The health sector has been in the news for some time. But this time, it is about the disagreement between medical doctors and other health workers. The bone of contention is the demand by registered unions for the scrapping of the Consolidated Health Sector Salary Structure (CONHESS), which gives more cash to medical doctors than other workers in the sector. Medical doctors say the workers’demand is an invitation to anarchy, writes DUPE OLAOYE-OSINKOLU
TROUBLE is brewing as paramedics are up in arms against the medical doctors, who they say, are being over-pampered by the government.
Medical doctors on their part said unions of other health workers are inviting anarchy by seeking parity in salary with them. The other health workers on the other hand, are asking the government to stop paying the doctors Consolidated Health Sector Salary Structure (CONHESS). CONHESS gives medical doctors salaries that are much fatter than other professionals in the sector. Doctors however, disagreed with the demand, saying should the Government grant the request; they (doctors) would go on strike. But the paramedics said that doctors have been in control of the sector for too long and are carrying themselves as the lord of the sector, despising other health workers. The medical doctors said that they strive not just to be experts but consultants in their various fields, noting that paramedics parade themselves as if they (paramedics) can perform the roles of doctors.
The battle line is therefore drawn between the pharmacists, nurses, laboratory scientists, other hospital workers on one side, and medical doctors on the other.
The Joint Health Sector Unions (JOHESU), a united platform of five registered Trade Unions with legal backing to represent the interest of workers in the health industry is making efforts to ensuring that they achieve some landmark in the area of salary structure of health workers, by bridging the gap in the allowances of other health professionals and the doctors.
JOHESU members include Non-Academic Staff Union of Educational and Associated Institutions (NASU), Medical and Health Workers’ Union of Nigeria, National Association of Nigeria Nurses and Midwives, Senior Staff Association of Universities Teaching Hospitals, Research Institutes and Associated Institutions and the Nigeria Union of Pharmacists, Medical Technologists and Professions Allied to Medicine.
All the unions believe they have an axe to grind with the Nigeria Medical Association (NMA), the umbrella body of medical doctors, which is the reason they came together to form a formidable body.
The General Secretary of NASU, Comrade Peters Adeyemi said there is an inbuilt arrogance about doctors because they are being over-pampered by the government. He noted that no worker in the health sector can be regarded as least important since a doctor cannot do their jobs.
“Right from the gate of the hospital, we have workers, whose duty the doctors cannot do, even issuing of cards, because no doctor can see a patient without a card. They can’t attend to patients on their own; they need nurses to administer drugs. Even the idea of only the doctors being made minister of health has to change. There are more qualified paramedics who can hold the position. They have arrogated so much authority to themselves, as if they can achieve anything without the contribution of other health workers. They always believe they are the only ones who are useful in the health sector,” he said.
But the President of the Nigeria Medical Association (NMA), Dr Osahon Enabulele said doctors were not fighting the health workers, and that they (health workers) are the ones fighting doctors. He said that all the agenda of JOHESU was aimed at undermining the authority of the doctors.
He said the problem in the sector was caused by the “perpetual greed of health workers to equate themselves with the doctors.”
But the health workers are asking for the reconstitution of the boards of University Teaching Hospitals and other parastatals under the Ministry of Health with equitable representation by union and professional association.
JOHESU’S Agitation
In a statement signed by the Chairman and Secretary of JOHESU, Ayuba Wabba and George Ayua, JOHESU, the group said the NMA should “concentrate on its professional matters rather than dabbling into matters it is ignorant of.”
The NMA President on his part said JOHESU’s agitation seeking equation with doctors will lead to anarchy. “We are saying everybody should be asking for what is realisable, the agitation must be based on anything besides an invitation to anarchy,” he stated.
Mr Wabba said there is hierarchy in the health profession, and wondered why a laboratory scientist should be bent on being like a doctor. “They want to be consultants in the hospitals,” he said.
He said if the government wants to concede to health workers demands,it also has to concede to so many other things, such as chief consultant and senior consultant that are no more in the structure. All these he said have to be restored.
