On July 1, 2014, the Nigeria Medical Association, NMA – umbrella body for medical profession in Nigeria, embarked on nationwide indefinite strike to press for implementation of a 24-point demand from the Federal government.

On Monday July 7, the NMA held an emergency delegates meeting with top government officials in Abuja.

The meeting, which lasted eight hours, had in attendance NMA delegates from the 36 states of the Federation and the Federal Capital territory, FCT. Representing the Federal government were Minister of Health, Professor Onyebuchi Chukwu, Governor Emmanuel Uduaghan of Delta State; Chairman of the Senate Committee on Health, Senator Ifeanyi Okowa, and Chairman, House of Representatives Committee on Health.

At the meeting, widely regarded as a last ditch effort to reach an amicable settlement, negotiations hit the rocks. Government felt it had made significant concessions, but the doctors were dissatisfied with the outcome of the meeting and resolved not to return to work until all their demands have been met.

Good Health Weekly caught up with the Health Minister, and Chairman of the NMA Lagos State branch, Dr. Francis Faduyile, shortly after the meeting. Excerpts of their responses are reproduced below.

Strike should not have taken place – Chukwu

“We are responding to their demands. After we met them on Thursday, we achieved something and they were able to get their members as a matter of duty to render emergency services and we had hoped that by this morning we will be happy to have them at their various stations.

I got a call that made it clear to me that after our long overnight meeting, they resolved not to go back to work, despite the fact that I was there personally around 11p.m. to address them.

Our colleague, Governor Emmanuel Uduaghan of Delta State also came in person to lend a voice; as well as the Chairman, Senate Committee on Health, Chairman, House of Representatives Committee on Health were also there and pleaded with our colleagues.

The doctors should return to work but this has not happened. As a doctor, and without sounding immodest, I’m convinced this is one strike that should not have taken place. With all sense of responsibility, I have gone through everything and even what we achieved on Thursday was just like a re-read. There is nothing new being introduced.

Circular: One is that a circular that was issued by government through our collective effort in January to ensure that distortion in relativity, which happened around 2014. We addressed it with a circular and they are aware that as of the time the President approved it, because it has financial implication, the budget had already been presented. And this was clearly made known to the NMA that there may be difficulty, which they accepted.

The President also told us that he has already directed the Ministry of Finance that once we have an appropriation act, she should do her utmost to see how we can begin to pay and we knew how long it took for the Appropriation Bill to become law. So, we pleaded that since we are working on it along with the Federal Ministry of Finance and because it was almost nearing the end of the journey that they should be patient. This is something that did not exist until January. It is totally new. To now demand this money that the accrued arrears since January until they have the alert on their phone they will not call off the strike.

Skipping: The second condition has to do with skipping. Skipping started in 1991. But it was not done by doctors. It was unauthorised but allowed for the non-doctors. After I came to office, I worked with a circular made by the head of civil service of the Federation, I became the first minister to stop skipping because I have gone through some programmes as prescribed by the council and tells what needed to be done up to this moment. So, we did not skip in 2011 and 2012.

After then, there union exercised their fundamental human right and then went to court. And the national industrial court ruled that since government has permitted them for a long time to skip even though unathorised, they must be negotiation before reversal. We have appealed that ruling as a means to obey the rule of law.

But our colleagues now said they are been cheated that even if they are to wait for the outcome of the appeal, they were not gaining what others are gaining and that government should begin skipping for them. They said they are willing to allow government to stop skipping if the court ruled in favour of it. Our negotiators accepted and work out modalities on that.

Consultancy: The third reason the doctors gave for not returning to work today (Tuesday) was the issue of consultants. Since the 70s to 90s non -medical doctors have been appointed by various hospitals and those hospitals are been managed by medical doctors. There is no medical director that is a non- doctor. But our colleagues appoint others as consultants within the hospital setting.

Again, when NMA complained and I stopped it. It was also the reason why others went to court and the court ruled that the ministry and government have the right to decide who should be a consultant in their hospitals. Those that were already enjoying that status before the ruling were asked to retain that position. We have also appealed the position but asked the Ministry to disobey the court, which is not possible. I am for the rule of law. If they were the one that got the judgment in their favour, will they expect government not to implement?”

We can no longer trust Govt

– Faduyile

“We can no longer trust the government judging from its activities in the past. We could not suspend the strike because when we looked at the documents that the negotiating team discussed and brought with the government. We observed that there are so many areas that are very ambiguous and the issues that we needed to get what we requested for were not fully addressed.

We observed that in recent time that the government is in the habit of saying I will do this for you and you will come back in another three months and they will still be on the same spot. So it is better for us to resolve issues once and for all so that we do not go in and out of strike action. Athough government has almost met all the demands, we cannot take such a risk to avoid a repeat of the strike in the future.

Areas still in contention: For instance, government views on the issue of directorate, the Act that sets up Teaching Hospital stated that you can only have three directors. Even with these three directorates we have areas where we have many directors like Ife, they have just appointed a director and if you are saying three directors and you see people having that, and we have not seen you taking concerted effort, it just looks to us that the Minister is playing hide and seek.

NMA is not saying anybody cannot be consultant but, yes, in a hospital setting, those appellations are not right. In those places where there are consultants, they are not within pure hospital setting. These are the things we want them to clarify in black and white so that we do not come again in another two months and start another argument or crisis.

Budget: They signed circular in January, up till to date, they have not effected it. They said it is because they want to add it into the budget but after the budget was done they said is not in the budget.

We did not argue, now that we discuss with them they now said they will look at how it will be in the next six weeks for us to come and sit down and see how far they have gone. This is what we did not agree with because earlier on, they did not show any commitment or present any clear documentation.

Sympathy with patients: The case of the patients is actually pathetic. It is a pity we are on strike. The doctors love the patient and we want to work. However, if we continue this way, patients will suffer more in future than what we are suffering now in the hospital. So it is good for us to once and for all clear it so that we can have a better patient management in future.

Government has done much but they can do more if they show some commitment.”