For the umpteenth time, crisis looms in health sector over equity, justice

ALL is not well in the health sector. Fellers indicate that if nothing was done urgently to address the demands of health workers under the aegis of Joint Health Sector Unions (JOHESU)/Assembly of Healthcare Professional Associations (AHPA), activities in the sector may be crippled by incessant strikes and protests.

Reasons: the health workers are kicking against plans by the federal government to privatize public health institutions in the sector; condemn the continued neglect of the Vaccine Production Laboratories in Yaba, Lagos; fault proposed healthcare agenda and health sector restructuring document; dissatisfied by gross mismanagement of tertiary hospitals by some Chief Executives; fault the constitution of the members of the 26-man Technical Review Committee on the National Health Act 2014.

Others include: non implementation of valid court judgments, collectively bargained agreements, Memoranda of Understanding (MOUs) and even circulars signed with government by the Federal Government; monumental injustice meted out to its teeming members in National Health Insurance Scheme (NHIS) by unlawful payment mechanisms dubbed global capitation; continued non-appointment of health workers as Ministers of Health; and lack of due consultations with the professional associations and regulatory bodies in the relevant profession in adopting innovative financing of the health sector through Public Private Partnership (PPP) arrangement.

The health workers said the Federal Ministry of Health has continued to disobey and flout valid court judgments, in favour of its members, in a civilian democracy that preaches the rule of law. They appealled to President Buhari to call the Federal Ministry of Health to order to comply fully with these judgments in the interest of industrial peace and stability in the health sector.

The health workers are also demanding among other things: the implementation of the spirit of the existing circular on promotion of their members from Consolidated Health workers Salary Scale (CONHESS) 14 to 15 as directors which places premium on the need to sanction defaulting hospital managements; specific steps must be taken by the Head of Service of the Federation to ensure the expedited issuance of an enabling circular authorizing consultancy cadre for health professionals that have adhered to due process, to be vested with consultancy status as a prelude to inculcating this cadre into the schemes of service of these health professionals; and that the Federal Ministry of Health cannot continue to be seen as a partial arbiter that does not disguise its bias towards the preferences of only one profession in a multi-disciplinary sector.
The health workers are also demanding the payment of arrears of specialist allowances to qualified hospital based health professionals with effect from January 1, 2010, should be ensured without any delay whatsoever; that the Federal Ministry of Health must now come up with a circular that facilitates residency programmes for all health professionals in Nigeria; immediate and full payment of arrears of the skipping of CONHESS 10 which remains outstanding since the year 2010; immediate and unconditional release of the circular on adjustment of salary since January 2014 and immediate payment of at least two months arrears, while the balance is accommodated with proven evidence in the 2015 budget; and sponsoring an amendment bill to correct once and for all the litany of contentious provisions in the obnoxious decree 10 of 1985 (CAP U15 463) LFN 2004 which formalizes the marginalization of all health workers by doctors; and immediate release of the circular on extension of retirement age from 60 to 65 years to be backdated to February, 2014 when the issue was presented to the National Council on Establishment.

The health workers who include all the professionals in the health sector besides doctors, petitioned President Muhammadu Buhari that the proposed healthcare agenda and health sector restructuring document will not serve the best interest of Nigeria and therefore called for a truly broad-based platform of professional associations and unions in the health sector to come up with an impactful health agenda for the country.

The petition to President Muhammadu Buhari was signed by: President, National Association of Nigerian Nurses and Midwives (NANNM), Comrade Abdulrafiu Adeniji; President, Pharmaceutical Society of Nigeria (PSN), Olumide Akintayo, President, Association of Nigerian Union of Allied Health Professionals (NUAHP), Dr. O. C. Ogbonna; President, Medical Laboratory Scientists of Nigeria (AMLSN), Alhaji Toyosi Y. Raheem; President, Senior Staff Association of Universities, Teaching Hospitals, Research Institutes and Associated Institutions (SSAUTHRIAI), Dr. B. A. Akintola; President, Association of Radiographers of Nigeria, Dr. Mark Okeji.

Others include: President, Health Information Managers Association of Nigeria, Mr. Wole Ajayi; General Secretary Non-Academic Staff Union Nigeria (HIMAN), Comrade Peters Adeyemi; President, Medical & Health Workers Union of Nigeria and Chairman, Joint Health Sector Unions (JOHESU), Comrade B. Joy Josaiah; President Nigeria Society of Physiotherapy (NSP), Mr. Taiwo Oyewumi; President, Nigerian Optometric Association (NOA), Dr. Damian Echendu; and Chairman, Assembly of Healthcare Professional Associations (AHPA), Dr. G. C. Okara.

The health workers said it is their hope that Mr. President Muhammadu Buhari will urgently redress the myriad of outstanding welfare issues of health professionals and workers in Nigeria in the same spirit in the days ahead.

The health workers said while global emphasis is being laid on the promotion of preventive healthcare through immunization and control of vaccine preventable diseases, Nigeria prefers to import all the vaccines for routine immunization.

It is on record that Nigerian medical laboratory scientists produced millions of doses of smallpox vaccine in Yaba in the 1960s and 1970s, which were exported to the West African sub-region for the eradication of smallpox. Yellow fever and Rabbis vaccines were similarly produced in country. Today, Nigeria is spending millions of dollars importing yellow fever and rabbis vaccines.

