₦airaland Forum

*Revisiting The NMA Strike -*
The Candid Opinion Of A UK-Based Doctor


By *Dr. Ijabla Raymond*


Although I practise abroad, I should point out that this strike affects me too. My family and friends all live in Nigeria.

I feel compelled to write on this subject because of its seriousness and the dearth of objective analyses on our social media. It is an emotive subject for both *NMA* and *JOHESU* members, and I can understand why punches fly around, but both parties must rise above petty and emotional considerations if we are to find a way forward.

For clarification purposes, the *NMA* represents medical doctors whilst *JOHESU* is a union of all health workers who are not doctors.


The NMA has a list of *24 demands* but I will limit myself to the most contentious ones. At this stage, it is probably best that I introduce myself. _*I am medical doctor of Nigerian heritage practising in the UK.*_



*WHO SHOULD HEAD THE HOSPITAL*

There is no contention – the medical doctor is the head of the *clinical team.* He/she leads the ward rounds, clinics, surgical operations, multidisciplinary meetings and so on because the ultimate and final responsibility for patient care rests in his/her hands.

The headship of the hospital is a different matter. This is an *administrative* office, which needs not be occupied by a medical doctor. This job is better in the hands of people who have administrative or business management skills. _This is the case in countries like the UK, Canada and the US,_ which heavily influence our health system. Therefore, it is difficult to reason with the NMA why this job should be the exclusive right of medical doctors.



*NON-MEDICAL CONSULTANTS*
The doctor-patient ratio in Nigeria is _dangerously low._ In my view, the roles of non-medical professionals such as nurses, physiotherapists, pharmacists etc need to expand to cope with the demands on doctors. It is important that this is done in a _safe way_ by providing the appropriate level of training for these individuals. *This is the case in countries such as the UK, Canada and the US where consultant nurses, pharmacists etc have existed for a few decades now.* I do not see any problem with non-medical consultants as long as these individuals are appropriately trained and can practise both competently and safely within an *agreed framework* . These professionals have separate (but complimentary) job descriptions and their roles are not designed to replace or dispense with the services of the doctor. If this arrangement enhances patient care, then where is the problem with it? The NMA needs to demonstrate to the public and to the government how the creation of these non-medical consultant positions will adversely affect patient care, otherwise, its demands will be perceived as obstructing the professional development of JOHESU members, and I don’t think this is helpful to anybody.


*HAZARD ALLOWANCE*
The types of hazard and the level to which healthcare workers are exposed vary considerably and depend on the type of job they do. For instance, psychiatrists are hardly exposed to body fluids and their risks for contracting diseases like HIV and hepatitis are much less than for a theatre scrub nurse. The risk of physical assault by a patient is higher for a psychiatrist than for a surgeon. And because psychiatric nurses spend more time with patients, their risks of assault are arguably higher than those of consultant psychiatrists.

The people who work in radiology departments such as radiologists, radiographers, nurses, porters and so on have greater exposure to radioactive materials than everyone else in the hospital.

The current health hazard allowance of N5,000 is unconscionable – it needs to increase. However, I think it is imperative to get an independent risk assessor for impartial advice.


*MISCELLANEOUS*
I have read far too many emotional arguments on these issues and very little of an objective discourse. It is important that I draw your attention to a few of these.
What has become obvious is the lack of understanding of the *concept of teamwork* . There is a pervasive notion among doctors that the other healthcare workers are there to serve them. JOHESU members think that doctors have become too conceited for their own good and are determined to put them in their “places”. *The most important person in the hospital is the patient* – it is *not* the _doctor_ , _nurse_ , _pharmacist_ or _laboratory scientist_ or anyone else. Every team member is important and must be respected, including the people who do the least clinical jobs like cleaning. I don’t imagine that any hospital will remain open for longer than a week if its cleaners went on strike and dirt was allowed to accumulate to the point where it constitutes a health risk.

I have heard so many anecdotal accounts of nurses not joining doctors on ward rounds or pharmacists altering prescriptions without first discussing these with the prescribing doctors or laboratory scientist slapping doctors; and these accounts are being given as reasons why doctors must continue to head hospitals.

These are *disciplinary matters,* which should be managed according to existing procedures. These excuses are emotional and should not be used to block the professional development of others.

The other reason I have heard doctors give for not wanting our non-medical colleagues to bear the "consultant" title is the fear that patients will confuse them or anybody else in a white-coat for a doctor and give such people an excuse for autonomous practice.

