The crisis in the health sector has continued to linger as a result of disparity in the welfare of medical doctors and other workers in the industry. In this interview, the president of the Medical and Health Workers of Nigeria (MHWUN), who doubles as the chairman of the Joint Health Consultative Council, the umbrella body of all the health unions in the country, Comrade Joy Josiah Biobelemoye, laments the inequality and the reasons why health workers may still resort to industrial action to get their rights, should the Presidency fail to intervene.
He also speaks on how health can be made affordable, plans to privatise public health institutions, and other issues.
The health sector
Affordability is a key ingredient in the Universal Health Coverage (UHC) projection. You have three A’s, availability, affordability and accessibility. With these three, if you have built the best hospital, glamorous in sight, people come into it, people have access to it. The equipment in it is state of the art, with the touch of a button you can get everything done; the services are available, when the patients walk in and see the service, equipment, but cannot afford it monetarily, they walk out. That means it is not readily accessible, affordable and available.
They should cut cost in the expenses and in their numerous unmerited allowances.
Agenda for Buhari
First thing is that his last four years as President have been very turbulent in the health sector, not because he wanted it to be so. So, in order to take away the turbulence in the health sector, first, he should heed our calls before his re-election. We wrote to him officially that, to set the health system right, the appointment at the top echelons should be fair. That means, where there are two ministers, minister for health and minister of state for health, at least one of them should be from the 95 per cent of service providers, that is, members of JOHESU. One of them can be picked from JOHESU, after all, there is no fast and hard rule that the minister of health should be a medical doctor; apart from the attorney-general’s office, no other one has specifications. So, if you pick the minister of health from the 95 per cent, then you can pick a medical doctor for the other post. Permanent secretary of federal ministry of health must and should always be a seasoned administrator. Second thing is, in the appointment, he should state that we should go back to the pre-1985 administrative format, where hospitals were headed by hospital administrators. Medical doctors were not heading hospitals then and I believe that the moment he approves hospital administrators heading hospitals, lots of medical doctors will be drafted into the professional service need areas. This way, we would equally have reduced the ratio of medical personnel population in administration. If hospitals are headed by administrators, and certain positions are not held by doctors, we would have saved 300 to 600 medical doctors to take care of patients. So, that is on the part of setting health care administration right.
The second big issue the President should look at is corruption, corruption in the system, in the federal ministry of health. If a doctor commits any offence, if there is any financial infraction committed by a medical doctor, MD or CMD in any of the health institutions, it would be covered up and nobody is punished. Even when we blew the whistle.
Also, whistleblowers must be protected. We have blown the whistle in FMC Owerri, JUTH and other places. But, today, I still call on the President to reassure health workers that they will be protected if they want to join the anti-corruption war and make health care better for Nigerians. The President should give us that cover by going to pay the salaries owed the whistleblowers in FMC Owerri and JUTH and elsewhere in the health sector. The ministry will always cover up to say that the salary was stopped because the workers went on strike. Then, as investigative journalist, you would wonder that, if management stopped their salary because they went on strike, what did they go on strike for? People didn’t go on strike because they wanted welfare, why they went on strike was because, after we had blown a genuine whistle, after the EFCC had also confirmed and even discovered more, rather than prosecuting, initially, the ministry was saying the top officer had not been found wanting, EFCC has not corroborated our allegations. After a committee set up by the government went in to see that a project that was said to have been finished and paid for, the ground was still fallow, no grass had been removed. The ministry of health said it was not their responsibility to suspend until the anti-graft agencies did something. After the anti-graft agencies had done something, EFCC had come in and found more infractions, they filed a case in court, after much pressure, the officer was suspended. Afterwards, the ministry decided to return the culpable officer to his position but the workers resisted.
The second thing I want the President to do is to restore confidence in our resolve to fight corruption in the health system by paying our FMC Owerri staff their salaries, after all, no-work, no-pay is not only for health workers. We were in this country when some other unions also embarked on strike for some months and they got their salaries. No-work, no-pay order was even withdrawn; so why must it be for health workers alone? Even within the health system, the same federal ministry of health, whenever other health workers go on strike for their rights or in promotion of the anti-corruption war, they are denied their salaries, but whenever medical doctors go on strike no-work, no-pay is not implemented except if the medical doctors are going on strike against the interests of the leadership of the ministry. For instance, in LUTH, last year, doctors went on strike for six weeks, they called it off early this year and they were paid their salaries. However, when we went on strike for a more cogent reason, the government went into an agreement with us but failed to keep that agreement. It was after several months of endurance, patience and communication, appeals that were refused that we decided to embark on a strike for six weeks, they had to hold back our members’ salaries for that period. So, you can see that there is need to enshrine equity in the federal ministry of health, and what is that equity we are talking about? We want to have people representing us in the sector so that Mr. President himself can get appropriate, fair information from the health system to enable him guide the health system to success. This is very germane.
JOHESU going on strike, how has it been resolved now?
At JOHESU, we are law-abiding even though the federal ministry of health and federal ministry of labour have been consistently disrespectful of the court, especially the federal ministry of health. I say this boldly because with judgement given in our favour, the federal ministry of health refused to implement them rather they would want to create a chaotic system. I don’t blame them because it is part of their strategy to keep the health system chaotic to confuse the minds of Nigerians so as to support their ill plans of privatisation of health institutions. They are pushing for privatisation, not because they want Nigerians to get better health, but for some reasons, so that they can go back to buy these health institutions with peanuts and make them their own properties, knowing that putting up infrastructure is cost-intensive, seriously expensive.
