Health workers commenced a nationwide strike on Wednesday.
Health workers in teaching and federal hospitals in Nigeria have embarked on an indefinite strike. The workers complain of being marginalized by medical doctors, non-implementation of court ruling by the health ministry, among other issues.
In this interview, the Minister if Health, Professor Onyebuchi Chukwu sheds more light on the controversial issues and proffers solutions.
Mr. Chukwu said there are three alternatives for striking health workers to choose from.
PT: What is the latest in your ministry?
MIN: The latest in the Nigerian health sector is that today some of the health workers are on strike.
PT: Who are these workers?
MIN: These are workers under the Joint Health Sector Union (JOHESU). This is a group of about five trade unions that operate in the health sector which includes the Medical and Health Workers Union of Nigeria, Senior Staff Association of Universities and Tertiary Health institutions. It also includes the nurses under the National Association of Nigerian Nurses and Midwives, Medical and Laboratory Scientists Association of Nigeria; and National Union of Allied Professionals. Basically, this is a grouping of health workers but excluding medical doctors and to large extent pharmacists. But I think, generally, all the other health workers belong to one or other of these groups operating under the umbrella of JOHESU. They have been on strike but we also know that since last week in two hospitals namely University College Hospital, UCH, Ibadan and the National Orthopaedic Hospital, Igbobi, Lagos, NUAP has been on a more localised strike.
PT: What attempts have been made to manage the situation?
MIN: But for the JOHESU, series of meetings have been held with that group and the ministry of labour and productivity. The meeting that was scheduled for yesterday (Wednesday) though their leader was able to make it but they couldn’t form a forum as the other members had left and gone back to their bases so we only had informal talks. I was there and the minister of labour and productivity, the two permanent secretaries of the two ministries, were also there alongside relevant directors. As it were, certainly, they’ve embarked on strike, and the reports reaching us is that the strike is at various levels as in some institutions, it’s as if nobody is on strike, but in some health institutions, the workers beside medical doctors and pharmacists are on strike. We are compiling the full report, hospital by hospital, establishment by establishment, to be sure who is on strike and who is not.
PT: So, what is the issue at stake?
MIN: You may recall that as part of the ongoing conversation with labour in the health sector, four issues that we couldn’t quite agree on how to move forward include the issue of skipping.
PT: What is skipping?
MIN: This entails people who should be promoted to the level of a principal but don’t want to be on CONHESS 10 which is the equivalence of grade level 12 according to the national wages and salaries commission but would rather want to be promoted straight to CONHESS 11 which is the equivalence of grade level 13. That is what is called skipping. So your promotion should be from, according to them, CONHESS nine straight to 11.
The second issue has to do with some of the provisions in the National Health Bill which is before the National Assembly. There are some of the areas they say they didn’t agree with and we felt that there is nothing we could do at this stage as the matter is before the National Assembly.
The third issue was the appointments of consultants. They also wanted other health professionals besides medical doctors appointed consultants in public hospitals. Though not in any scheme of service, they wanted that to happen.
Finally, the issue of allowances to specialist cadre; they felt, what is in CONHESS does not quite represent what they believe was their negotiations with the salaries and wages commission. So these four issues because they could not be resolved through dialogue and negotiations were then referred in accordance with the rules governing labour, to the national industrial court for judgment. Three to four weeks ago, we got reports that the national industrial court approved of the issues. The memo that was sent to the minister of health starting first from the Senior Advocate of Nigeria that represented government through our legal unit and then to the minister, suggested that the minister should allow an appeal by government on the grounds that the judgments were confusing.
PT: How do you mean by the judgments were confusing?
MIN: What they meant by the judgments were confusing, take for instance the issue of skipping; whereas it was expected that the industrial court would decide whether the head of service was right by principle to direct that skipping should not be done in any government establishment, the court said because they have been skipping before, what government should have done was to negotiate with them. So, it’s a bit confusing because we thought if there is a government policy, the issue should be whether it is right or wrong, if the government policy is right and if anybody has breached it, then you must revert it in the interest of this country. We must be law abiding. But if you say because you have not been able to apprehend thieves, then they have not been stealing. Indeed, robbery has been going on. And then suddenly you now discover that this is wrong and you now put a stop to it, and a court is saying since all these while you couldn’t stop armed robbery, you should have invited the robbers and negotiated. So, I understand the stand of the Senior Advocates that this requires appeal in order not to jeopardize public good in Nigeria. The other example they gave on why the minister should allow an appeal is that of the consultants outside the medical profession in public hospitals. The court ruled that government through the federal ministry of health has the right to decide who should be appointed and who should be designated consultants in any of their hospitals, but those who were formally given that should be allowed to enjoy it and can subsequently be stopped. It’s a bit confusing where the court has agreed that it is wrong for anybody outside the federal ministry of health to begin to answer consultant, but if an error has been done by any agent of the ministry of health, we should allow that. It’s a bit confusing too. So, based on these and the fact that in the country we are preaching the rule of law, any party that is not satisfied with anything that has been done at a lower court reserves a right of appeal so government feels strongly that in order not to jeopardize public good in this case, that they are grounds for things to be properly clarified and that is why the federal ministry of health working with the office of the attorney general has gone ahead to appeal. So, the matter is before the court as it were. And any matter before the court, it means you shouldn’t take any further judgment.