This reason is *not good enough* because this problem can be solved by wearing names badges and/or colour coded uniforms. Also health professionals should introduce themselves to patients at the start of consultations. But more significantly, this can be an issue of regulation - any one found to be (criminally) practising over and beyond their job description, competence level or professional registration becomes liable to disciplinary procedures.

Our health system suffers from poor regulation. This is why anyone can open a chemist and dole out antibiotics indiscriminately. It is the reason doctors are scared that consultant pharmacists, nurses and physiotherapists will steal their patients.

But it is also the reason why doctors may recommend an operation to a patient where none is necessary just so they can charge more. This is a problem that is in urgent need of attention.

I hope that this something both NMA & JOHESU will flag up in the near future.
Another recurrent theme in these debates is the abuse of junior doctors by both medical and non-medical staff, which appears to be endemic. There is a consistent narrative of junior doctors being asked to do other people’s jobs such as collecting blood from blood banks, taking samples to laboratories etc. In extreme cases, these doctors are asked to undertake non-clinical tasks by more senior doctors. This is simply unacceptable! I think it is fair to place the blame for this at the hands of consultants who are supposed to be responsible for junior doctors. But this in itself is not a good argument for blocking JOHESU members from becoming consultants in their specialties or for stopping them from heading hospitals if they have the right qualifications.

I am concerned that the NMA is losing public sympathy. Increasingly, I hear people describe doctors as selfish and heartless. This is very sad and rather unfortunate. They say doctors do not have any motivation to end the strike because patients are forced to pay exorbitant fees to them in their private hospitals. Those patients who cannot afford these fees are left to suffer or die. If the NMA has made any efforts to change this public perception, then these do not appear to have been effective.


*CONCLUSION*
The current strategy (i.e., recurrent strikes) is not working. Over the last decade or two, the NMA and non-medical health workers (more recently represented by JOHESU) have taken turns to go on strikes. Perhaps, it is time for both parties to sit together, talk to each other and resolve these contentious issues once and for all. _It’s pointless for the government to enter into agreements with one party knowing fully well that the other party will ask for a reversal of those agreements._

I think the time has come to incorporate Ethics, Teamwork and Communications into undergraduate curricula. The various online comments I have read from medical and non-medical colleagues show that whilst many easily mouth off "team work", a practical understanding of what this means is lacking.


Disciplinary procedures are there for a reason. They must be followed when necessary.
Although I practise abroad, I should point out that this strike affects me too. My family and friends all live in Nigeria. And who says I am not planning to come home to practise?

Lastly, we must all be mindful of our own mortality. Most of us will be ill someday.

And when this happens, the only thing that will matter to us is to be looked after by caring and competent health-workers regardless of their individual specialisation. We can create that environment if we forget our individual egos and work as a team.

Doctors are just been selfish, any profession can be a consultant in his field of study and not necessarily in medicine. When you were upgrading you salary nobody stood against you but now you making a fool of your self.JOHESU is not demanding equal salary because allowance can not be the same. You people are so blinded to the fact that we all pass through the same university and even attended some common courses in school. But now you are speaking as if others do not labour in school

