Lagos State Commissioner for Health, Dr. Jide Idris who confirmed that the government is tired of strikes in an interview with Sola Ogundipe & Chioma Obinna, in this concluding part of the interview said the sacking of 788 striking doctors was a difficult decision for the government but was taken in the overall interest of the health sector.

He also denies claims that the decision to sack the doctors was deliberate action the government felt happy doing, stressing that it was necessary action to take to save the system. Excerpts:

THE argument is that doctors know the civil service regulation and signed the agreement so why would they now fault it?

They have continuously done this over the years and of course, because of the need for peace, government continued to bend over, but for how long? The last time they went on strike, all those who went on the strike got full pay among other things. So government opted for the short term effect by sacking the doctors? There is need to restructure the system especially the human resources aspect, and sacking is part of the overall restructuring of the system in terms of engagement, code of ethics, and performance evaluation.

More deaths are recorded outside of strike actions than during strikes. Studies have been done on this and we are doing more studies in Lagos to see the outcome.

Restructuring programme

We know many doctors do not stay at work during working hours; they don’t control their juniors, while others run their own practice on government time. There has to be some point where all this must come to a stop. The restructuring programme that is going on with the human resource system will take care of that.

Will the sacking of doctors not affect the curriculum of the medical college?

No it will not. We have had discussions with the College (LASUCOM) on that basis. In the short term, it will not. Even before the dismissal, doctors were overworked, so how do we rationalise this with the situation where there are fewer doctors? If the system is properly restructured, all this will be taken care of. A doctor can claim to be seeing 200 patients in a day, the question is how effectively? What is the yardstick? We understand the load, but from what has been happening in the system of late, this is not necessarily the case. Some doctors do not get to the office before 10.00AM, yet get full pay for the hours they work.

The performance aspect needs to be assessed. There will be retraining of the new doctors. The doctors coming in are not green, they were trained in the same facility, those we trained before, 90 percent of them leave. As part of the restructuring now, we train in the context of strengthening the system, the seniors are there, and it is the same patients. Effecting a change is never easy.

Don’t you think the patients are still the victims while this restructuring is on going?
I agree with you and that is our priority now to try as much as possible to reduce the effect. Before they went on strike, patients were victims, they had complaints. But again, patients were still victims but our priority now is for us to reduce the negative of that consequence.

It has been said in some circles that the number of doctors actually recruited is lower than the 373 being announced. What is your comment?

Yes, we have approval to recruit 373. We have applications from different areas. But we can’t just recruit immediately.  They have to go through some examinations and interviews and orientations. They are being deployed in batches.  Some of them are going to be for short term basis and some for longer term. It is going to take time.

The NMA Lagos, accused the government of engaging doctors as casual staff. What is the position on this?
I don’t understand what you mean by casual staff. If you employ on locum basis, you don’t consider the doctors as casual staff, rather, you are just engaging for some hours. Some doctors are willing to accept that, using their spare time. When you have shortage, will you say no?

They have locum staff in some of their private clinics. Locum engagement is an international standard. The problem with our people is that they want to work permanently. They want permanent seats so that they can do anything, which is good. But again, when you get there, is your performance related to it?

Teaching allowance for house officers

Teaching allowance for House officers, should have also shift ground a little and allow peace to reign? One, the State government shifted ground on so many things. Two, the state government reserves the right to determine its own policy. When her policy was determined, it took into consideration on the consequences on the entire system. Like I did say, if you continue to pay house officers teaching allowance, you have no moral obligation not to pay the junior nurses, the pharmacists, and then quantify that in terms of cost. If the federal government can pay that, how much of the federal resources accrue to Federal Government?  They have the wherewithal. But the problem is that our state government has said that, if we have more resources we will have pay more.  At least as from now, what we are paying, how many States are paying considering the size of people we deal with? Besides, is it by force you must work for the state government?

Many have described the measure taken by the state government as strong arm tactics. Is this the only solution?
Like I told, the decision to sack was not deliberate. It is not something government felt happy doing.  But it is something we felt was necessary to do to save the system that is number one.  It may mean an end to or to address some certain issue. Like I did say, one of the attributes of leadership is that you take some hard decisions as at when necessary to save the situation. I don’t consider it as a strong arm tactics. If you look at when it started, every single thing government promised to do, government has done. If there were mistake in the implementation, yes, we have admitted those mistakes are being corrected. Government has appealed; government has called them to order. Other people had come in. Why would you call it a strong arm tactics?  I don’t consider it as a strong arm tactics.

As a government official, a medical professional and a Nigerian, what is your admonition, to healthcare providers and leaders in charge so that peace continues to reign within the system?

This issue is nationwide. The health system is known for things like this because there are many players. For doctors, there are codes of ethics.

Both sides need to consider their roles and responsibilities in ensuring peace. The government must do what is required of it.  The doctors must not because of the peculiarity of their work start playing god. I think the situation is more of understanding of individual roles and trying to blend those roles together.

Unfortunately in this country, one of the problems has to do with inequity from the top. Up till now, we don’t still have a health Bill that will specify things.  There is duplication of roles at the Federal and state levels. I don’t see how the Federal will enact a policy in a federation and you are forcing everybody. There are different ways of looking at it.  In fact, the system is not perfect.

In fact it is far from perfect and it is going to take concerted efforts between government and the professionals, not only the doctors now but all the major actors in the health system to sit together. There is so much suspicion now and one of the issues is that doctors supposed to be the leader of the team.

The leadership role is being challenge by the other members of the team which is one of the major causes of the strike of other health workers.

From what have just said, it may be right or wrong; it appears there is no going back on the decision of the government?

Like I did say, I won’t preempt the decision.  It is a hard decision to take. But again, I don’t feel happy as a doctor being forced to take this kind of decision but again; I belong in the system to see what will be in the system.