On the agitation for CONHESS, Enabulele said he started the battle for Consolidated Health Sector Salary Structure (CONHESS) as a way of stopping regular migration of doctors to other countries to seek greener pastures. “I introduced the concept of specialists’ allowance. You have to be appointed as a consultant to earn the specialist allowance. They also want it. They want to take final decision on patients. They can do anything elsewhere, but in the hospital setting, consultants are in charge. If there is a case of negligence, nobody thinks of nurses, they look for doctors.
Earlier, this year, there was a strike called by health workers at the Federal Medical Centre, Abeokuta over alleged superiority tussle between nurses and doctors. The action grounded the hospital for about five days.
A doctor allegedly slapped an assistant nursing officer in the heat of an argument, and failure of the hospital management to react when the matter was reported made the nurses association embark on strike. At a point, the loggerhead manifested when the issue of the health bill came up for assent. The health workers said President Jonathan should not sign it as it was, while the doctors urged Mr President to sign it.
Contentious Bill
The contentious provisions in the Health Bill according to the health workers include, National health system and regulation of health services; headship of the tertiary hospitals commission and the federal capital territory primary healthcare board. Others include status of the Armed Forces medical corps and membership of the National Council on Health; provision of essential drugs in primary care services; and developing primary care facilities in Nigeria. Also, establishment, composition, functions and tenure of national health research ethics committee; research of experimentation with human subjects; removal of tissue, blood products from living persons; removal, use or transplantation of tissue and administering of blood and blood products by medical practitioner or dentist. But medical doctors said that it was better for the bill to be assented to first by Mr President and amended later.
The doctors said the health bill was the boldest step any government had taken in the last 10 years to address the challenges facing the healthcare delivery system in Nigeria, noting that those opposed to the bill are ignorant of the potential for transformation therein should the bill be faithfully implemented.
The current agitation of the health workers include, non-skipping of Salary CONHESS 10 now before the National Industrial Court for adjudication, National Health Bill, Consultancy and Specialist Allowance, Call/Shift duty and other Professional Allowances, Presidential Committee Report on Harmony in the Health Sector namely: Promotion of Health Professionals from CONHESS 14-15, Request for implementation of 2008 Job Evaluation Committee Report, Need to review the retirement age, Re-constitution of Boards of management dissolved since September, 2011 and increase in retirement age from 60 to 65 years.
Baring intervention by older health professionals and other stakeholders, this brewing enmity might assume an unhealthy crescendo in which professionals would be exchanging blows.
Optometrist’s grouse
Other areas of the health sector where grudges are being nursed against the medical doctors is the eye care. The optometrists are complaining bitterly that the government only recognises the ophthalmologists, even though they only perform eye surgery in cases of glaucoma or cataract, while other eye ailments are being taken care of by optometrists.
Dr Tony Chiwike of Optic Ideal Eye Clinic, Lagos, said, other areas of health care professions is being neglected by the government.
“ In the eye care profession, we have the optometrists, which is the first point of contact for any eye problem. Then we have the ophthalmologist, which is like a tertiary form for those who require surgery. The situation now is that the government only recognises the ophthalmologists, while the optometrists are being relegated to the background.
“In some other advanced countries such as in the United States, and in Britain, all these professions have their distinct places. The ophthalmologists have their own functions, while the optometrists have their own duties. Any patient that has an eye problem comes to the optometrist, who attends to him or her, but if he or she needs a referral, maybe due to eye conditions like glaucoma or cataract, the optometrists refers such cases to ophthalmologists. If the patient needs eye glasses after the surgery, then the patient has to be referred back to optimist.
“However in this country, ophthalmologists want to take care of everything concerning eye care. It is not done that way in other countries.”
Chiwike added that Ophthalmologists have sent a proposal to the government on the issue to enlighten people on who to go to when they have eye problems and also to warn professionals not to encroach on other people’s duties. He blamed the government for not doing enough for optometrists in terms of recognition. He said only the medical doctors are being recognised, while other health professionals are not being accorded their rightful place. If they are accorded their rightful place, they would do more.
Baring strong intervention by health professionals of old and other stakeholders, this brewing enmity might assume an unhealthy crescendo in which professionals would be exchanging blows, if these issues are not resolved.
