Never ending health crisis 


GL 1

GL 2.  CONHESS 1

GL 3.  CONHESS 2

GL 4.  CONHESS 3

GL 5   CONHESS 4

GL 6   CONHESS 5

GL 7.  CONHESS 6

GL 8   CONHESS 7 

GL 9   CONHESS 8    

GL10  CONHESS 9    CONMESS 1

GL12  CONHESS 10  CONMESS 2

GL13  CONHESS 11  CONMESS 3

GL14  CONHESS 12  CONMESS 4

GL15  CONHESS 13  CONMESS 5

GL16  CONHESS 14  CONMESS 6

GL17  CONHESS 15  CONMESS 7


For the benefits of those asking us what is really happening currently in the tertiary health sector. The conflict centres around MONEY and LEADERSHIP positions which in turn is link to money. Other confounders are gross indiscipline, ego, lack of job description, failure of supervision and conflict of interest. As a whole, it is a systemic failure needing urgent, radical and wholistic repair to prevent complete collapse. 


There are currently two salary structures in the public tertiary hospitals in Nigeria. They are called CONMESS for medical doctors and CONHESS for all other hospital workers including those in the administration and accounts. CONMESS was born on 29/09/2009 via the circular SWC/S/04/S.410/220 while the CONHESS was born on 08/12/2009 through the circular SWC/S/04/S.410/Vol.II/349 of National Salary Income and Wages Commission (NSIWC) respectively. Both the two salary structures are consolidated and derived from the traditional grade level (GL) system as shown above. Note that there is no GL 11 in the traditional grading system for all civil servants which is taken care of in both CONMESS and CONHESS, hence the APPARENT lack of level skipping in them. 


The States and local government councils are still using the traditional grading system and pay less than the FG. To my knowledge only Yobe State has just started paying health workers exactly as the FG!


I will be using the traditional grade level system for ease of understanding. Very very few people including those in the Accountant General of the Federation's office easily comprehend the interrelationship of the 3 salary scales. 


Between 1998-2013, doctors and any other hospital worker of equivalent level had identical basic salary while between 2009-2013 they had identical basic salary, hazard and teaching allowances. The differences were in call allowances where doctors earned higher and specialist allowance to medical consultants or specialists on GL 15-17 only. Note that doctors on GL 15-17 that are not specialists are not PAYED specialist allowance. In 2014 relativity was restored where the basic salary of doctors became 20-50% higher than equivalent levels of other hospital workers from GL 13-17 only. There had always been differential pay relativity between doctors and other health workers from 1960 to 1998 at various ratios. In the years 1998-2013 that was when relativity was lost. When it was restored in 2014, the conflict resolution compromise was to forgo 25 years of arrears.


After graduation from medical school, a doctor practices for 12 consecutive months under supervision of a specialist or a very senior doctor of no less than GL 15 before given licence to practice independently. These group of doctors are called house officers. Pharmacists, degree nurses and medical lab scientist have similar program and they are called interns. All are now employed at GL 10. It used to be GL 10 for doctors and GL 9 for the other 3 until around 2013-2014 except for degree nurses that started internship around 2016-2017. Both earn salary for one year only because of the services they offered, but they are not regular staff and hence not the entry points in to civil service. 


The entry points (post NYSC) for doctors in to civil service were GL 12, pharmacists GL 10, medical laboratory scientists GL 10, degree nurses GL 9 and non degree nurses GL 8 in the tertiary public hospitals. In contrast entry point for degree holders in other ministries is GL 8.

In 2013 the National Industrial Court of Nigeria (NICN) passed a judgement for skipping of GL 12 for health workers on CONHESS ie any other hospital worker except doctors. So the entry point of pharmacists, medical lab scientists (and degree nurses around 2017-2018) becomes GL 13 around 2013-2014. In view of this, the entry point of doctors also shifted to GL 13 between 2016-2017. Other health workers are variously employed at GL 8-9.


Medical doctors can pursue their post graduate studies through Residency Training Program (RTP) or traditional postgraduate degrees of MSc and PhD otherwise they join the public service like any other degree holder. Doctors that join the RTP in tertiary and teaching hospitals are called Resident doctors. They gain entry only after passing an exam with a pass rate of 35-45% and average waiting time of 2-4 years. They are doctors under training to become specialists. They are temporary staffs throughout the training and get promoted only after passing exams, 2-4 years after starting the program in the first stage and 3-5 years in the second stage. This is a privilege enjoyed by 15-25% per exam. The specialist exams are conducted twice a year in Ibadan and Lagos. Other health workers including specialist medical doctors are permanently employed in the hospital. The latter are also University lecturers for teaching, research and supervision of undergraduate and postgraduate students including non doctors. 


Medical doctors with first degree in the University are employed as Lecturer II similar to PhD holders while every other degree holders are  employed as Graduate Assistants, in the military doctors occupy the rank of equivalent of army Lieutenant and 2nd lieutenant in others, DSP and ASP in police, in Custom and Immigration same, SIO1 and SIO2 in DSS respectively.


