The Nigerian Medical
Association, NMA, an
association of all medical
doctors in Nigeria on July 1
embarked on a nationwide
strike.
With the NMA strike, doctors
working in government-
owned hospitals have
boycotted work, leaving
majority of sick Nigerians
stranded.
In an open letter to the
Secretary to the Government
of the Federation, Pius
Anyim, on June 11, the
association listed a 24
‘minimum point’ demand
which it expected
government to meet before
its members would return to
work.
The letter was titled “Facing
the Challenges in the Health
Sector”.
However on Thursday,
President Goodluck Jonathan
ordered the sack of all
resident doctors in Nigeria.
Mr. Jonathan directed the
suspension of all Residency
Training Programme and the
hiring of part-time medical
officers to replace the
doctors.
The inadequate funding of
the Residency Training
Programme is one of the
reasons the NMA is
aggrieved.
Below is a list of the
challenges faced by the
NMA:
1. A demand that seven
Deputy Chairman Medical
Advisory Committee, DCMAC
(four for Teaching Hospitals
and three for Federal Medical
Centers be appointed to
assist the Chairman Medical
Advisory Committee, CMAC.
The association noted that
the CMAC is presently
saddled with statutory
responsibilities that are too
heavy for an individual to
handle. The DCMACs is
expected to have the same
qualifications as the CMACs.
The NMA also argued that
directors in other
government establishments
are supported by deputies
and sees no reason while
that of the CMACs should be
different.
2. The association opposed
the appointment of directors
in hospitals. The position, it
said, distorts the chain of
command and induces
anarchy while exposing
patients to conflicting
treatment and management
directives with mostly
negative consequences.
3. A demand that grade level
12 (CONMESS 2) in the health
sector be skipped for
medical and dental
practitioners.
4. The association also
demand that the title
‘Consultant’ should not be
assigned to non-doctor
personnel. Arguing that
consultant describes the
relationship between a
specialist medical doctor and
his patients, the association
said that giving the title to a
non-doctor personnel will
only lead to anarchy and
chaos in the system.
5. The immediate
implementation of a January
3, 2014 circular and
immediate payment of the
arrears for 22 years during
which members were short-
changed. It also demand an
adjustment of doctor’s salary
to maintain the relativity as
agreed.
6. The acceleration of the
passage of the National
Health Bill and extension of
the Universal Health
Coverage to cover 100 per
cent of Nigerians rather than
30 per cent as currently
prescribed by the National
Health Insurance Scheme,
NHIS.
7. Appointment of a Surgeon
General of the Federation
with immediate effect.
8. A correction of entry point
of a health officer to
CONMESS 1 Step 4 as
originally contained in MSS/
MSSS while the Registrar/
Medical officer is moved to
CONMESS 3 Step 3.
9. Call duty allowance for
Honorary Consultants should
be increased by 90 per cent.
10. An adjustment in the
specialist allowance as
contained in the 2009
collective bargaining
agreement. Also all doctors
on CONMESS 3 and above
must be paid specialist
allowance or its equivalent,
not less than 50 per cent
higher than what is paid to
other health workers.
11. Hazard allowance for
medical doctors must be at
least N100, 000 per month.
The hazard allowance for
medical doctors is said to be
at N5, 000 per month
presently.
12. Immediate release of the
circular on rural posting,
teaching and other
allowances which must
include house officers.
13. An immediate withdrawal
of a circular by the Central
Bank of Nigeria, CBN
authorizing Medical
Laboratory Science Council of
Nigeria, MLSCN to approve
licenses for importation of
In-Vitro Diagnostics, IVDs.
14. Immediate release of the
circular for the retirement
age for medical doctors as
agreed with the Federal
Government.
15. The FG through the
health ministry should
formalize and implement the
report of the interagency
committee on residency
training. The FG is expected
to release the uniform
template on the appointment
of resident doctors in line
with earlier agreements. Also
a concrete funding
framework for residency
training must be established
while the overseas clinical
attachment must be fully
restored and properly
funded in the interest of the
nation.
16. That in the interest of
harmony in the Federal
Medical Centre, Owerri, the
government should pay the
salaries of our members in
the center as agreed on
October 21, 2013.
17. Immediate concrete
steps must be put in place
for the reintegration of our
members back into the IPPIS
platform.
18. All attempts to coerce
house officers not to join
NARD must stop.
19. The orchestrated
intimidation, harassment and
physical assault of our
members in the departments
of pathology (Laboratory
medicine) by laboratory
scientists and tolerated by
the Federal Ministry of Health
must stop.
20. The endless circle of
incomplete salary payment of
our members in many
hospitals in the name of
shortfalls in personnel cost
must stop.
21. Universal applicability of
all establishment circulars on
the renumeration and
conditions of service for
doctors at all levels of
government must be
granted.
22. Government should as a
matter of urgency set up a
health trust fund that will
enhance the upgrading of
hospitals in Nigeria.
23. The position of the Chief
Medical Director/ Medical
Director must continue to be
occupied by a medical doctor
as contained in the Act
establishing the tertiary
hospitals. This position
remains sacrosanct and
untouchable.
24. The NMA henceforth shall
not accept the continued
violation of any of any of the
terms of the 2009 Collective
Bargaining Agreement. This
is exemplified by the
payment of the Medical
Physicist and Optometrist
with OD (who are on
CONHESS) call duty
allowance using CONMESS
circular. Similarly, the phrase,
“Ministries, Departments and
Agencies”, MDAs in the said
agreement should replace
“Federal Ministry of Health
and other Federal Health
Institutions” as contained in
the 2009 CONMESS circular.
