Doctors in a health-crisis system – The Guardian

The decision by the National Association of Resident Doctors (NARD), to embark on a three-day warning strike the other day, once again, set the stage for another paralysis of the nation’s health care delivery system. Nigeria, of course, cannot afford another disruption of a system already in a very bad shape and has earned the description of a health-crisis system.
Although the warning strike has ended and the doctors are back to their duty post, government should do everything to stop the main strike planned from July 1, 2014.
As usual, the warning strike brought untold hardship and agony to thousands of patients across the country. Although doctors’ industrial actions have always spelt doom for the sick and dying in hospitals, the latest came at a time it was thought government had settled all lingering issues that could cause any dispute and more pains.
Going by reports, the strike paralysed healthcare services nationwide, many hospital departments were deserted, even though they were open and the consultants were on ground with the nurses, pharmacists and other support staff to manage the situation. While skeletal services were offered to patients on admission, the Out-Patient Departments were virtually empty as no new patients were admitted. Emergency Departments suffered the same fate, leading to avoidable death of more than a few patients.
At the Lagos University Teaching Hospital (LUTH), Idi-Araba, for instance, the strike coincided with an on-going indefinite strike by doctors of the hospital over a cocktail of demands including the astronomical increase in hospital charges, which they said is affecting their training as resident doctors. The situation was the same at the National Orthopaedic Hospital, Igbobi, Neuro-Psychiatric Hospital, Yaba and University of Benin Teaching Hospital (UBTH), among others.
Consequently, families had to take their members in need of medical attention to private hospitals while those who could not afford the exorbitant charges in such hospitals resorted to unorthodox treatment.
What is worrisome is why the strikes have always been over the same issues and why these cannot be settled once and for all to save the nation unnecessary trauma!
The NARD embarked on the strike to press home its demands over non-implementation of agreements it reached with the Federal Government. According to the doctors, the issues in contention include parity in salary between doctors and other health workers; skipping grade level 12; failure to produce a blueprint on residency training in conjunction with the association and other stakeholders, among others.
According to the association, its members have become wary of going back and forth with government over its responsibility to meet the demands of NARD. On its own, the Medical and Dental Consultants Association of Nigeria (MDCAN) said government should be blamed for the incessant strikes in public hospitals in Nigeria.
As MDCAN said, the strike was unwarranted if only the government kept to its promises. Also involved in the strike are members of the Joint Health Sector Unions (JOHESU), over non-payment of promotion arrears.
So many strike actions by the doctors over the same issues, perpetually remaining unresolved leading to untold adverse consequences on the health sector are an embarrassment to Nigeria. This is the second strike by doctors within six months. The last strike was a five-day warning strike from December 18, 2013.
Why are the issues not resolved once and for all? Why must Nigerians continue to bear the brunt of strikes caused by mis-governance? When would the government learn to honour agreements it wholeheartedly reached with different labour unions? There is no doubt that Nigerians are traumatised by the spate of industrial actions ravaging the economy.
After each strike, government also has a habit of hurriedly putting up another agreement it knows it would not fulfill. That then sets the stage for another round of strike, a vicious cycle without an end. One simple explanation is that the government of Nigeria cares very little about the people for it is the people who suffer and die whenever there is any crisis in healthcare delivery. To make matters worse, it is reasonable to conclude that government officials are incapable of caring since they can afford to rush abroad for medical treatment having helped themselves sumptuously to state resources. That is why the hospitals are left in a deplorable state.
The appalling state of healthcare in Nigeria, certainly, is an embarrassment to the citizenry. The number of available doctors is grossly inadequate. The recommended doctor to patient ratio is 1:600. But according to the World Health Organisation (WHO) statistics, the ratio in Nigeria is 1:10,000. Available statistics show that there are merely 259,719 registered doctors in Nigeria catering for over 160 million people.
Furthermore, there are just 78,727 specialists and 63,780 general practitioners in the country. This is grossly inadequate and nothing is being done to improve on the situation as the poor state of the hospitals has forced thousands of Nigerian doctors to seek better working conditions in other countries.
According to reports, there are over 4,000 Nigerian doctors practising in the United Kingdom alone. The number is astronomically high when those in the United States, Europe, Middle East and elsewhere are added. It is common knowledge that some of the best specialist doctors in Europe and America are Nigerians. Indeed, according to the Nigerian Medical Association (NMA), two-thirds of Nigerian doctors are practising abroad!
Grim as this situation in Nigeria is, there is no plan to train and encourage doctors, which is part of the complaints of the National Association of Resident Doctors.
Whatever it takes must be put in place to address all issues plaguing the nation’s health sector, including meeting the demands of the NARD, as well as those of other medical unions, to save Nigerians from further suffering and the nation from further embarrassment.