It is this negligence of the whole picture while so much attention is given on the small one that worries me. If the medical profession would spend as much energy fighting for their salaries as they would ensuring that the government provided 24-hour electricity in major hospitals and concentrated on giving real care to the nation; perhaps it would be easier to be sympathetic to them.
Lagos State doctors are on strike. Again.
This time, the public opposition to the strike action is full-throated. Words like “insensitive”, “criminal”, “negligent” and the almighty “greedy” are being heard. Someone has kindly decided to provide a history of strikes by doctors in the employ of the Lagos State government; calling for strikes to be declared illegal and suggesting that the striking doctors should be replaced in a year. Perhaps they are right.
Or perhaps not.
At the root of the frequent problems with medical practitioners is the issue of economics and the migration of talent. Not to put too fine a point on it, but doctors still have the easiest time migrating from Nigeria to get long-term employment in the Big Three – USA, UK & Canada. Apart from these, other destinations for Nigerian medicals include South Africa, Australia and the Carribean. Each of these destinations provides better pay and working conditions as well as an improved quality of life. It is very easy for a doctor (please also substitute dentist, pharamacist, physiotherapist or nurse) to compare their current pay to their counterparts in those countries and clamour for more pay; and they frequently do. After all, they have classmates who live and work in those countries.
Nigerian governments (as major employers of clinical personnel) find themselves in competition with economies with deeper pockets. It’s a difficult battle to win. However, many people choosing to stay in Nigeria unconsciously agree to trade-offs in their quality of life and pay – more time with family and friends in return for bad roads etc. Believe it or not, doctors also understand this. CONMESS was created as an acknowledgement of these issues – a different salary scale that would pay doctors more – not as much as their foreign counterparts – but enough to calm them down.
The problem is that, like the minimum wage, some states have been slow to fully implement CONMESS. There have been internal negotiations as to what percentage of CONMESS doctors would actually receive and this has led to the recurrent flare-ups.
It’s not all one-sided though.
In the same manner the increase in minimum wage dented states’ budgets, CONMESS isn’t exactly cheap to operate. Smaller states, with correspondingly smaller wage bills, were among the first to pay 100% CONMESS but some of the biggest ones have lagged behind. Decisions are often taken at the Federal level which affect States, whether they like it or not. At Alausa, there must be some people wondering how Abuja gets off placing a higher wage burden on their shoulders without giving them the tools to bear it.
Doctors must also accept that there are issues in Nigerian healthcare delivery that go beyond their salaries. Hospital administration across board is a disaster and needs to be reformed. Equipment is often unavailable and simple things like gloves, syringes and cotton wool are bought by patients, even in emergencies. Medical education has deteriorated to unbelievable levels. Furthermore, we are seeing public health emergencies such as diabetes, hypertension and cancer while the medical profession pretends not to see. Visitors to hospital often complain of the aloof disposition of those meant to be their caregivers; and those that are well-off prefer to go to private clinics or fly abroad.
It is this negligence of the whole picture while so much attention is given on the small one that worries me. If the medical profession would spend as much energy fighting for their salaries as they would ensuring that the government provided 24-hour electricity in major hospitals and concentrated on giving real care to the nation; perhaps it would be easier to be sympathetic to them.
In my view, the strikes are symptomatic of a much bigger problem – Nigerian healthcare desperately needs to be turned on its head.
Note: CONMESS stands for Consolidated Medical Salary Scale
Cross-Posted on Seyitaylor.posterous.com