The President of the Nigerian Association of Resident Doctors, Dr Emeka Orji, speaks with LARA ADEJORO on the resolutions reached after the association’s Ordinary General Meeting.
In the communiqué issued after your Ordinary General Meeting, you rejected the 35 per cent or 25 per cent increase in the Consolidated Medical Salary Structure as agreed in the Memorandum of Understanding with the government. Why did you reject it?
We have never agreed on any percentage rather than 200 per cent. Even the MoU you referenced, it was stated that the government had an agreement with the Nigerian Medical Association, so that has been their position that they agreed with the Nigerian Medical Association but NARD is saying that even if such an agreement exists, that percentage is not enough to take care of the progressive degradation and devaluation of our salary that has happened since 2009 when the current CONMESS was approved if you take into consideration the inflation rate, exchange rate, fuel price and the cost of living. We did the mathematics and applied the figures, we got over 270 per cent for the increment necessary for the CONMESS to be the value and incidentally, the 270 per cent was before the recent fuel price increase. We have also applied the current increase in petrol and what we got was about 500 per cent we have asked repeatedly to know how the government arrived at the percentage it is offering the NMA. Was it just something they offered without any basis? Nobody has answered the question.
You mentioned two figures in your communiqué. Is it 25 per cent or 35 per cent the government offered?
Sometimes, they would say 25 per cent, and sometimes they would say 35 per cent. At a particular time, they said 23.5 per cent. We keep saying that what they are offering the NMA was not a product of the Collective Bargaining Agreement, and that is why there is this confusion because when you have a CBA, everybody knows the figure agreed and it will not be changing. We are not aware that they had a clear negotiation that led to the percentage they are saying. However, the highest we have heard from them is 35 per cent but it is not enough.
Going by your calculations, the amount was around 270 per cent, why did you bring it down to 200 per cent?
When we wrote that letter on July 7, 2022, the percentage was around 200 per cent, this 270 per cent was an update on the figure as of 2023. By the time we repeated the figure in April when we issued the ultimatum, we got 270 per cent, but because we had submitted a letter in 2022, we are just insisting on the letter. About two weeks ago when the fuel price was increased, we got the current price of fuel and applied it, and we got close to 800 per cent, but we do not want to keep changing the figures because we believe that some of these things will be sorted out when there is a round-table discussion, which I can tell you that up till this moment, NARD has not been brought into any negotiation for the upward review of CONMESS.
You asked the government to declare a state of emergency in the health sector but some say it is too early since we just inaugurated a new government. What do you say to that?
It is not early to declare a state of emergency in the health sector. It means the people saying so do not value health and maybe because the person is not informed. The health sector of any country should be prioritised because we started making the call before the new government came in. Even as we speak, there is brain drain; people are still leaving and it has become a crisis. If you visit our hospitals, we do not have enough doctors and nurses there. Some departments have been shut down across the country because they don’t have the manpower. If something that is leading to loss of lives, morbidity and mortality in the country is not an emergency to anybody, then I wonder what an emergency should be.
You said the Medical and Dental Council of Nigeria should stop downgrading the certificates of your members, don’t you think the action is to stop brain drain in the country?
I don’t know about that but let us assume for the purpose of argument that it is the intention; so you deliberately downgrade the certificate below its worth because you want to prevent brain drain, is that not illegal? It is a criminal offence. I wish they would come out to say that and that is why I said I do not know if that is the intention. It is just that when you train somebody and you know the worth of the person but because you do not want the person to leave, you then place him at a status below the level of training you have given him, that is certainly illegal. We have no idea why they are downgrading the certificate. We have made efforts to get the explanation but they are refusing to meet. We know that we have discussed with the National Postgraduate Medical College of Nigeria and the West African Colleges of Physicians and Surgeons that issue the certificates and they told us they were not carried along when the MDCN did that. There is no other country that has downgraded the certificate except Nigeria, so it is strange. When we say many of these things, people do not want to believe it but the truth is there is no African country with this kind of training that has downgraded their certificate except Nigeria. We are calling on them to withdraw the downgrading and do the right thing.
For your members that are owed in Abia and other states, are there any commitments from the governments in those states that they will be paid?
Ekiti state has paid, from what we know. I am not sure of Ondo State. We have a new government in Abia State that has promised to pay monthly salaries from this month, and to offset the arrears owed all workers between now and December, 2023. If the new governor does that, it will be good because it will help to resuscitate the collapsed health sector in the state. We expect that he will make the payment between now and December. If he starts paying this month, we will be sure he will be able to offset the arrears.
You also mentioned that some of your members in different federal tertiary hospitals have yet to be paid the arrears of the hazard allowance. Which hospitals are defaulting in payment?