BREAKING NEWS!!!
QUACKS TAKE OVER GOVT HOSPITALS AS LAGOS STATE GOVT GETS 48 HOURS ULTIMATUM!
- LAGOS JOHESU SET FOR TOTAL WITHDRAWAL OF SERVICES!
Sanity is set to return to Lagos State secondary and tertiary health institutions as LAGOS JOHESU, under the guidance of the National body issues a 24-hour ultimatum to the Lagos State Government.
You may recall that a few days ago, the Lagos State Government, through Ministry of Health and Medical Directors of State and Tertiary institutions commenced a mass recruitment of unqualified personnel and quacks to man the various emergency units.
Underground investigation by Nurses on Air revealed that from Saturday May 19th 2017, medical directors of Lagos State owned Government hospitals began interview and negotiation with quacks for a sum to be paid to the unqualified personnels who were to be engaged as locum staff to carry out medical services in various government hospitals in Lagos State.
Nurses on Air was there live as the negotiations by representatives of the ministry of health went ahead, in spite of the existing mutual agreement between Lagos State health workers and the government to run skeletal services, and cushion the negative effect of the ongoing nationwide strike on Lagosians.
In less than 48 hours after the negotiation, yours truly secured photos and video evidences of quacks resuming and taking over the premises of secondary and tertiary health institutions.
Among those seen posing as qualified health personnel were Community Health Extension Workers (CHEW) and unidentified quacks from private hospitals in Lagos state. (See pictures below).
It is a known fact that community health workers are trained to work within the Primary Health Care settings and are not authorised by any international or local law to legally practice in secondary and tertiary health institutions.
This is the first time in the history of global health systems that such unimaginable act will be carried out by any government, a possible confirmation of the dilapidated state of Nigeria's health sector with the fear of a total collapse, if there is no urgent intervention from the presidency.
Nigeria currently ranks 187th out of 190 countries in the WHO global rating of health systems, an abysmal performance and heartbreaking reality, a direct indictment on the Nigerian government and those at the helms of affairs of the Nigeria health sector.
According to health experts and analysts, the ongoing crisis tearing apart Nigerian healthcare system, has its origin rooted in the abolishment of the former law which entrusted the administration and management of Nigeria's healthcare system only into the hands of qualified health administrators.
The stage is now set for either peace or total war as LAGOS JOHESU has threatened to completely withdraw the services of its members if the ugly situation is not reversed.
As politicians gear up for the 2019 elections, there is a palpable feeling that the current scare of Ebola outbreak in Africa, the inability of the national assembly to resolve the ongoing crisis in the health sector, the increasing call for the sack of the current health minister Prof. Isaac Adewole as well as the government's perceived insensitivity to the plight of Nigerians, may all combine to turn the tables against the incumbent government.
With the harsh realities of the nationwide strike biting harder than ever, Nigerians have called on the presidency to urgently intervene and resolve the ongoing crisis before it consumes and destroy the country's health sector, with Nigerians and the APC government becoming the major casualties.
* * *

Salaries of core civil servants extremely low ―FG

tribuneonlineng.com

May 23, 2018 4:49 PM

THE Federal government has admitted that the about 80,000 of its employees who constitute the core civil service are poorly remunerated and is working on an upward review of their salaries.

Head of Civil Service of the Federation, Mrs Winifred Oyo- Ita, made this known on Wednesday in Abuja at the Service-wide sensitization workshop on 2017-2020 Federal Civil Service Strategy and Implementation Plan (FCSSIP) for Directorate Level Officers (GL 15-17) in the ministries and extra-ministerial departments.

She, however, vowed to stop the salaries of thousands of workers who have failed to update their Integrated Personnel Payroll Information System (IPPIS) records via online Portal.

She accordingly, announced May 28, 2018, as the deadline to complete the registration process.

She disclosed that the review of the salary structure of the core civil servants who are the workers in ministries and departments was part of the mandate of the Presidential Committee on Minimum Wage set up by President Muhammadu Buhari.

Oyo-Ita, who described the salaries of the core civil servants as extremely low, said this category of employees who are the backbone of the government receive fraction of salaries of their counterpart in Federal government parastatals and agencies.

She clarified that people talk about high Federal government wage bill because of these parastatals and agencies, including military, paramilitary agencies, universities and host of others that constitute the entire public service, stressing that disparity was so wide.

She noted that the current administration was committed to repositioning the civil service but insisted that this could not be achieved if the issue of salaries of workers is not taken seriously.

The Head of Service said the 2017-2020 Federal Civil Service Strategy and Implementation Plan was designed to achieve holistic overhauling of the service for effective service delivery to Nigerians.

She said: “Public service is the entire gamut of the organizations that source funds from the Federal Government and their activities are guided by extant regulations.

“When people talk about the personal cost of government being so high, they are talking about the entire public service structure. But within the public service structure, there are just a few people, which is just about 80,000 in number and these 80,000 are the core civil servants.

“It is on the shoulder of this core civil service that the entire public service and governance lies. These 80,000 people are the people in ministries and departments whose salaries are extremely low.

“For example, what a public servant in a parastatal on level 16 earns, is two and half times what a Director in a ministry earns and that Director is now meant to supervise that parastatal or agency, which he is earning a fraction of their salaries.

“These 80,000 people are the poor civil servants that really need attention. We are looking into this under the Presidential Committee on Minimum Wage. We will address all these matters so that a fair salary structure is put in place,” she said.

On the IPPIS online data registration, Oyo-Ita said: “I want to use this opportunity to draw your attention, that in spite of several circulars and advertisements in the print, radio and Television requesting employees to update their records online, some employees are yet to update their IPPIS records via the online Portal.

