The ongoing crisis in the health sector may escalate following a threat last week by three other associations in the sector to embark on strike.
Felicia Adams owns a grocery store at the Federal Medical Centre (FMC), Ebute-Metta, Lagos. The ongoing strike by doctors at the hospital has, however, negatively affected her business.
“I have not restocked since the strike started because sales have been very low,” she said to a reporter on Friday.
“My sales have dropped by more than 70 per cent. Before now, I used to restock every two days.”
Apart from patients who are the primary victims of the strike by members of the National Association of Resident Doctors (NARD), owners of businesses located within or around tertiary health facilities, like Mrs Adams, are also counting their losses. The resident doctors working in public tertiary health institutions called the strike on August 2 over unpaid salaries and allowances.
Mrs Adams said she avoids buying perishable wares and now makes her snacks in small quantities.
Similarly, public transport operators in the neighbourhood of the hospital also complain of low patronage. Our reporter met Chesta Eluakigbe, a commercial tricycle operator, at their park in the hospital premises.
“This garage used to bubble with passengers, we don’t use to park waiting for passengers as we do now,” he said.
However, despite its effect on his business, Mr Eluakigbe said the doctors’ demands are legitimate. “I wish I could join them on the strike but my family will starve. The federal government should pay them what they are being owed.”
A fruit trader who sits opposite the FMC, identified simply as Favour, also said the strike has affected her business because her customers are mostly the hospital’s patients and their relatives.
“We come out because we cannot sit at home and watch our fruits go bad. Before the strike, I used to sell seven packs of bottled water every day but now, I struggle to sell a pack,” Ms Favour said.
At the Neuropsychiatric Hospital, Yaba, in Lagos, everywhere was silent when our reporter visited. However, unlike at the FMC, commercial transport operators there said the strike had not really affected them, because of the hospital’s location in ever-busy Yaba.
National Hospital, Abuja
On Friday, our reporter met Halima Habib opposite the gate of the National Hospital, Abuja, where she sells fruits.
“It’s already afternoon and I have had only two customers. On a normal day, I usually leave this place by 1 p.m. But since the strike started, we stay here until 6 p.m. and still go back home without selling all our fruits,” she added.
A taxi park adjacent the hospitals’ gate was almost empty. The few drivers were seen rushing towards potential customers. “The strike has affected all businesses around here,” one of the drivers, Joseph Akpan, said to our reporter.
“The government should give the doctors what they want so that they can resume work.”
Hospital like a graveyard
The wards, general reception and emergency unit of the National Hospital were deserted but some of them were rendering skeletal services. A patient, Mary Agha, said she had requested to see a neurologist.
“The nurse on duty simply asked me if I was a Nigerian at all, and didn’t I know that doctors were on strike.”
Our reporter heard a nurse tell some patients to come back whenever the strike is called off. “Even if you wait till night, no doctor will attend to you because none of them is within the hospital premises,” the nurse told a waiting patient.
Tayo Haastrup, the hospital’s spokesperson, was not available to speak on how the facility was managing the situation.
At the Federal Medical Centre (FMC) in Jabi, the management drafted in corps members to fill the vacuum created by the absence of the striking doctors. But business owners there were also lamenting.
“I am looking for another location,” said Rebecca Ajeh, 45, who sells corn beside the hospital’s gate. “I don’t know when the doctors will call off the strike.”
The reporter noticed only three taxi drivers around the hospital. One of them, Rasheed Abah, said at least 20 of them used to serve the area before the strike.
“We just come here for the sake of it. In fact, we don’t bother staying here for long because no passengers are on the ground. The few people that come to the hospital usually come in their personal cars,” Mr Abah said.
Hospital management defies strike
However, our reporter observed that the general reception of the FMC, Jabi, was filled with patients that Friday morning. The maternity unit, and the pre and post-natal departments were very busy with many nursing mothers and pregnant women around.
“All departments in the hospital are functioning at almost 80 per cent capacity, an ad-hoc staff member who spoke with PREMIUM TIMES on condition of anonymity, said. “Our operations are not 100 per cent but work is ongoing. The emergency unit is functional, surgeries are ongoing as expected. Many people will die if we all decide not to attend to patients.”
A patient, Moses Okoro, said he brought his daughter to the hospital for treatment because she woke up with a cough and high temperature. “So far, I have been well attended to. We were asked to run a test, which I did at the laboratory in the hospital here. Everything is going on fine. But my daughter’s case is minor, I don’t know about the severe cases,” he said.
But Mariam Eze, a patient in her early 40s, said her surgery slated for August 8 was not carried out due to the strike.
“I am going through severe pains. I have to take at least two injections every day to survive the pain. I wish I could afford a private hospital,” she said.
Joseph Eziechila, the head of clinical services and deputy to the chief medical director (CMD) at the hospital, told Us in a telephone interview how the hospital had been managing the situation.
“We brought some doctors who are corps members that just passed out from the orientation camp. We sent them to the internal medicine and surgery departments where the few hands available are getting overwhelmed
“Another thing is that the consultants and other staffers on ground are working really hard. That is why we have been able to maintain services at this level,” Mr Eziechila, an ophthalmic surgeon, said.
Mr Eziechila urged the government to sort out the issues immediately. He said it is only in Nigeria that doctors go on strike all the time, adding that the situation contributes to the migration of Nigerian doctors abroad.
