THE POSITION OF THE NMA WITH RESPECT TO THE ONGOING STRIKE ACTION BY JOHESU – CHIEDOZIE JUDE ACHONWA

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It is no longer news that JOHESU has been on strike for over a month now over sundry demands which include among others equal pay with medical doctors, headship of our public hospitals. Since the strike commenced, the Nigerian Medical Association (NMA) FCT has been following up on matters arising from it. We would ordinarily have ignored JOHESU as it concerns her ongoing strike but we are at the moment constrained to respond and put the record straight to debunk JOHESU’s deliberate peddling of falsehood, twist of facts, misinformation and manufacture of non-existent figures just to hoodwink and get the sympathy of the innocent and unsuspecting public who may tend to believe their propagandaif we keep quiet. While unionism and activism is encouraged, it must not be carried to the extreme with the delusion that the system can always be brought to its knees for unreasonable, baseless and reckless demands to be acceded to. The NMA wishes to state clearly that the ongoing JOHESU strike is essentially against medical doctors in particular, and the peace-loving Nigerians in general. The unnecessary strike, we must let Nigerians know, is centered on quest for equal pay with Medical doctors as well as leadership (clinical governance) contestation in our hospitals.

Naturally when a sick person visits the Hospital, it is to see a medical doctor to get cured of his/her ailment.In getting the patient cured, several other factors come into play between the doctor and the patient. It is within these factors that the allied healthcare professionals play their supportive roles. It must however, be emphasized that these support staff only act upon the instruction or directive of the doctor. This is the standard practice world over, and is the concept of governance in clinical practice which Nigeria cannot be an exception. Apart from the fact that the training of a medical doctor is all encompassing (it covers all the fields of other healthcare professionals in addition to the core patient care and management), it is the doctor that is held accountableshould anything go wrong in the overall management of the patient. Nigerians can therefore, be the judge as to who qualifies to be the leader of the health team.

While NMA appreciates the supporting roles being played by members of allied healthcare professionals and considers them important stakeholders in the health team, it is, however, in the best interest of this country for everyone to stay within their roles as team players. Nigerians need to understand that the Hospital is structured in such a way that every treatment/instruction must be directed from the medical doctor. No patient receives anything in the Hospital unless the doctor says so. The reason is not far-fetched. It is in the best interest of the patient so that he/she is not mishandled. The outcome is better imagined when a doctor gives instruction on patient’s management and the other healthcare workers also give separate and possibly conflicting directives on the same patient. It is akin to the proverb ‘’too many cooks spoil the broth’’.The unwarranted leadership contest in the health sector by JOHESU in recent years has led to several untold hardships on our patients with attendant avoidable loss of lives in some of our public health institutions. Comparison of Nigeria health indices between the remote past and recently shows that we fared better in the former when there was orderliness, strict observance of roles, and obedience of doctors’ command with respect to patient care. Questions must be asked while this unfortunate scenario doesn’t play out in private or public-private Hospitals. The answer is obvious; everybody knows his/her boundary and must conform to laid down rules and organogram.

Concerning the quest by JOHESU to earn equal pay with doctors, it must be reiterated that NMA has never been against any wage or salary increase or adjustment for health workers. Rather, NMA has, in her numerous engagements, severally advocated for wage or salary increase for all Nigerian workers. It must be emphasized that what JOHESU is asking for is not necessarily increment in salary per se, but equal pay as doctors. They want government to pay them exactly the same amount as paid to doctors. Is a court clerk paid the same wage as a judge, or an air hostess as a pilot? The answer is definitely NO. It should be expected, therefore, that NMA will never allow JOHESU to use subterfuge and backdoor approach to become doctors. The universities are out there with clearly spelt-out guidelines for anyone who wishes to study Medicine and Dentistry. We wish to encourage JOHESU to take advantage of that rather than employing this back door approach to become ‘’doctors’’.

The concept of wage relativity is used in wage management to ensure that only equal job of equal value attract equal pay. This was succinctly and clearly stated in the judgement of National Industrial Court of Nigeria in 2006 and affirmed by same in 2013 in matters involving JOHESU. Relativity exists between the salaries of healthcare workers in the hospitals and their counterparts in other agencies and parastatals of government. Engineers, administrators and accountants in hospitals (members of JOHESU) earn between 2 to 3 times the salaries of their counterparts in the core public service. Whether this is deserved is not the question, but for the purpose of this conference, is it not contradictory, deceitful and ironical that the same healthcare workers who on onehand accepted an advantaged salary over their counterparts outside the health sector on same levels and steps will turn around to reject salary difference with the doctor who does a superior and different job from them?

