Resident doctors and the Federal Government are sticking to their rigid positions on their dispute, thus indicating that the end to the strike, which enters day five today, is not in sight
WITH an army of over 16,000 doctors, the National Association of Resident Doctors (NARD) is the single largest medical group in any teaching hospital in the country. The doctors are on strike because the government has not honoured the Memorandum of Understanding (MoU) they both signed.
Speaking with The Nation, NARD President Dr Uyilawa Okhuaihesuyi listed their grievances as non-disbursement of the Medical Residency Training Funds, poor working conditions in state and federal hospitals, irregular payment of salaries and a paltry N5,000 monthly, called hazard allowance, which was last reviewed in 1991.
“Between April 10 and now, it’s 116 days. This year alone there have been two major strikes – April 1 and August 2, 2021.
“I got a letter from the Ministry of Health yesterday evening saying we do not have a right to go on a strike. The letter said there is a court judgment that restrains us from going on a strike. I am aware that the Ministry of Labour has a meeting with the Ministry of Health today at 2pm. I am aware that they said they will call us after their meeting today.
“However, we heard from the Chairman of the House Committee on Health, Hon. (Dr) Tanko Sununu, who said they are trying to schedule a meeting with us on Monday but we have not gotten the invite yet,” Dr Okhuaihesuyi said.
The doctors are also demanding the immediate withdrawal of the circular removing House Officers from the scheme of service. They decried the undue hardship caused by the GIFMIS platform due to the delays in payment of their salaries, ranging from three to seven months. Also, NARD noted that despite the government’s promise to migrate her members from the GIFMIS to the IPPIS platform, they are still stuck on the GIFMIS platform which is laced with irregularities. Furthermore, it noted that the bench fee for outside postings by resident doctors has been abolished, however, some Chief Medical Directors have renamed the bench fee as training fee, causing hardship on her members.
NARD said with regards to the non-payment of the National Minimum Wage Consequential Adjustment, the list of affected institutions and personnel strength had since been submitted to the Federal Ministry of Health as directed by the Memorandum of Agreement (MoA) signed with the Federal Government, yet nothing has been done.
“The National Executive Council (NEC) noted that the Chief Medical Directors, in collaboration with NARD, have submitted the list of salary shortfalls for 2014 to 2016. They noted with dismay the merry-go-round behaviour of the Federal Ministry of Health in disbursing the salary shortfalls to her members.
“They observed with concern the conditions of our members under different state government employs, especially Abia, Imo and Ondo states who currently owe our members 19 months, seven months and four months’ salary arrears.
“They however appreciated the promise by Abia State Governor to pay three of the 19 months arrears owed our members in ABSUTH by August 2, 2021.
“They observed with serious concerns the poor response of most governments in domesticating the Medical Residency Training Act of 2017, while commending states like Delta and Benue which have adopted the law.
“The NEC lamented the acute manpower shortage in most tertiary health institutions and the attendant burnout effects on our members. They noted with serious concerns that this situation is made worse by the ongoing deadly brain drain decimating the nation’s health care system.
“The NEC bemoaned the non-remittance of her membership dues by the Registrar of Medical and Dental Council of Nigeria, Dr. T.A.B Sanusi, despite following all the dictates of the Nigeria Labour law and appropriate stakeholders’ consultations.
“The NEC observed with serious concerns that despite several meetings with the Presidential committee on Salaries and other top government stakeholders on the review of hazard allowance for health workers, the hazard allowance still remains a paltry sum of N5,000.
“The NEC also noted the non-payment of COVID-19 inducement allowance to some of our members in federal and most of our members in state tertiary institutions.”
What the government is saying
Minister of Health Dr Osagie Ehanire appealed to the resident doctors to call off its strike as ‘this could lead to the loss of many lives’.
He urged them not to allow their Association be used by enemies of Nigeria to cause instability in the health sector.
Also, Chairman of the Senate Committee on Health, Ibrahim Oloriegbe, and Chairman of the House Committee on Health, Yusuf Sununu, on Wednesday, during an event by NAFDAC, appealed to the doctors to call off their strike and give allowance for dialogue.
Ehanire added that their demands do not warrant a strike because of the 12 resolutions by the NEC of NARD, only five items relate to the Federal Government. The minister explained that the remaining seven demands have nothing to do with the Federal Ministry of Health.