The other aspect is that of leadership. 


a) At present both the substantive and State ministers are medical doctors (prerogative of Mr President).


b) The following are departments in the Federal Ministry of Health (FMOH), ii, iii and iv are headed by medical doctors http://www.health.gov.ng/index.php/department/84-departments. 


i) Department of Procurement with two divisions; capital and recurrent.

 

ii) Department of Family Health with five divisions; Child Health, Gender adolescent school and elderly care, Health promotion, Nutrition and Reproductive Health.


iii) Department of Health Planning Research and Statistics. 


iv) Department of Public Health with eight divisions; Non-communicable diseases, Neglected Tropical diseases, Occupational health and safety, Port health services, National Tuberclosis and Leprosy Control Programme, National Malaria elimination programme, HIV AIDS and Epidemiology services. 


v) Department of Finance and Accounts.


vi) Department of Human resources.


vii) Department of Food and drug services. 


c) The following are agencies under FMOH http://www.health.gov.ng/index.php/department/79-the-ministry. Agencies i, iii and iv are headed by medical doctors.


i) National Primary Health Care Development Agency (NPHCDA).


ii) National Agency for Food & Drugs Administration and Control (NAFDAC).


iii) National Health Insurance Scheme (NHIS).


iv) National Institute of Medical Research (NIMR).


d) All the chief executives of tertiary hospitals are specialist medical doctors (Act of the National Assembly). There are 13 Federal Specialty Hospitals, 21 Federal Medical Centres and 22 Federal Teaching Hospitals http://www.health.gov.ng/index.php/department/83-parastatals. 


e) The following are directorates in the tertiary hospitals 


i) Director of Clinical Services and Training/Chairman Medical Advisory Committee headed by specialist medical doctor. There are divisions like 2 deputies headed by specialist medical doctors, (deputy) director nursing headed by a nurse, (deputy) director pharmacy headed by a pharmacist.

ii) Director of Administration headed by an administrator with divisions that include establishments, account and supply, audit, expenditure, works, nutrition, kitchen, laundry, security, etc.


f) Headship of clinical departments, clinical and training laboratories in the tertiary hospitals for teaching, training and research of undergraduate and postgraduate students. They are all headed by specialist medical doctors/unversity lecturers and in the laboratories they are also called Pathologists with units headed by optometrists, radiographers, medical scientists, technicians etc. 


In my opinion the solutions to the unending crisis in the health sector are mainly,


1. Implementation of the Presidential Committee of Experts on Inter-Professional Relationship in the Public Health Sector report by Yayale Ahmed committee submitted to FG on 19/12/2014.


2. Invitation of "foreign" experts like PricewaterhouseCoopers and Agenda for Change for proper job evaluation and placement.


3. Consideration for law amendments and the movement of all tertiary hospitals under affiliated universities. They also have their issues, but they seem to be relatively more stable. There is high academic loss in the current setting. 


4. Strengthen and make wholistic coverage the National Health Insurance Scheme (NHIS), and then privatise all tertiary hospitals. Both LGA, States and FG shall concentrate in primary and secondary health care services especially the former. In my limited opinion, this is the best long term solution to our low quality health care services in Nigeria. There shall also be active support for purely private investments in health. The investors will decide who heads or leads who, what, which and how. 


5. Positions of leadership in the FMOH, parastatals and its agencies can be tackle by the FG as it deems fit.


You can correct me where I erred. May God forgive my mistakes. 


Aknowledgement: Dr N.L. Orhue, my friends in other climes. 


ibrahim Toli

doctoli@gmail.com

You did some justice to the matter. Kudos.

What's the possibility of having a private sector analysis/evaluation of the situation? PWC like you mentioned.

The way out would have been to privatise these institutions but we know this is almost impossible at this time, for the fear of rise in cost of healthcare and medical training

The 50% percent salary increase there got me deep, I mean the government just up and increase salary like that without any recuse or evaluation. No ratio or lateral increase for others. Just like that
Total overhauling and then health administrators at the helm of affair is what we need. Harmonise all salaries and do a job evaluation... then pay salaries accordingly....

I still wonder how a neurosurgeon and cardiathoracic surgeon will be getting the same pay with a community physician. Job evaluation....

On point

Yahale Ahmed has done perfect job evaluation kudos to President Jonathan. Each member of staff has been properly evaluated based on stress of academic activity, input etc. This evaluation was agitated by Johesu. Now that the report came out and the jealous folks took a look at it and it's not in their favour, they quickly kicked against it. Solution is to implement the report and let's everyone rest.

MrBigiman:
Yahale Ahmed has done perfect job evaluation kudos to President Jonathan. Each member of staff has been properly evaluated based on stress of academic activity, input etc. This evaluation was agitated by Johesu. Now that the report came out and the jealous folks took a look at it and it's not in their favour, they quickly kicked against it. Solution is to implement the report and let's everyone rest.

Doctors are not on strike yet you are mostly online.
You must be working in a mushroom private hospital where they pay you peanut.
Sorry

Amarabae:

Doctors are not on strike yet you are mostly online.
You must be working in a mushroom private hospital where they pay you peanut.
Sorry

U know much more than any physician except surgeons. They should make u a consultant already.

Enjoy!

