both the federal and state civil service, pharmacists and physicians were on the same grade level and enjoyed only a marginal one grade level difference over other health professionals because of the difference in years of training. Without any fundamental shift in the duration of training or course content, physicians under the aegis of the NMA took maximal advantage of their dominance of the leadership bracket of the FMOH to alter the augean stable with a discriminatory salary scale styled MSS while non-physicians including health professionals were placed on the Health Salary Scale (HSS).

The status quo, according to him, was further altered to give more advantage by another physician-health minister, late Prof. Oshotimehim who again came up with an equally oppressive CONHESS and CONMESS scale for non-physicians and physicians personnel in 2009. All avenues to redress the injustice of discriminatory salary wages to non-physician health workers was destroyed by the trio of Prof. Christian Chukwu 2011-2015, Prof. Isaac Adewole 2015-2019 and Dr. Osagie Ehanire 2019-2023 when they led the FMoH,’’ he said.

“Without recourse to bar-charts, graphs and other arithmetical indices for simplicity, the status quo today is that physicians now enter the civil service for houseman-ship on the equivalent of GL 10 and proceed to GL 13 after youth service. Pharmacists who hitherto were on the same grade level as physicians and other health professionals now start Internship on the equivalent of GL 09 and proceed to GL 10 after youth service,’’ he claimed.

He argued that, in real terms, salary experts will confirm that true relativity is permanently entrenched at the entry point in the civil service.

“Presently as it stands, after youth service, a physician who starts at GL 13 will have his contemporary health professional who takes off at GL 10 as benchmark in this discourse. By existing civil service protocol, it will take a minimum of 10 years for any health professional who starts on GL 10 to attain GL 13 where the physician kick-starts his career.’’

Ajurotu expressed concern that the discriminatory policies may not be corrected with the recent appointment of Dr. Salma Anas, as the Special Adviser on Health by Mr. President.  

“In the last 10 years, the Hospital Services Department which is the hatchet tool of oppression by the FMOH and NMA has produced the likes of Dr. Mrs. Shokunbi, Dr. Balami, Dr. Hammedu, Dr. Mrs. Adebiyi and recently Dr. Salma Anas. These are the agent provocateurs used to prevent and scuttle adjustment of CONHESS since January 2, 2014 in Nigeria. These facts are there for anybody to verify.

“We respectfully draw the attention of President Tinubu to the highlights of a recent engagement with JOHESU/AHPA when His Excellency was inundated with facts which led to generation and escalation of entropy in the health sector. President Tinubu goes into the history book as the first Head of Government in this democratic dispensation (1999-2023) to appoint a Special Adviser (Health) in the person of Salma Anas, a physician. The Special Adviser (Health) was Director of Hospital Service Department of the FMOH up until a few days ago.

“She goes on record as one who signed a letter C.3739/T/117 of April 3, 2023 on behalf of Dr. Enahire which announced to JOHESU that the FMOH concurred with the conviction of NMA that relativity will be distorted if CONHESS was adjusted.

“Ironically, the same Sama Anas processed enabling documents on behalf of NMA/NARD for more adjustments on CONMESS including a plethora of allowances and transmuted same to the National Salaries, Income and Wages Commission in May, 2023, “few days after, JOHESU’s request was jettisoned” for consideration and payment to our over-pampered physicians which confirms the disposition of working only in the interest of their members.”

The two professional bodies alleged that the Special Adviser on Health is instigating crisis in the sector by using her erstwhile influential position in the FMOH to leak development and content of memos related to JOHESU/FG talks to the NMA.

The unions are of the view that appointment of administrators of the sector from outside the Nigerian Medical Association (NMA) portfolio would enable them to have a fair chance of re-positioning the failed health sector.