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For over five weeks, medical services in public health institutions across the nation have been paralysed as a result of industrial action by health sector workers under the aegis of the Joint Health Sector Unions, JOHESU.


However, the workers have agreed to suspend the strike tomorrow.

In a chat with President of Nigeria Labour Congress, NLC, which most of the striking workers are affiliated to, Comrade Ayuba Wabba, speaks on the strike and how to end industrial unrest  in the health sector. The interview was conducted before JOHESU agreed to suspend the strike.

First, this situation is getting out of hand because it has taken longer than necessary. Two, the needful has not been done, because issues of industrial relations like this require prompt and adequate attention particularly that those issues are issues related to a Collective Bargaining Agreement, CBA, that was fully signed and also a pronouncement of the Industrial Court. I am aware that those issues have taken more than three years now.

We have several agreements that have been signed, several MoUs that have been signed towards addressing the issues but every time, those agreements have not been consummated. That is why the issues have lingered for a very long time. I am also aware that the issues of cadre interests have actually come in, and that is why the issues have been prolonged.

The health system can only function if the workers work as a team, because every health worker in the team has a role and responsibility. It is only when they work harmoniously that they would be able to deliver on their mandate. Even the person cleaning the hospital has a responsibility that is very central because it is a place where you need to maintain the highest level of hygiene for the patient to receive the best of treatment. Same with a nurse; a surgeon can do the best of surgery, but if there is no quality nursing care that would ensure that the wound heals, it would be in jeopardy.

So, everybody is as important as the other. It is just like a football team, where you have a goalkeeper, the defenders, mid-fielders and the strikers. You can’t say it is only the goalkeeper that is important or the strikers, no, everybody is important and it is when the team works harmoniously that they would be able to win a game. The defender is important because if you don’t take care of him and you concede too  many goals, if you have the best of strikers, it means the team will not work optimally. This is the same with the health system.

The health system must work as a team and in that team, everybody is very important.   In fact, what is happening is long expected, when they increased the salaries of doctors two times and left the other health professionals; you should know that this issue will come up. Therefore, managing it for the past two or three years has not taken us to the final destination and therefore, it is still a challenge.

Whatever the issue, the court or sack may not address the it. What will address the issue is for government to create a neutral platform; bring technocrats, lawyers and others that will look at the entire quagmire and give a pronouncement that will be fair and be in line with best global practices to which everybody will conform. That would be the best situation not allowing the Minister or somebody that has an interest, because the Minister of Health is a physician, so, he has a vested interest.

So, my recommendation to address this issue is to get somebody that is neutral. You remember during the last administration when the issue was getting out of hand, they brought in the Secretary to the Government of the Federation to actually lead the discussion and that was how he was able to know the truth and said no.

The Ministry of Health should not have gone this way, and the unions would not have gone this way, let us look at it this way. That was how the last agreement was signed because it was also the same mistake that was made when they increased CONMESS and left out health professionals as far back as 2009. That was what brought about the issue. That was how JOHESU was formed, and because they were left out, they have to agitate. In fact, it was a long process of negotiations which led to the signing of 2009 agreement which addressed the issue.

But now, an increase has been made in a sector where there is a team work and you have not been able to accommodate the other party. Again,  saying that they are demanding for the same salary structure as the medical doctors is not correct and the impression has to be made very clear. There is no way other professionals are going to be paid the same salary.

Parity

There used to be the issue of parity; even at the point of entry, they don’t enter the service at the same level. Other health professionals enter the service at nine and 10, physicians or doctors enter the service at 12. So, already, at the point of entry, there is the issue of parity created. Clearly speaking, that is a deviation from the real issue. The real issue is that there is a problem, and from the discussions that I have had, nobody has said there is no issue, either government or the Ministry of Health or even the health workers.

Everybody agreed that there is a problem and that discussion is going on and that government has made an offer while the unions had made a counter-offer. So, that is the reality, going any other direction rather than tested process of collective bargaining which is enshrined in ILO Convention 87 and 98 and in our Labour Law, will not bring about peace, stability and progress in the health sector. If everybody is happy, the health sector will work optimally.

Administrators

What has happened is clearly about management process. Let me give you an example; recently, Kenya was in the same quagmire and the government  took drastic decision. The first decision was to get technocrats to manage the administrative aspect of hospitals. Kenya did that, they addressed the issue and the issue died naturally. They said the issues of clinical service, professional service and management and administration are different.

The issue of core administration should be handled by competent administrators who are vast in administration. That was what Kenya did that brought about peace. This issue of muddling up administration and clinical issues has created more problems. We must also look at global best practices.

What is the situation in other countries? Ghana operates what we call single spine salary structure where every professional comes in, you fit in according to your grade level and that has addressed the issue. Same in countries like US and UK. Whereas in Nigeria, where they say if you obtain the highest level of qualification as a nurse or a pharmacist, even with a PhD, (we have Phds and professors now in Nursing care, and in pharmacy and they are appointed as consultants); but someone woke up one day and said the word ‘consultant’ can only be used by a clinician.

That is not in line with the best global practices because in the UK, we have nurses that have acquired the relevant qualifications, they are called consultants in nursing services, we have consultants in pharmaceutical services. Today, Lagos State appointed a consultant in pharmaceutical services. They created a grade known as consultant pharmacist. Once you acquire the qualification and standard, you must be so appointed.

 Skipping

We have the issue of double standard. If we are strictly going by the rule of law, we must apply rule of law. Take for instance the issue of skipping. The issue of skipping applies only to other health professionals, but five years back, someone woke up and said the issue of skipping which is a service wide issue, should be stopped for other health professionals.

That issue was tested in the court of law and the court said no, just as you skip from 10 to 12 in the core civil service, these workers in the other professions should be allowed to skip.   That was accepted, but instead of applying that strictly to those that it applies to, they extended it and I am aware that Salaries and Wages Commission issued a circular to say that the issue of skipping is only limited to this cadre but you can see illegality and double standards. They extended it and that is also part of the problem today.

Resolution

Our recommendation is to bring in neutral people, competent lawyers, administrators and people who are neutral.  Let us present the facts, let them look at them in comparison with what is obtainable in the other sphere,  and then try to give a direction that government will conform with. The issue of using your position of authority to try to undermine due process or give false information, will not assist because I have seen in the media where some of those confidential information have to be provided because somebody lied that there was no agreement.



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