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10 Ways To End Doctors’ Strikes (forever)in Nigeria - Health - Nairaland

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10 Ways To End Doctors’ Strikes (forever)in Nigeria by ArabaONE: 11:08pm On Jul 20, 2014
BY FEMI OGUNYEMI
A GOVERNMENT official once told me : ” You people
(doctors) should do as we say; after all we pay your
salaries”.
And a colleague once said to me: “They (government)
should just give us what we want.”
Both are wrong; and herein lies the locus of persistent
conflict.
Government’s action impinges on ALL doctors, including
those whose salary they don’t pay.
And my colleague would be better served in getting
what “has been agreed” rather than what he “wants”.
Subtle differences but key to understanding the nature
of negotiation.
It reminds me of advice a Professor gave me many
years ago regarding negotiating employment contracts
in new jobs: “Meet YOUR needs by making the other
party happy that you’ve met THEIR needs”. Everyone
wins. Tricky, but it works.
Why do doctors strike?
Contrary to what some might think, doctors do have a
right to strike. According to the ILO, every worker does.
The impact of such a strike on the community, economy
and the profession itself is severe, especially in
developing countries like Nigeria. All stakeholders and
involved groups must take an ethical approach and
share a moral obligation to put society first.
An empty ward in a Lagos owned hospital due to the
strike by the medical doctors
There are three main reasons why doctors strike:
*Medical practice, and the doctor-patient relationship
continues to change. Patient care decision-making, in
both public and private practice, is now shared between
employer requirements, patient demands, insurance
companies, other third party payers, and government
regulations. The doctor is no more the sole determinant
of patient care and there is some frustration from this
disempowerment. Doctors have become like any other
employee who must sometimes negotiate wages and
compensation to meet personal economic needs.
*Doctors may have a genuine dissatisfaction with
inadequate facilities, drugs, and lack of support from
employers and elected government officials. Non-
physicians often quote the Hippocratic Oath: “The
health of my patient will be my first consideration” as a
reason that doctors should NOT go on strike. In fact,
when doctors feel they are unable to provide safe and
effective care for their patients, the Oath may be the
exact reason they should strike; the “first, do no harm”
principle.
*The failure of government and employers to honour
collective bargaining agreements, CBAs, for improved
wages and conditions of service is a major crucial
reason in Nigeria. A signed MOU is an agreement; a
pact. Failure, refusal or delay in implementation breeds
distrust and a perception of a lack of commitment. This
not only presents immediate conflict but prejudices
future negotiations.
The NMA had listed 24 “demands” of government. I had
planned to address each of these issues in this article
but will defer that for now.
However, having written three reviews (Vanguard
Newspapers April/May 2014) on the National Health Bill
2014, I must reiterate that this Bill MUST NOT be
signed by President Goodluck Jonathan in its present
form.
The NMA should actually take a lead role in its public
review!
Nine of the 24 “demands” appear to be directly related
to what I call SCC, that is Salaries, Compensation and
Conditions of service. These are @3, 5, 8, 9, 10, 11, 14,
17 and 21.
The problem for doctors is that their SCC is lumped
together with the rest of the civil service as they are
considered by government to be like any other “public
service employee”.
There is an inherent mistake in this philosophy. A doctor
is not something you do, it is something you are!
This is why it is so much more difficult for doctors to
simply discontinue practising medicine, and it makes
them susceptible to exploitation in negotiations.
How to end doctors strikes (FOREVER) in Nigeria
*The establishment of a clearly defined, mutually agreed
condition of service for doctors, is the single most
dramatic step in halting doctors strikes in Nigeria.
The UK NHS is the biggest government run health
service in the world. There is a distinct code of service
for doctors, entirely separate from the civil service.
Let’s look at the NHS Terms and Conditions of Service
Handbook. There are seven parts.
Part 2 deals with PAY: pay structure, maintaining round
the clock services, overtime payments, pay in high cost
areas, recruitment and retention premia, career and pay
progression.
Part 3 deals with Terms and Conditions of Service:
hours of the working week, part time employees and
fixed time contracts, contractual continuity of care,
annual leave and general public holidays, sickness
absence, maternity leave and pay, redundancy pay,
travel cost reimbursement, subsistence allowances,
mutually agreed (their words) resignation schemes,
whistleblowing and injury allowance.
One can see from the above why there was no doctors
strike in the UK for 37 years! After a strike in 1975, that
of June 2012 was a mere 24 hour revolt to highlight
pension disagreements.
*Legitimate Collective Bargaining Agreements, CBAs,
must be respected and implemented in a timely manner.
The courts, and mutually agreed arbitration panels,
must be involved.
*The importance of ethics must be integrated into the
profession, the government and employers. ALL parties
have a moral obligation to society.
* The profession must resist the impulse to make
economic demands beyond the capacity of the employer
(government) or which could hinder the provision of
other services like education or public utilities. Doctors
have a duty of care to patients, while government has a
duty of care to the public. Fortunately, or unfortunately,
they are one and the same. Some demands may also
require legislation by the National Assembly; this will
take time.
* Government should resist the urge to arbitrarily call
certain groups of workers as “essential services” so as
to deny them a right to strike. In fact, if such workers
are considered “essential” then they deserve a separate
mechanism of pay and service conditions.
* Both parties must put forward trained and skilled
negotiators.
* Government must avoid threats of unjustifiable
disciplinary action.
* The media, TV, newspapers, radio, and social media is
crucial to ALL parties in communicating with the general
public. To garner public support and understanding,
disagreements and agreements must be transparent.
* The NMA should embark on a major membership drive
to include ALL registered Nigerian doctors. These
members should be regularly surveyed, balloted and
informed on all matters being discussed on their behalf.
* Finally the MDCN, the doctors’ regulatory body, has a
duty in restoration of respect to the profession. There is
a feeling that professional standing may have been
diminished by repeated strikes in the past. The MDCN
can encourage and accredit more CPD activities in the
fields of management and administration. They can
design and monitor a code of standards of good
medical practice in Nigeria.
source:
http://www.vanguardngr.com/2014/07/10-ways-end-doctors-strikes-forever-nigeria/
Re: 10 Ways To End Doctors’ Strikes (forever)in Nigeria by adeoladrg(m): 7:19am On Jul 21, 2014
I dey come.
Re: 10 Ways To End Doctors’ Strikes (forever)in Nigeria by alentyno: 7:35am On Jul 21, 2014
.

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