Historical trend of salary award/adjustment and relativity:

Pre-independence to 1974: Practitioners of Medicine and Dentistry (medical and dental practitioners) were grouped in Senior Service Scale A which was the apex for remunerating public officers. The relativity between the salaries of medical doctors and graduates of other health sector was 1:1.58 at the entry point and 1:1.65 at the terminal point
1975:Udoji committee eroded the relativity in the health sector, and the ratio dropped to 1:1.27 at the entry point and 1:1.07 at the terminal. The NMA protested which led to the setting up of the Justice AtandaFatai-Williams presidential committee to look into the complaints in 1990.

1991: Due to the findings of that committee, circular 1, 1991 containing two separate salary structures in the health sector was released. This was following the approval of the memorandum by the Federal Executive Council at its 11th meeting in 1990. It was an attempt to correct the distorted relativity. These were:
A. Medical System Scale (MSS) for consultants and below
B. Medical System Super Scale (MSSS) for consultants Special Grades I and II.
(A and B were contained in a single circular).

C. Health System Scale (RUSS/HSS) for other health care workers.
The relativity at the entry point was 1:1.28 and 1:1.2521 at the terminal.
1993: The 45% award on salaries for public officers in 1992 was implemented on the 8th of February 1993 for doctors to restore the relativity between MSS/MSSS and other salary structures.
However, on the 9th of February 1993, a 15% award was applied to other salaries through circular CND.26/S.5/Vol.IV/380 without corresponding application to MSS/MSSS. This brought down the relativity at the entry point to 1:1.1 and 1:1.94 at the terminal.

1995: The industrial arbitration panel award of professional allowances eroded the relativity. Consequently, NARD/NMA demanded for the restoration of 1:3.33 ratio prior to the award. In response government did a comparative analysis of salary/wages worldwide and found a relativity range of 1:2 to 1:2.7. Government eventually signed an agreement with NARD on a relativity of 1:2.5

1998: The Federal government carried out harmonization of salaries. The MSS/MSSS were harmonized into HATISS for doctors in tertiary institutions and HAPSS for those in regular public service. The NMA and NARD protested to the Federal Government on what they called ‘’drop in salary’’ for those who were paid HATISS. The Association rejected the HATISS structure and asked government to pay her members with HAPSS pending a possible correction of the error they observed in HATISS. This was approved by government.

NARD complained of a distortion in relativity as a result of the harmonization of salaries. The National Salaries, Income and Wages Commission(NSIWC) did half-hearted correction of the observed errors in the conversion of MSS/MSSS into the HATISS structure. These corrections were rejected citing inadequate address of the relativity problem observed. The relativity at the entry point was 1:1.2, at all other grades it dropped to 1:1

2001: The relativity of 1:2.5 (4:2:1.7) for call duty allowance was sustained.
2006 and 2013: JOHESU went to court to seek pay parity with Doctors at the NICN but that wasn’t granted.

2014: The NMA persistent protest led to the setting up of the AlhajiGoniAji presidential committee to look into her complaints in 2013. Consequently, the Federal government signed an agreement with the NMA on relativity at each grade level with CONHESS as the reference. A circular on the correction was issued on the 3rd of January, 2014. Relativity was 1:1.2 to 1:1.5

In all it dropped from 1.58 to 1.2 for fresh doctors, and from 1.65 to 1.5 for consultantSpecial Grade 1 and or a Professor of Medicine on full appointment in a Hospital.

We wish to, at this juncture, remind the government that NMA will not accept any attempt to further distort or erode the existing relativity as agreed and signed in the collective bargaining agreement of 2014. It is important to note that this agreement was reached with a lot of comprise and sacrifice already on the part of Nigerian doctors. It is worthy of note that members at the recently held NMA ADM unanimously resolved to utilize every means legitimate to forestall any attempt to disregard or breach the said agreement. It must be placed on record that NMA has put before government issues that border on universal health coverage, improvement of health facilities and equipment as well as issues regarding conditions of service. It is our hope that government, while engaging in dialogue on these matters with a view to making progress, will not precipitateanother crisis by bowing and acceding to pressure from JOHESU.
Doctors in the FCT have been going about their legitimate duties in all public health facilities. They have had to go extra miles to cover for the absence of the allied health professionals in order to ensure service delivery to patients. Management of our public health institutions have been visited and encouraged to create an enabling environment for doctors to carry out their duties and we are very much satisfied with their cooperation. We wish to seize this opportunity to call on patients who may have mistakenly fallen for the propaganda of JOHESU that the entire health institutions have been locked down by their strike to visit and access care from our Hospitals.
We urge the allied health professionals to be reasonable in their demands, suspend their strike, return back to work to join the doctors to continue the good work for the benefit of the masses.

Dr. Chiedozie Jude Achonwa Dr. AbdullahiNasiru
Chairman, NMA-FCT Secretary, NMA-FCT

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