PT: So, what was the court’s ruling over the National Health Bill disagreement?
MIN: Actually, when they went to court, they decided to drop issues related to the National Health Bill. I don’t know the reason but they decided at the court that they don’t want to pursue further issues related to the national health bill. The other issue that has been brought to the fore is what happened to the presidential committee on harmony in the health sector. You would recall that it went through all the processes and the minister of health then took it to the federal executive council. Clearly, what happened in the council with the president in council, is that the federal executive council having reviewed that report felt that given the fact that a number of the members of that committee, doctors and non-doctors alike, refused to sign the report. And actually, the report was signed by less than one-third of the membership, it meant that whatever decision the federal executive council took on the matter, the other people who didn’t sign and whose interest they were representing, may not still be satisfied since government is desirous of ensuring lasting harmony in the health sector, the federal executive council decided that the president would raise another committee and that committee would then do further work on it and then advise the president finally on the matter. So, it’s beyond the Ministry Of Health now. It is no longer anything that the minister of health can say anything on any longer. And I think it’s only reasonable to give Mr. President the opportunity to act further as decided by the federal executive council.
PT: You said UCH’s strike is localized, what exactly is their grouse?
MIN: At the University College Hospital, they told me personally that their grouse was that the federal ministry of health based on their demand had actually approved that vacancies should be established for CONHESS 15 positions, the equivalent of grade level 17. After due diligence, the federal ministry of health was of the opinion that we should allow that but in order to curtail a situation in which you have so many people bearing director within a small hospital, would then go through the due process and write to the national council of establishment through the head of civil service of the federation for national service to approve the new scheme wherein all grade level 17 or the equivalent of such officers in all the health institutions, just like you have in medicine should go by the appellation Chief. For that doctor answering Chief Medical Officer, it means the doctor is on grade level 17. It is the end of your career as a medical doctor as it were as a medical doctor in the public service. And we feel it should be the same for the others in the public health service including pharmacists, and medical laboratory scientists and so on. So, when you hear someone is a Chief Physiotherapist, you know he is a level 17 officer, same also applies to a Chief Nursing Officer. Rather than they having directors and we having confusion with appellation, director appellation should be reserved for administrative positions. When you head a directorate, you should then be called a director. We can even make it to be something that is rotational with a tenure and make it open for people who are on grade level 17 to be eligible such that you could serve two or three years and you give opportunity to other grade level 17 officers to also try their hands on administration.
PT: So, why is the University College Hospital, UCH, on strike?
MIN: Why they decided to go on strike at the UCH is that there was a recent promotion interview and they felt that since the minister of health had directed all federal hospitals to implement that new policy, they were expecting people, as in, some of their members to have been promoted to directors.
PT: Is the result out?
MIN: The results are not yet out according to them but they feel someone may be sitting on it. We assured them that we would look into it and would even have to invite the CMD of UCH with the original copy that was produced and if missing, would have to produce another one. And if the promotion panel recommended that people would be promoted, they should be promoted.
PT: So, why the disagreement?
MIN: We don’t really have any disagreement there, they are just being impatient. We are still talking with them, we have proposed that we meet on Monday, that is, the ministry of health, labour and productivity and their own representatives. We are waiting for them to acknowledge that they have accepted that date for us to meet.
PT: Has the appeal been filed?
MIN: Yes, it’s been filed and they (the group) have been served. Even the issue of skipping, to be honest, they are not too strong on it; if you really ask them.
PT: So, what do you intend to do during the meeting since the case is still pending in court?
MIN: We intend to appeal to them to be law abiding and to help us promote the culture of the rule of law in Nigeria as it were. We want them, since both parties are in court to respect the court since the matter is in court.
PT: Is there any alternative to the skipping?
MIN: There are three alternatives to the skipping.
PT: So, what are they?
MIN: If people must get to CONHESS 15, it means there can’t be any skipping. One is for them to accept, which I think the national council of establishment would not accept that both the director and deputy director should be on the same grade. The second option is to drop probably one of the designation in their scheme of service. The Pharmacists have done that long ago. For instance, the pharmacists are different in the sense that years ago, the national council for establishment approved that for pharmacists that the position of assistant chief pharmacist was abolished. So, there’s nothing of such anymore. You get promoted straight from principal to chief pharmacist. The principal is actually on level 13, on CONHESS, it is 11. They’ve been able to harmonize their own. This could also be an option for the other professions. These are options that are open to them if they wish.
The third option is to appeal to the national wages and service commission to create a CONHESS 16 but informal discussion with them showed that they are not too keen on that because CONHESS 15 is already equivalent to grade level 17. So, except they go ahead to create a grade level 18, to which a CONHESS 16 would be equivalent to, then that would be possible. But if they create CONHESS 16, it would be distorting the whole public service salary scheme.