“The on-line Records update is a key requirement for the implementation of the HR Module of IPPIS and must be completed by every employee of the Federal Government to maintain their records on the IPPIS platform.

“I wish to inform you that the portal will close officially today 23 May 2018 but will be opened for corrections until Monday, 28 May 2018 and those that are yet to update their records are advised to do so not later than date as failure to do so will lead to stoppage of the salary of the affected employee on IPPIS platform,” she said.

CEHRA, Centre for Economic and Human Rights Advancement flag of her national office, CEHRA is a human right NGO that is set to defend the right of down trodden populace

CEHRA, Centre for Economic and Human Right Advancement flag of her national office, CEHRA is a human right NGO that is set to defend the right of down trodden populace

APC HIJACKED CDHR LAGOS BRANCH
It is no longer a news that the All Progressive Congress(APC) has finally hijacked the only mass based civil right group in Lagos state CDHR.
The committee for the defence of human rights CDHR Lagos branch has been the only viable organization that has been opposing the anti-people policies of the Lagos state government. On several occasions the CDHR Lagos branch has led several protests against the APC led government in Lagos ranging from protest against the illegal auctioning of lagosians vehicle seized by the state agent like LASTMA n VIO, call for the return of the lekki free zone land back to the original owners I.e the Idasho community, opposing the street trading law n campaign for the liberation of the market men n women, call for the removal of madam Folashade Ojo the daughter of the APC leader Asiwaju bola Tinubu, as iyaloja general and the cdhr call for the right of market men n women to indipendently elect their leaders not by impositions and the barbaric Lagos state mobile court which is in sharp contrast with administration of criminal justice system etc.
This action of the lagos state branh of cdhr does not go down well with the national leadership of d cdhr whom we suspected to have been romancing the state government therefore the national leaders of the organization with some BOT members conspired together to destabilized the branch n they started instigating some errant members of the branch that contest and lost woefully against the current state excos to be causing crisis in the branch.
The mallachy led NEC has tried in many ways to persecute the state excos led by our own authentic n the unshakeable chairman Comrade Alex Omotehinse with all manners of frivolous allegations mallachy set up a Disciplinary committee headed by one Debo Adeniran to witch-hunt the exco but as God will disappoint mallachy n his co-hurt debo committee freed the chairman n came up with a contradictory decisions yet the NEC make a pronouncement that Onagunwa that forged n sold the CDHR ID cards be returned as cordinator then the branch appealed the NEC decision to the higher authority AGC but bcs of the NEC despiration to fulfil their promise they convened an emergency NEC meeting to decide on d letter that went to AGC.
They have successfully devide the branch now by creating an APC wing of the CDHR Lagos branch with Comrade Kayode Opeifa as the chairman n Akeem Dauda (aka Lagbaja) as d secretary.
It may interest you to know that kayode opeifa is d former commissioner for transportation in Lagos state n still an active card carrying member of All Progressive Congress n also Akeem dauda (lagbaja) is an APC seating ward chairman in Ikeja Lagos state
The Branch Coordinating Council want to use this medium to inform d general public that the APC wing of CDHR has been put in place in Lagos headed by APC chieftains Opeifa n lagbaja they now use d rights house as their contact while the authenthic lagos branch of cdhr still maintain temporary secretariat at 24, ibikunle oyebanjo street opp tuns-oye int'l school opeki Ipaja lagos.

My right, is my right,is my right.

Thanks
Signed.
State Coordinating Council (BCC)
Cdhr Lagos State Branch

if you have opportunity you will do worse, you can only give sesitive appointment to those you know are capable and trust worthy, that is why our country is in the present problem. The question you need to ask is are this people qualify for the position, they are all Nigerians for God sake and being a member of RCCG is not enough to disqualify them, when Buhari apointed his son as his PA people still reacted, so what ever you do people will either speak for or against, I do not see anything wrong in what acting president has done Carry go Osinbajo (SAN)

Good one congratulation to Mr. Ahmad, it is a season of change

What is the name of the pastor, and from which church? this is a mere religion propaganda.

BB 25/10/16
MFD 26/4/16

Hollandia is selling bad yoghurt that is dangerous to health beware

The bible says the woman has no power over her body except the man so also the man, you can ask for it at anytime of the day but discuss with her and understand the real problem, could it be she need help or not enjoying it. Maybe you are always in a rush.

The righteous are as bold as lion, if he is sure of himself let him face the law and prove himself