They called on Mr. President Buhari to support the unions to reactivate the Vaccine Production Laboratories Yaba for the production of vaccines within the country.

They alleged that the health sector is one of those sectors placed under the supervision of Vice President Yemi Osinbajo and that six doctors including agents of Western donor agencies in Lagos State that championed the commercialization of health facilities were charged with the responsibility of crafting the health policy of the Buhari administration.

The health workers said one of the key recommendations of the six-man Committee was to canvass a ‘reform of the Federal Ministry of Health and reduce the number of agencies from 14 to three based on alignment of scope and deliverables’.

They alleged that the Buhari administration has sought views and position papers on healthcare agenda from strange templates especially a particular group of entrepreneurs in healthcare rather than the true representatives of healthcare providers and who are well structured into various healthcare professional associations and trade unions.

The health workers further alleged that the pecuniary motives of the entrepreneurs in healthcare who belong to an array of professions and background remain an inclination to access funds provided by the International Finance Corporation (IFC). “They plan to lord their concept of privatization and commercialization on the health sector, notwithstanding the damaging effects it will bring to consumers of health services and the economy of the Federal Republic of Nigeria. It is apt to put on record that the operatives of International Finance Corporation who are citizens of Nigeria have no respect for our laws,” they said.

The health workers added: “They insist on a version of reforms in healthcare that are self-serving in terms of their narrow commercial interests and those of their foreign pay-masters.

“The team has been canvassing the agenda of bringing foreign chain retail promoters in pharmacy practice into Nigeria for instance.”

The health workers warned that foreign company domination which prevents Nigeria from building capacity through Nigerian providers.

They called on President Muhammadu Buhari to redress the impending damage the re-structuring of healthcare sector will occasion, in the public interest by directing appropriate quarters to embrace rational and home grown-initiatives to tackle challenges in the health sector.
The health unions said some pressing challenges and distortions in the sector have lingered for so long and therefore appealled to Mr. President Muhammadu Buhari to urgently call the authorities in the Federal Ministry of Health and the management of tertiary hospitals to order.
They said: “The gross mismanagement of our hospitals by some Chief Executives of tertiary hospitals has assumed an alarming proportion. A case in point is the Federal Medical Centre, Owerri. For over three months, health professionals and workers, members of our Associations and Unions at the Federal Medical Centre Owerri were on strike, practically closing down the hospital for the entire period, subjecting patients and members of the public to untold hardship. It is hoped that the Fact Finding Committee that was constituted last week would carry out her assignment expeditiously.

“Many Chief Executives of hospitals have continued to run our hospitals as if they are private estates without government statutory rules and regulations. Modern healthcare practice is a multi-professional and multi-disciplinary endeavour. Any team is as good as its component parts.”

The health workers also faulted the constitution of the members of the 26-man Technical Review Committee on the National Health Act 2014. “Of more concern is that, representation in the Technical Review Committee has not been extended to professional Associations and Unions in the Health Sector,” they said.

The health workers said the government must face the reality that in the context of the National Health Act 2014, the professional associations and trade unions in the health sector constitute major stakeholders. “Why will they sideline key stakeholders in fashioning the implementation of the National Health Act? It will not augur well for the sector.”

On the NHIS they said: “In the spirit of the broad spectrum of reforms, JOHESU recalls the monumental injustice meted out to its teeming members in Nigeria’s version of a health insurance scheme. For over five years now the NHIS encourages unlawful payment mechanisms dubbed global capitation, while Health Maintenance Organisations (HMOs) also capitate secondary and tertiary facilities which out rightly disrupts the equilibrium of the health system.

“We demand that the Federal Government must direct the board and management of the NHIS to immediately adopt lawful payment mechanism to wit, capitation for primary providers and fee for service for secondary and tertiary providers.

“Government must also redress the capitation modes by embracing international global best practices on what constitutes a primary facility for capitation in Nigeria.”

On the appointment of the Minister of Health, the health workers wrote: “The former administration set the record of appointment of two members of the same profession as Ministers in charge of the Federal Ministry of Health which comprises a multiplicity of professionals.

“This unwholesome development facilitated unprecedented injustice, management crisis unlawful appointments in regulatory agencies in health and generally facilitated the worst output by any leadership at the Federal Ministry of Health in recent times.

“We therefore respectfully urge President Muhammadu Buhari to facilitate the appointment of our members as Ministers of Health. Many of our members are seasoned administrators and managers of cognate experience, logically eligible for appointment under the dynamic watch of President Muhammadu Buhari.”

On PPP, the health workers said it must be structured to avert job losses. They said: “Such financing could be in the form of equipment leasing from manufacturers with arrangement to source consumables of such equipments from the manufacturers with down payment of not more than 50 per cent cost. In the pharmaceutical sector, Drug Revolving fund as entrenched in the EDL act, if well executed without diversion of fund can be a bail out from problem of underfunding. DRF can be initiated without Government funding (zero financing) as evidenced in the recently commissioned three-storey complex at National Orthopaedic Hospital, Igbobi built without fund from government because of a focussed execution profile.

“There is also need for health system audit and general overhaul for efficiency, therefore some services like catering, security, mortuary services and general maintenance can be totally privatised.”