For some years, Nigeria's health sector has been perennially embroiled in one strike after another. Investigations have shown that beyond ego and pecuniary interests of the leaders, there are also supremacy battles among the diverse professional groups within the health care delivery system fuelling the strikes even as government officials appear befuddled in the whole affair.

As the year 2013 was drawing to a close, Nigerians were under the heat of the warning strike called by the Nigerian Medical Association (NMA) even as they also warmed up to begin 2014 with another round of strike. Mercifully, as Nigerians returned to work after the Christmas and New Year festivities, the NMA and the federal government representatives reached a compromise and the proposed New Year strike was shelved. Then just before the ink drawing that agreement between the doctors and the government dried up, came the notice given by the Assembly of the health care professionals and Joint Health Sector Unions that its five-day warning strike begins next week with a resolve to down tools indefinitely if its demands were not met. This has prompted the question of close watchers of developments in the sector: "When will the health sector strikes end?"

What are the issues in contention by the various bodies? In an earlier press briefing in Abuja, NMA President, Dr. Osahon Enabulele said: "These demands bother amongst others, on the absence of a regulatory environment for practice in the health care sector, funding of health care in Nigeria and expansion of Universal Health Coverage to cover all Nigerians, health infrastructural upgrade, fundamental injustices done to doctors in terms of workplace conditions/conditions of service, and other health sector challenges."

In calling off the intended strike, the NMA President said it was in response to some welcome developments in the implementation of the Memorandum of Understanding (MOU) reached between the NMA and the Federal Government, including the decision by it to redress the gross injustice done to doctors, establishment of a Hospital Development and Intervention Fund (HDIF) for health infrastructural upgrade, appointment of a Surgeon-General of the Federation, and expansion of Universal Health Coverage; among other reasons.

The following day, the Professionals and Joint Health Sector Unions working in all tiers of the health care delivery system in the country and estimated to number 95 per cent of the entire workforce, gave notice of an imminent five-day warning strike between January 15 and January 21. In his address to the media, the President of the Pharmaceutical Society of Nigeria, Mr. Olumide Akintayo, who spoke on behalf of six other industrial unions, said they would embark on the action to enable President Goodluck Jonathan's government accede to its grievances and was prepared to down tools indefinitely if its demands are not met.

Other leaders of unions at the meeting were Mr. Wabba Ayuba, Chairman, Joint Health Sector Unions, Mr. Abbultafiu Adeniji, President of the National Association of Nigerian Nurses and Midwives, Dr. G. C. Okara, President, AMLSN and Chairman, Assembly of Health Care Professional Associations and Mr. Taiwo Oyewumi, President, Nigeria Society of Physiotherapy. Others were Dr. Mark Okeji, President, Association of Radiographers of Nigeria and Mr. Wole Ajayi, President, Health Information Managers Association of Nigeria.

Akintayo listed the immediate demands of the unions to include circularization of the approval of consultancy status for some cadres of health workers and payment of the arrears of all honorary consultants appointed by the boards of management of hospitals, which were arbitrarily stopped on the directive of the Minister of Health, Prof. Onyebuchi Chukwu since December 2010.

According to them, "This is in line with due process as dictated by the pronouncement of the National Industrial Court of Nigeria in July, 2013 and the subsequent agreement of the representatives of Joint Health Sector Unions and the government in August 2013."

Others are; a presidential directive compelling the National Salaries, Incomes and Wages Commission to negotiate and approve reasonable and respectable allowances as well as emoluments for health workers in Nigeria as indicated in collectively signed agreement since 2009; an unconditional halt to the appointment of a Surgeon-General for the Federation as the concept remains both unconstitutional and outrightly unlawful.

Akintayo further advised the government to redress all the other areas of injustice in the sector by amending the extremely obnoxious Act 10 of 1985, which laid the foundation for oppression in the sector through appointments unduly skewed in favour of medical doctors contrary to international best practices.

Among other demands, are rejuvenation of a well-funded and properly positioned Presidential Committee of Experts on harmony in the health sector for a permanent and equitable structure in the privileges of all health care providers in Nigeria and privitisation of medical services to free funds for capital expenditure, especially research and development of the health sector.

While the NMA applauds President Jonathan on his decision to appoint a Surgeon-General of the Federation whose roles, it said would undoubtedly help to address some of the problems confronting the Nigerian state, including the address of the burgeoning negative impact of medical tourism on Nigeria, amongst other responsibilities, the Professionals and Joint Health Sector Unions (JOHESU) are strongly against the creation of that office.

JOHESU contends: "The justification for the position of a Surgeon-General in contemporary publications and reflections is hinged on the need for such a public officer to be saddled with the responsibility of coordinating public health. This assertion on face value is ridiculous and certainly most unconvincing because the basic tenets of medical training positions any registered medical practitioner to undertake the responsibility of driving processes that border on public health.

"The Office of the Surgeon-General in whatever nomenclature will mean an unnecessary duplication of offices and functions which are presently being articulated and undertaken by the offices of the Minister of Health and the Minister of State for Health with an array of directors, deputy directors and assistant directors. The set-up at the Federal Ministry of Health and State Ministries of Health has created the offices of the Director of Hospital Services, Director of Public Health which are today the exclusive preserve of doctors who also dominate the Top Management Committee (TMC) of the Federal Ministry of Health/State Ministries of Health with over 80% of the directors who are doctors. Some stakeholders in health probably see Nigeria as a health outpost that deserves a Chief Medical Officer. The fact is that health care is increasingly a team concept and multidisciplinary where each stakeholder contributes to a pooled effort to achieve desired outcomes."

Akintayo further stated that the office of the Surgeon-General was unconstitutional as an attempt to introduce a bill to formalize it had failed in the Sixth Parliament. He added that resurrecting it now would increase the problems of the health sector just like the separate salary scale for the doctors instigated crises in the 90s. The unions declared that if the creation of that office was not stopped, other professional bodies would soon start agitation for a similar office to be created for them.

According to them, in Nigeria today, the rule of the thumb has replaced the rule of law and due process in the health sector. "Medical stakeholders with tacit government endorsement presume to be wiser than the law courts, the legislature and other statutory templates like the National Council on Establishment made up of the Head of Service of the Federation and the 36 state equivalence.

"Doctors now insist that their wishes and fancies must be elevated to the status of laws and schemes of service in the health sector. This is the impunity that is being forced down our throats to accept in the first few days of 2014, a year Nigeria proclaims to be its centennial celebration, but in reality, the liberties of freeborn citizens are randomly compromised through unadulterated enslavement, injustice and recklessness at its apogee."

Way Forward Analysts believe that the government must stamp its feet and ensure that all sides are brought to the negotiation table to resolve the ego crisis first before issues of welfare and virile health sector funding can be discussed. The Presidential Committee of Experts on Harmony in the health sector, which embraces all sector professionals must be revisited and strengthened given the current developments. As things stand, only a composition of such a respected group can restore confidence to all the sides since the federal government itself is no longer seen as an unbiased umpire by some health professionals. Moreover, every group in this perennial crisis professes to be serving the public interest, therefore, they would be duty-bound to respect decisions reached by the committee.

By Godwin Haruna

Good write up

The FG has 7days-1day, to avert the looming crisis in the health sector.
It will be indefinite, blood banks won't work,Drugs will be scarce,Patients will be turned back from the wards among other unpalatable measures. We can only pray people don't die.
It will be tough and excrucating for our patients.

FMOH, the ball is in your court. Save us from avoidable deaths.