Many of the staff in federal tertiary health institutions are paid through the Integrated Payroll and Personnel Information System from Abuja. The majority of the people on IPPIS have been paid but we have a few people who were omitted and we have been trying to engage the government since the last arrears was paid. Even when they started paying last year, there were some people they omitted and have yet to be paid as of the last count. We have more than 15 centres involved and they are being slow in responding to this. We also have another group of staff who are being paid by the hospitals that employ them; they are not on IPPIS, they are on a non-regular platform and most of them have not been paid. We have about 120 doctors at the University of Nigeria Teaching Hospital, Enugu, that have not been paid and other hospitals that have locum doctors. They are doctors and there is no difference in the work they do. The only difference is the platform of their payment. We have up to 1,000 locum doctors and it is a dangerous repeat of the event that led to our prolonged strike of 2021.
Why is the number of locum doctors up to that?
That is what we keep saying; because the bureaucracy of employment is long, before any Chief Medical Director completes that process, it takes like eight months and what many of them do is to maintain services to prevent a collapse of the departments, so they employ some doctors and nurses as a locum and they pay them from their budget and internally generated revenue. If the allocation to the hospitals is reduced, the CMDs will not have enough funds to pay them, so we know that many of them are owed salaries. Some of them are owed up to six months. That was what happened in 2021 and we called for them to be migrated to the IPPIS platform so that their payment will be regularised. That took time and it led to a strike before that was done. We are getting to that stage again and that was why we denounced locum employment because it is casualisation. They don’t get the benefits those on IPPIS get, like hazard allowance. They don’t get the medical residency training fund and it is the same training and work that they do. So, there is no reason they should not be on the IPPIS platform. If the circular for one-for-one replacement had come out now, the CMDs would have migrated those on the locum platform to fill up the gap and even get more people from outside. Also, we do not agree with some of the provisions of the MoU that the government signed with us, but for the ones everyone agreed on, the government has not met the timelines. If NARD comes out to say this has become an ultimatum, everybody will start blaming us, but the government will enter into an agreement and breach it and expect you not to complain, that is the problem.
You mentioned the demand for bench fees from resident doctors in the Lagos State University Teaching Hospital, Ikeja, seeking supernumerary posting, can you shed more light on it?
Residency training is such that when you are rendering services, you are being trained at the same time. But some hospitals do not have full accreditation for some specialties, and what they do is that when you work for them, you need to go into a specialty. So, they will write a hospital in Nigeria that has the full accreditation to do that training, you go there and you start working there while you are being trained. For instance, I am in the Federal Medical Centre, Umuahia, and we do not have full accreditation for orthopaedics, when I became a Senior Registrar, that is when I should specialise, and they sent me to the National Hospital, Igbobi, Lagos, because they have the full accreditation for orthopaedics and I spent two years working and training and my salary was paid by the FMC, Umuahia, while I am working for NOHIL. Essentially, NOHIL did not pay me a dime but in addition to that, they will ask you to pay a training fee which is the bench fee. I paid N320,000 and in some hospitals, you pay up to N500,000 for a hospital you are working for free of charge because they are training you. When we complained about this in 2021, the National Council of Health abolished it. The NCH involved the federal ministry of health and the state ministries of health, and it was that body that abolished the bench fees. LASUTH is collecting bench fees and we are asking why. Two weeks ago, a resident was supposed to come there for specialist training, they asked him to pay over N500,000 but it is illegal because it has been abolished. Our members have frowned at it because it should not be coming from Lagos and we made several efforts to see if we can resolve it without going public but everything was rebuffed. We have also written officially to the CMD, and if this continues, we have to escalate and I am sure that is not the image they want.
Why did you ask the West African Colleges of Surgeons and Physicians to immediately discontinue the practice of charging your members using parallel market exchange rates?
They are not a Nigerian institution, so when they want to charge for the examination fees and update fees, if it is $100, they will multiply it by the parallel market exchange rate and ask that we pay that in naira. We are saying that is illegal and unacceptable; whatever conversion they are doing should be the official rate. They are part of the West African Health Organisation that should be getting sponsorship from the member states, so they must have a way of accessing dollars from those states at the official rate. Besides, why are they doing the conversion? Nigeria is the largest country patronising them and their staff in Nigeria are paid in naira.
How does the increase in the price of petrol affect the health sector?
With the increase in petrol price, our members find it difficult to go to work now. We have been receiving reports of people who are not able to access fuel because of the scarcity, and even when you get it, you spend more than the minimum wage. Our members believe the subsidy regime has been enmeshed in corruption and if the best way to handle it is to remove the corruption, we will not stop them but we are saying the government should increase people’s income so that we will have enough to buy the PMS and the money they will save from the removal of subsidy should be invested without the money getting involved into another round of corruption. They should prioritise the health and education sectors with the investments and pay attention to other sectors, and Nigerians will see the benefits, in addition to cushioning the effect of the subsidy removal. The government needs to increase the income so that people will have enough money for transportation.
What kind of minister of health does Nigeria need at this time?
The minister must be someone who is experienced and well-versed in what it takes to be a minister of health. It should be someone that has a panoramic view of the departments and sub-specialties that they are going to superintend over. When you hear that the minister of health should be a medical doctor, it is because, by our training, we have different training sections, even in administration. The minister must be ready to work, solve problems, advise the president properly and bring up good policies to resuscitate the health sector.