The University College Hospital, Ibadan, was not providing services on Saturday when our reporter visited. The clinics and shops were under lock and key as of 9 a.m.
Some of the nurses, who spoke on condition of anonymity, told our reporter that major activities were suspended at the hospital and that the coronavirus cases at the facility did not help matters.
“Maybe on Monday, things may improve because we learnt the strike may be called off before then,” one of the nurses said.
LASUTH ARD talks tough
The situation looked more critical at the Lagos State University Teaching Hospital (LASUTH) as the striking doctors said the state government had ignored them.
At a media briefing addressed by the hospital’s chapter of NARD on Friday, the doctors also condemned the removal of house officers from the scheme of service in the state.
Azeez Ojekunle, the president of the chapter, said the state was the only one to adopt the said circular, not minding the roles of house officers in efficient health service delivery.
Mr Ojekunle said: “They are the first point of contact to the patients and practically live in the hospital premises working as house men. Being in the scheme of service determines the reference point for calculation of remuneration, entry grade level for career progression among others. Now this cadre is being removed from grade level on the scheme of service and left at the mercy of any government.”
He also spoke about the medical residency training fund (MRTF) which he said is stipulated by the Medical Residency Training Act, 2017, but is yet to be implemented in the state.
“The Act regulates state sponsorship of the residency programme and Mr Governor in the discharge of his duty has approved the fund, but we are still awaiting the release. Yet, some states like Delta have made the payment to their doctors.
“Ideally, we are supposed to demand the arrears but we are only asking for the payment for 2021,” the president said.
Speaking further, Mr Ojekunle said there is a need for a template for the recruitment of doctors in the state and that the government needs not to wait till doctors lament before recruiting more hands.
“The recently advertised recruitment process for the deficit of over 150 resident doctors and medical officers was preceded by the suspended strike action in April 2021. Also, the last one done in 2019 and the penultimate one in 2017 followed strike actions.
“How long shall we continue to embark on strike action before recruitments can be done while the system witnesses continuous exit of our members either upon completion of the specialist training programme or quest for greener pasture? There is an exigent need for a template for regular recruitment as obtained in other climes,” Mr Ojekunle said.
Also in the demands of the association is the construction of residency quarters, a project which is said to have been on for over a decade.
“The foundation for a single block is yet to be laid despite completion of architectural design more than six years ago with approval and budgetary allocations in the current dispensation. Resident doctors, as the name implies, are meant to be resident within the hospital premise for seamless service delivery,” the association said.
Meanwhile, on Friday, a few patients were seen waiting at the lobby of the Family Medicine Department of LASUTH, but a downpour made it difficult for this reporter to follow up whether they received care or not.
Toluwani Orungbeja, the spokesperson for ARD at the hospital, said the association’s members had complied fully with the ongoing strike and there has been no admission or treatment of patients by the doctors.
Although consultants are maintaining skeletal services at the teaching hospital, there is a limit to the number of patients they can attend to.
“We are willing to resume work and carry out our duty but the government has put us in this predicament. It is quite unfortunate,” Mr Orungbeja said.
Lagos government reacts
However, the state’s commissioner for information and strategy, Gbenga Omotosho, told us that the doctors were wrong in their claims.
On recruitment of doctors, Mr Omotosho said the recruitment of medical practitioners and teachers do not need the governor’s assent in the state.
“It is a lie that they must go on strike before doctors are recruited. The governor made a standing rule that he doesn’t need to be consulted before new doctors are recruited to fill spaces. I think only the teaching service commission also enjoys such blanket approval,” the commissioner said.
He added that his colleague in charge of the ministry of establishment, Ponle Ajibola, had dealt with most of the issues raised by the doctors at different fora.
About the strike
The National Association of Resident Doctors (NARD) started the nationwide strike on August 2 in Nigerian public tertiary hospitals. They cited several reasons, including delays in the payment of their salaries and allowances.
The strike coincided with a spike in COVID-19 cases in the country, leaving many worried that it could have serious consequences for the battle against the third wave of the pandemic.
Last year alone, medical practitioners were on strike three times over demands for allowances for treating COVID-19 patients and increment in basic salary.
NARD is also demanding the payment of COVID-19 treatment allowances in the absence of death-in-service insurance, having lost at least 19 of its members to the pandemic, while also protesting the shortage of manpower in public hospitals.
At the root of the strike action is the government’s constant failure to honour the agreement reached with NARD over its demands.
The government, through the ministry of labour and employment, started issuing threats, including the application of the “no-work no-pay rule” and sacking doctors, but all yielded no fruit.
A meeting about two weekends ago between the leaders of the Nigerian Medical Association (NMA), NARD and government representatives also failed to resolve the issues after the striking doctors backed out at the last minute.
As negotiations broke down, the government headed to the National Industrial Court to seek an interim injunction restraining the striking doctors. But that too was unfruitful as the judge, John Targema, refused to grant the government’s request.
Meanwhile, the ongoing crisis in the health sector may soon escalate following a fresh threat last week by three other associations in the sector to also down tools if pending issues are not resolved before September 18.
The NMA, the Medical and Dental Consultants’ Association of Nigeria (MDCAN) and the Medical and Dental Doctors in Academics (MEDSABAM) unanimously agreed to join NARD if the government fails to resolve the pending issues on or before the deadline.