BY FEMI OGUNYEMI
A GOVERNMENT official once told me : ” You people (doctors) should do as we say; after all we pay your salaries”.
And a colleague once said to me: “They (government) should just give us what we want.”
Both are wrong; and herein lies the locus of persistent conflict.
Government’s action impinges on ALL doctors, including those whose salary they don’t pay.
And my colleague would be better served in getting what “has been agreed” rather than what he “wants”. Subtle differences but key to understanding the nature of negotiation.
It reminds me of advice a Professor gave me many years ago regarding negotiating employment contracts in new jobs: “Meet YOUR needs by making the other party happy that you’ve met THEIR needs”. Everyone wins. Tricky, but it works.
Why do doctors strike?
Contrary to what some might think, doctors do have a right to strike. According to the ILO, every worker does.
The impact of such a strike on the community, economy and the profession itself is severe, especially in developing countries like Nigeria. All stakeholders and involved groups must take an ethical approach and share a moral obligation to put society first.
There are three main reasons why doctors strike:
*Medical practice, and the doctor-patient relationship continues to change. Patient care decision-making, in both public and private practice, is now shared between employer requirements, patient demands, insurance companies, other third party payers, and government regulations. The doctor is no more the sole determinant of patient care and there is some frustration from this disempowerment. Doctors have become like any other employee who must sometimes negotiate wages and compensation to meet personal economic needs.
*Doctors may have a genuine dissatisfaction with inadequate facilities, drugs, and lack of support from employers and elected government officials. Non- physicians often quote the Hippocratic Oath: “The health of my patient will be my first consideration” as a reason that doctors should NOT go on strike. In fact, when doctors feel they are unable to provide safe and effective care for their patients, the Oath may be the exact reason they should strike; the “first, do no harm” principle.
*The failure of government and employers to honour collective bargaining agreements, CBAs, for improved wages and conditions of service is a major crucial reason in Nigeria. A signed MOU is an agreement; a pact. Failure, refusal or delay in implementation breeds distrust and a perception of a lack of commitment. This not only presents immediate conflict but prejudices future negotiations.
The NMA had listed 24 “demands” of government. I had planned to address each of these issues in this article but will defer that for now.
However, having written three reviews (Vanguard Newspapers April/May 2014) on the National Health Bill 2014, I must reiterate that this Bill MUST NOT be signed by President Goodluck Jonathan in its present form.
The NMA should actually take a lead role in its public review!
Nine of the 24 “demands” appear to be directly related to what I call SCC, that is Salaries, Compensation and Conditions of service. These are @3, 5, 8, 9, 10, 11, 14, 17 and 21.
The problem for doctors is that their SCC is lumped together with the rest of the civil service as they are considered by government to be like any other “public service employee”.
There is an inherent mistake in this philosophy. A doctor is not something you do, it is something you are!
This is why it is so much more difficult for doctors to simply discontinue practising medicine, and it makes them susceptible to exploitation in negotiations.
How to end doctors strikes (FOREVER) in Nigeria
*The establishment of a clearly defined, mutually agreed condition of service for doctors, is the single most dramatic step in halting doctors strikes in Nigeria.
The UK NHS is the biggest government run health service in the world. There is a distinct code of service for doctors, entirely separate from the civil service.
Let’s look at the NHS Terms and Conditions of Service Handbook. There are seven parts.
Part 2 deals with PAY: pay structure, maintaining round the clock services, overtime payments, pay in high cost areas, recruitment and retention premia, career and pay progression.
Part 3 deals with Terms and Conditions of Service: hours of the working week, part time employees and fixed time contracts, contractual continuity of care, annual leave and general public holidays, sickness absence, maternity leave and pay, redundancy pay, travel cost reimbursement, subsistence allowances, mutually agreed (their words) resignation schemes, whistleblowing and injury allowance.
One can see from the above why there was no doctors strike in the UK for 37 years! After a strike in 1975, that of June 2012 was a mere 24 hour revolt to highlight pension disagreements.
*Legitimate Collective Bargaining Agreements, CBAs, must be respected and implemented in a timely manner. The courts, and mutually agreed arbitration panels, must be involved.
*The importance of ethics must be integrated into the profession, the government and employers. ALL parties have a moral obligation to society.
* The profession must resist the impulse to make economic demands beyond the capacity of the employer (government) or which could hinder the provision of other services like education or public utilities. Doctors have a duty of care to patients, while government has a duty of care to the public. Fortunately, or unfortunately, they are one and the same. Some demands may also require legislation by the National Assembly; this will take time.
* Government should resist the urge to arbitrarily call certain groups of workers as “essential services” so as to deny them a right to strike. In fact, if such workers are considered “essential” then they deserve a separate mechanism of pay and service conditions.
* Both parties must put forward trained and skilled negotiators.
* Government must avoid threats of unjustifiable disciplinary action.
* The media, TV, newspapers, radio, and social media is crucial to ALL parties in communicating with the general public. To garner public support and understanding, disagreements and agreements must be transparent.
* The NMA should embark on a major membership drive to include ALL registered Nigerian doctors. These members should be regularly surveyed, balloted and informed on all matters being discussed on their behalf.
* Finally the MDCN, the doctors’ regulatory body, has a duty in restoration of respect to the profession. There is a feeling that professional standing may have been diminished by repeated strikes in the past. The MDCN can encourage and accredit more CPD activities in the fields of management and administration. They can design and monitor a code of standards of good medical practice in Nigeria.