Facebook Share Twitter
Share

Hi guys. Glad to join u hia 2day, my first time. However, İ had been peeping into nairaland for ova 2yrs. İ enjoy d viewpoints of u all. Permit me to dwell on some of the issues having to do with the docs and healthcare.
Sacking RDs or suspending d prog is simply a serious issue. This will impact negatively on our healthcare. Our dr numbers were alredy criticaly low. So any shock in residency prog wil threaten the supply of specialist docs in future.But who wud expect GEJ to hav don otherwise given dat docs took up a prolongd strike in the face of pubhealth emergency linkd to ebola and terorism!B4 d sack, docs had bn off wok fo ova 6wks and people tried to cope. Perhaps people could keep copin til d prog is restored. Elswhere its a good step to suspend any activity believd to have become unfit for purpose; this helps in evaluating the challenges and replanning steps.And thats simply wot FG gave as a reason.But FG is supposed to hav designd an efective plan B. Howeva does a med consultant or RD traind free of charge by de taxpayer and paid salaries while being traind need to use strikes to hold de taxpayer to ransom b4 allowing d taxpayer enjoy the fruit of taxpayers labor!!İts incredible that docs wud down tools to prove if the nurse or others are able to do the work of the doc or replace them!! This is not what d doc is trained to do and docs in US and UK don’t reduce themselves like this!!
Now why do we need to fault the president for this action. Is this step not likely to be in the nation’s best interest! After all this action was probably advised by med docs: uduagham, 2 ministers, okupe and numerous others in politics.
Nonetheless, it is a painful experience. If dis action lingers it means docs will find it hard to move ahead in their career. But have d docs ever pondered that this is simulative to the mess other health workers’ suffer due to docs suppressing, undermining, and blocking other health workers’ career progress!!Docs want to grow in their career but don’t want others to do so ignoring that improved healthcare delivery calls for advancement in all healthcare disciplines. Just like a med consultant contributes to training of students and RDs, a nurse consultant is there to enhance training of nursing students and would-be nurse consultants thus bringing about standard nursing practice and optimum patient outcome. This is how it works in climes to witch Nigerians are gravitating for medical care. I have noticed this is what other health workers have been suffering in the hands of docs in Nigeria. No doubt this marginalisation is one of the causes of the crises in the health sector and not because nurses and others envy med docs.
Two, for ova 30yrs docs hav bn running things in our healthcare with abysmally poor results. Dont u think sth is wrong in ur approach with which you are managing the hospitals and the health ministries at the three tiers of government!! May be Nigeria can try other hands including hospital/health administrators. This is how it is done overseas where Nigerian RDs want to go to for one year overseas training.
Imagine where Nigerian doctors will advertise nursing vacancies for nursing officers 1 and 2 only but advertise positions for medical consultants and registrars. This means that nurses with advanced degrees should not think of having a career in our health care system. Imagine where a CMD/MD employs a nurse with over 20 years work experience on level 9!!!! Imagine when a CMD/MD fails benches a nurse on a certain grade for 12 years or more!! Imagine when a CMD/MD refuses to approve a nurse’s application for training for Bsc or Msc or simple conference or seminar not even to talk of overseas training. So you see the docs style of running our healthcare have killed other health workers careers completely. And this is the reason why health care delivery in Nigeria is poor simply because the docs keep undermining other career development. If the nurse becomes a consultant, does s/he have to answer a consultant physician or surgeon; is s/he not going to answer a consultant so or so nurse! So how would this title threaten the office of the consultant med doc or compromise patient outcome!! And what has the doctor got to dictate the career progression or direction of other health professionals!!!!!
There are several arguments about who heads the health team. I do not think this should be a problem. Traditionally, the doctor is the head of the team just like the chairman heads a meeting. However this does not mean that in a team the doctor is accountable for the practice of a nurse or that the nurse reports to the doctor. For example, if the consultant is subpoenaed over a patient case, the doctor will defend his practice simply as a doctor and the head of the team. The nurse will be needed to defend his or her nursing care of the case as a nurse and member of the same team, the nurse will be held liable for not doing his or her work including not calling the physician or any other team member to other. This clarifies claims that the doctor owns the patient. The patient is owned by the hospital with care responsibility shared among the health team members. The doctor owns the patient as a doctor while the nurse owns the same patient as a nurse. If the doctor admits a patient, the doctor does so according to his profession’s and the hospital’s protocols and draws up his care plan. Accordingly the nurse admits the same patient according nursing’s and the same hospital’s protocols and formulates a nursing care plan which includes cares that the nurse will ask the doctor and other team members to give to the patient. This is how it works in nations that we cite as best practice examples. So what you head the health team for really is not to bully, suppress or undermine others but to ensure that every team members contribute positively and optimally to the care of the patient and that the team works effectively. But it is not only the doctor that does this. The nurse is a clinical leader and clinical leadership implies that every team member is supported to function effectively and that care outcome is of high quality. Thus the nurse can report the consultant (who claims to own the Nigeria patient) for poor practice with the consultant investigated and disciplined. In other words the patient belongs to the healthcare team and not the consultant. This is what leadership and responsibility are all about in contemporary healthcare practice. And this is how clinical leadership works in nations that Nigeria sites as examples of well run health care systems. It has nothing to do with whether you had X years in medical school plus X years in residency or whether you crushed all the human skull before becoming a medical doctor because such are part of the demands of your course and you are fully compensated by an entry point of grade level 12 as a medical officer or 15 as a consultant together with superior allowances. Docs u people need to re-examine ur attitudes.