The seven resolutions, according to him, are salary arrears owed resident doctors in state hospitals; domestication of Medical Residency Training Act; speedy release of MRTA approved funds by states; Minimum Wage-Adjusted CONMESS 2019; payment of COVID-19 inducement allowance by states; accreditation of unaccredited departments in states training institutions; and central posting of House Officers in states institutions.
Ehanire however said the government has set aside a lump sum for the payment of their hazard allowance. He urged the NARD to hold the Nigerian Medical Association (NMA) responsible for any delay, as the NMA is negotiating on behalf of medical doctors, while JOHESU is negotiating on their behalf of other health professionals.
He added: “Medical Residency Training Fund is captured in the 2021 Supplementary Act in the sub head: Service Wide Vote. This was communicated to NARD representatives at the meeting hosted by the Federal Ministry of Labour and Employment on July 22, 2021. Meanwhile, due diligence is ongoing to clean up submissions from hospitals engaging resident doctors because 2020 payments were corrupted and found to have been marred with double payments to over 500 residents, costing loss of funds to the government. NARD has admitted this and agreed to support the government in the recovery of funds that were wrongfully paid to its members.
“The process of migrating NARD members to IPPIS is ongoing, though temporarily suspended to clear some issues, and will resume shortly. There are some isolated cases of non-payment of monthly salary, underpayment of monthly salary of some Resident doctors due to incomplete information or wrong information submitted from the hospitals, and the IPPIS is sorting out the challenges.
“The Federal Government has paid N9.3 billion to Insurance Companies for Life Group Insurance and payment of death benefits for health workers. The Federal Ministry of Health is in receipt of 131 cheques, totalling N159,233,234.00, from various insurance companies for 46 NARD members from 52 health facilities for group life insurance.
“Currently, additional 95 cheques are being processed from various insurance companies. It is noteworthy that insurance claims are dependent on due diligence. Submissions from the hospitals where some deceased Resident Doctors worked did not have complete documents (such as last pay slip for claim payment etc.). This was communicated to NARD representatives at the meeting convened by the Federal Ministry of Labour and Employment on July 22, 2021. NARD was advised to follow up their submissions from the hospitals where the deceased members worked.”
“The Federal Government has already suspended payment of Bench fees and this has been communicated to the Chief Executives of all Federal Tertiary Health Institutions vide Circular DHS/828/T.2/26 dated April 14, 2021. The abolition of Bench fees makes training of Resident Doctors free, receiving full salaries and allowances while undergoing specialist training bond free. There is nowhere in the world where such a gesture is obtainable.
“An isolated case of demand for payment of Bench fees was reported in Lagos University Teaching Hospital. The CMD has been advised accordingly and any fees paid after the issuance of the circular provisionally abolishing Bench fee is to be refunded.
“A circular was issued to CMDs/MDs to make submissions on arrears of consequential wage adjustment of National Minimum Wage. As at July 30, 2021, 38 hospitals have made submissions with cost implication of 1,696,088,700.31. The consequential adjustment of minimum wage arrears affects all hospital workers and not only Resident Doctors. Furthermore, the government is working to ensure that the salary shortfall of 2014, 2015 and 2016 is paid as soon as it is cleared.
“The removal of House Officers’ cadre from an established post in civil service is a decision of the National Council on Establishment, a body which regulates and provides guidance on Federal and state government establishment matters. The entry point of doctors in the civil service is MO or Registrar. We recognise that House Officers and Youth Corps doctors are pre- full registration and pre-service conditions respectively. We note that newly qualified doctors can only enter the scheme of service with full registration and satisfy pre-service conditions.
“Government is working to pay all health workers the balance of COVID-19 allowance, and we seek the understanding of all health workers concerned in this regard.”
Effect of the strike on Nigerians
As of day four of the strike, only consultants, nurses, and a few health workers are taking care of patients in all teaching hospitals. Since the resident doctors are a significant number of the workforce in any hospitals, current work load on the remaining work force is expected to increase significantly.
Across states in the country, patients have been on the receiving end of the strike as there are not enough hands to manage cases, while those buoyant enough are gathering funds to move to private hospitals to receive unhindered qualitative care.
In states like Edo, Enugu, and Lagos, where doctors have complied with the strike, some patients have had to wait longer hours to receive attention, while some others, especially at the University of Nigeria Teaching Hospital (UNTH) and the National Orthopaedic Hospital Enugu (NOHE), were turned back. Similar treatments were meted to patients in Ogun, Delta, Bayelsa, Anambra, Katsina, Imo, Cross River, Plateau, Osun, and other states.
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