IMMINENT CRISIS IN THE HEALTH SECTOR – MATTERS ARISING

By Fabian Anawo

An imminent crisis is brewing in the health sector between doctors and other health care professionals.

The crisis is about the remuneration, allowances and career progression for the non physician cadre in the health sector.

Other health care professionals have always accused doctors of monopolizing everything to their advantages while dictating what others should earn.

For years now, the non physician cadre under the aegis of the Joint Health Workers Union, JOHESU, have been agitating for the upward review of their salaries and allowances under the CONHESS scheme, the same way that of doctors under the CONMESS scheme was adjusted.

CONMESS salary scheme has enjoyed three upward reviews without any for CONHESS. These were in 2014, 2017 and 2018 and a fourth time has been proposed in May this year awaiting approval. The salary adjustment for 2018 excluded those on consolidated salary scales, but somehow, doctors who are on CONMESS benefited from it.

Other health professionals believed that it was made possible because doctors are in charge in the Ministry of Health, the then Minister of Labour, Dr. Chris Ngige is a doctor and the then Head of Service of the Federation, Shade Yemi-Esan is also a doctor.

All avenues in the past sought to redress the perceived injustice of discriminatory salary wages to non-Physician health workers have failed, especially between 2011 to 2023. This JOHESU believes was because the leadership of the Ministry of Health have been doctors. The same reason, the Acting National Secretary of the Union, Chief Chief Matthew Ajurotu advised President Tinubu to appoint seasoned Administrators to head the Ministry of Health and it’s agencies to a better repositioning of the country’s failed health system which is rated 187th out of 191 health systems of the world.

Reacting to JOHESU’s agitation for upward review of CONHESS, the Nigerian Medical Association, NMA, said in a letter dated June 7, 2023, addressed to the Permanent Secretary, Ministry of Health said the adjustment of CONHESS would have negative consequences on the health sector.

In the letter titled, ‘Adjustment of CONHESS: Matters arising,’ signed by its President, Dr Uche Ojinmah, and Secretary General, Dr Jide Onyekwelu, NMA said “We wish to clearly state that CONMESS was not reviewed upward, rather error in translation of the Collective Bargaining Agreement that gave rise to CONMESS in 2009 was corrected.

“Despite writing the petition that we were shortchanged immediately, the CONMESS circular was released, it took the government five years to effect the corrections and we had to forfeit the arrears as the government said that they didn’t have the money to pay with a ‘plea’ for our patriotic understanding.

“At the same time, the salary relativity that we lost with the unilateral merging of the Medical Salary Scale and Medical Super Salary Scale with other salary structures was also restored just to right the wrong that was done to us but still without any payment of arrears.

“NMA shall not sit idly by and allow anyone to degrade our salary by tampering with relativity, as this shall worsen medical brain drain with attendant negative consequences on our fragile health sector.”

Talking about relativity that must not be tampered with, is relativity not enshrined in the salary and the Grade Level at which doctors and others entered the Civil Service?

At present, after Youth Service, a Physician starts at GL 13 while Pharmacists, Laboratory Scientists and others take off at GL 10. Is this not relativity? The moment a doctor passes the requisite Fellowship programme of a Medical Post-Graduate College, he moves automatically to GL 15 and all things being equal will be at the peak of GL 17 between 10 and 12 years, a feat that others may attain in 25 years.

This statement by doctors on salary relativity and telling government not review CONHESS seems to have angered JOHESU who are now poised for a complete showdown. They said that they are ready to correct all the injustice once and for all.

JOHESU recalled that in the past, Pharmacists and Physicians entered the Civil Service on the same Grade Level with doctors enjoying only a marginal one Grade Level difference over other health professionals because of the difference in years of training.

According to JOHESU, the norm was that Pharmacists and Doctors entered the Civil Service on the equivalent of GL 08 for Internship and Houseman-ship respectively and move to GL 09 after Youth Service.

Other Health professionals who are graduates started on GL 08 after Youth Service, while Registered Nurses and Midwives started on GL 07.

It noted that without any increase in the years of training or course content, physicians took maximal advantage of their dominance of the leadership bracket of the Ministry of Health to alter the Augean stable with a discriminatory salary scale styled MSS while non-Physicians including health professionals were placed on the Health Salary Scale, HSS.

Today, Chief Ajurotu said that Physicians now enter the Civil Service for Houseman-ship on the equivalent of GL 10 and proceed to GL 13 after Youth Service. Pharmacists who hitherto were on the same Grade Level as Physicians and other health professionals now start Internship on the equivalent of GL 09 and proceed to GL 10 after Youth Service.

On this same issue of relativity, the Federal Government set up a Technical Committee of experts to resolve it. The experts after meeting for months in 2021 confirmed that CONMESS has been adjusted to the disadvantage of CONHESS and recommended an upward review for CONHESS.

The membership of the Technical Committee included representatives from salaries, Income and Wages Commission, Budget Office, IPPIS, Federal Ministry of Labour and Employment, Office of the Head of Service of the Federation and the Ministry. A previous recommendation on adjustment of CONHESS in 2018 put at N22.6 billion at that time was allegedly sabotaged by the duo of Dr. Chris Ngige and Prof. Isaac Adewole.

Another vexsatious issue is the consultancy Cadre for Pharmacists. The National Vice President of JOHESU, Dr. Obinna Ogbonna alleged that as far back as 2011, the National Council on Establishment approved the Consultant cadre for pharmacists and in 2020 and 2021, official circulars were issued from the Office of the Head of the Civil Service of the Federation for its implementation only for the Minister of Health Dr. Osagie Ehanire to stop it.

He said that in 2021, Dr. Osagie Ehanire gave directives to the Board of the University College Hospital, Ibadan to terminate the Consultant status of all non-physician health professionals and wondered why doctors would rise to the peak of their career and block others from doing so.

JOHESU has consistently argued that the Ministry of Health fared better when non physicians, the late Professor Eyitayo Lambo and Professor ABC Nwosu headed it. It therefore recommended that seasoned Administrators outside the NMA portfolio should be appointed as Ministers to enable all sector professionals to have a fair deal and sense of belonging and not to be treated as second fiddles. The Ministry of Health needs the touch of a seasoned administrator to reposition it and restore the glory it enjoyed in the seventies when foreign nationals including the Saudi royal family come to Nigeria for their health needs. Today, Nigeria’s health system is in shambles ranking 187th out of 191 health systems of the world.

It will be better if President Tinubu would allow the reforms shaping Nigeria in the last few days to catch up with the Health Sector. The health sector needs a fresh breath of air and a departure from the era of dominance by a sect, a health sector where there will be equity, fairness and justice to all health care professionals .