MrBigiman:


U know much more than any physician except surgeons. They should make u a consultant already.

Enjoy!

Make an auxilliary nurse a consultant

WesleyPepper:
Make an auxilliary nurse a consultant

Bros make she enjoy am oh. I am a very peaceful somebody.

MrBigiman:


Bros make she enjoy am oh. I am a very peaceful somebody.

No allow Hippocrates turn for him grave oo
We must not allow charlatans like her have their way !!

DrStealth:
Never ending health crisis 


GL 1

GL 2.  CONHESS 1

GL 3.  CONHESS 2

GL 4.  CONHESS 3

GL 5   CONHESS 4

GL 6   CONHESS 5

GL 7.  CONHESS 6

GL 8   CONHESS 7 

GL 9   CONHESS 8    

GL10  CONHESS 9    CONMESS 1

GL12  CONHESS 10  CONMESS 2

GL13  CONHESS 11  CONMESS 3

GL14  CONHESS 12  CONMESS 4

GL15  CONHESS 13  CONMESS 5

GL16  CONHESS 14  CONMESS 6

GL17  CONHESS 15  CONMESS 7


For the benefits of those asking us what is really happening currently in the tertiary health sector. The conflict centres around MONEY and LEADERSHIP positions which in turn is link to money. Other confounders are gross indiscipline, ego, lack of job description, failure of supervision and conflict of interest. As a whole, it is a systemic failure needing urgent, radical and wholistic repair to prevent complete collapse. 


There are currently two salary structures in the public tertiary hospitals in Nigeria. They are called CONMESS for medical doctors and CONHESS for all other hospital workers including those in the administration and accounts. CONMESS was born on 29/09/2009 via the circular SWC/S/04/S.410/220 while the CONHESS was born on 08/12/2009 through the circular SWC/S/04/S.410/Vol.II/349 of National Salary Income and Wages Commission (NSIWC) respectively. Both the two salary structures are consolidated and derived from the traditional grade level (GL) system as shown above. Note that there is no GL 11 in the traditional grading system for all civil servants which is taken care of in both CONMESS and CONHESS, hence the APPARENT lack of level skipping in them. 


The States and local government councils are still using the traditional grading system and pay less than the FG. To my knowledge only Yobe State has just started paying health workers exactly as the FG!


I will be using the traditional grade level system for ease of understanding. Very very few people including those in the Accountant General of the Federation's office easily comprehend the interrelationship of the 3 salary scales. 


Between 1998-2013, doctors and any other hospital worker of equivalent level had identical basic salary while between 2009-2013 they had identical basic salary, hazard and teaching allowances. The differences were in call allowances where doctors earned higher and specialist allowance to medical consultants or specialists on GL 15-17 only. Note that doctors on GL 15-17 that are not specialists are not PAYED specialist allowance. In 2014 relativity was restored where the basic salary of doctors became 20-50% higher than equivalent levels of other hospital workers from GL 13-17 only. There had always been differential pay relativity between doctors and other health workers from 1960 to 1998 at various ratios. In the years 1998-2013 that was when relativity was lost. When it was restored in 2014, the conflict resolution compromise was to forgo 25 years of arrears.


After graduation from medical school, a doctor practices for 12 consecutive months under supervision of a specialist or a very senior doctor of no less than GL 15 before given licence to practice independently. These group of doctors are called house officers. Pharmacists, degree nurses and medical lab scientist have similar program and they are called interns. All are now employed at GL 10. It used to be GL 10 for doctors and GL 9 for the other 3 until around 2013-2014 except for degree nurses that started internship around 2016-2017. Both earn salary for one year only because of the services they offered, but they are not regular staff and hence not the entry points in to civil service. 


The entry points (post NYSC) for doctors in to civil service were GL 12, pharmacists GL 10, medical laboratory scientists GL 10, degree nurses GL 9 and non degree nurses GL 8 in the tertiary public hospitals. In contrast entry point for degree holders in other ministries is GL 8.

thanks for the information. I jus Google today and saw this information. Please how many months/year will it take one to move from step to the next in each conmess level.ie from conmess3/3 to the next step or conmess.thanks

Hello, just seeing this though....
Is it only pharmacy,degree nursing and mls
Is physiotherapy not included?

WesleyPepper:

No allow Hippocrates turn for him grave oo
We must not allow charlatans like her have their way !!

you will be assassinated for that statement

JoannaSedley:
The 50% percent salary increase there got me deep, I mean the government just up and increase salary like that without any recuse or evaluation. No ratio or lateral increase for others. Just like that
Total overhauling and then health administrators at the helm of affair is what we need. Harmonise all salaries and do a job evaluation... then pay salaries accordingly....

I still wonder how a neurosurgeon and cardiathoracic surgeon will be getting the same pay with a community physician. Job evaluation....

life no balance. community health or public health physicians are feeling the heat of covid now. lol

Hello house
Good morning
Pls, who know the pay for doctors working with NHIS or NPHCDA (new entry doctor)
Thank you

Specialist na specialist whether neurosurgeon or family physicians, so pay must be the same because what #50 BCG vaccine will achieve, 5million naira surgery might not achieve it.