So, they are looking at making the public health institutions deliberately ineffective by diverting funds, starving them of funds and also creating inequality, so that there will be upsurge of strikes and crises in the system. That is their main aim so that they can paint it that, if it was in a private system, the strikes won’t be there. But they forget to tell Nigerians that, if it was in a private system, the managers would have enshrined equity. They won’t oppress or deny someone his rights, because they can revolt, if it is denied in a private system.
We have just finished the Alternative Dispute Resolution (ADR) centre, it is an arm of the National Industrial Court. So, court sent us an order. We did not suspend the last strike, not just because of the court order. Prior to the court order, we had reached a point where we were to suspend the action. But we were looking for certain ingredients of commitment from government, and that is why the sincerity of the government brings peace, but in our case, the government operators are not sincere. The President is a sincere person, but those he has appointed, I just pray he will not make the same mistake by repeating these people. Those he appointed were not sincere. At the peak of the strike, the National Assembly also intervened. They intervened at the two levels, both at the top level and lower chamber and it went on smoothly. First invitation, we were not too comfortable that we were in diverse opinions: he was a medical doctor, but we said, let us listen to him. So, we went and we have to make this bare because even on that day the ministry used it as propaganda to say we were being sponsored by the opposition. We went into that discussion with the former Senate President, he listened to all our facts and all that and he now told us that before we came he had also had a discussion with the minister on how we could resolve the issue and that the minister had also given him some assurances, the main reason he was bold to call us. After our agreement on September 30, 2017, it was agreed that the income and wages should work out the financial implication of adjusting the core health salary as was adjusted for the CONHESS. The financial implication was N22.6 billion; however, as an afterthought, the federal ministry of labour, because it was also headed by another medical doctor, which is an error, himself and the minister of doctors, who instead of being minister of health transformed himself to be minister of doctors, now connived to see that they forestalled the implementation. They lied to us and Nigerians that government had no money to implement it and government had no ability to pay.
The Senate president pleaded with us to suspend the action and then we went to court and the court said we should suspend by 31st. So believing that we have got something from there, and in order to also respect the court. But in contrary that court gave us order, we were not served that order and we proved that to the court. We showed the court the day we were formally served, and that is why today, contrary to the evils plans of the then minister of health and minister of labour, that I, Joy Josiah and the JOHESU leadership will be in prison for contempt of court, we are walking freely because we were not served and I still maintain it. So it was based on this, we decided, we are going to suspend the action even though we have not gotten the alert. With the firm promise from the senate president we felt we should respect not only the executive, the judiciary, but also the legislature. So we did what we did. But as soon as we suspended and started the ADR which the industrial court asked us to go to, the federal ministry of health now opened their box of dishonesty and then while we were in the ADR obeying the court, they disobeyed the court by issuing a circular that our members should not be paid the April salary. This was intended to create another round of crisis so that Nigerians will now be angry and throw their sympathy behind them. So that they will say if possible privatise these places and they will go back and buy them. If not, what is the rationale when court has intervened. When court has said that no party should do anything that will jeopardize the peace and we are trying to ensure that, they went to destabilize that peace by disobeying the court.
We are calling on Mr. president to take charge of the federal ministry of health and refuse to listen to the low sided information that is getting to him. The same federal government that they lied in the name of Mr president that government don’t have money to pay, the same Mr. president who they said do not have money to pay genuine agreement with the critical health sector, approved money that was more than N26 billion or more for the aviation workers who were owed many years before he became President. He never signed an agreement with them, but this is the president that signed an agreement with us. Some people because of their selfish end in order to keep the health system chaotic decided to mislead and say government does not have money. The same president also provided more money for education. So why would you make me to believe that Mr president knowing the critical nature of the health sector will disagree to provide money to redeem a valid entered agreement by his government.
Any plan on ground to actualize your payment?
Yes, we have a plan, we have so many ways we can take government on, but we want to give the president the benefit of the doubt and if the immediate past leadership, partial, unproductive, bias head in federal ministry of health is not reappointed, we will give him the benefit of the doubt to see whether he will resolve the issues amicably. If they are reappointed it means the president is saying he likes the chaotic situation that have been in the health system. Also, I told you, they just got the consent judgment from the ADR, there are timelines for some of the things we have agreed upon and mind you when you get through that we are at about 14 or 15 issues that were resolved by the ADR. But on the issue of the core health we did not agree to adjustment. We stood our ground and so it is opening room for further engagement and if sincerely done, we will avert whatever crisis it would have caused. But if not, certainly our people will be better informed now and then we will take all the necessary steps within the provisions of the law.
Well some of the issues are four and two weeks timelines. So JOHESU will meet and then we will reassess the situation. There are also some interventions which are ongoing which we are also respecting, the MLC also intervened at some point and there are also some discussions and interventions going on, but if at the end of all those interventions truth is suppressed, he that is down fears no fall and so we will spring back. But I pray that the president who has solved problems in aviation, education will also solve this which his government has entered agreement with. The president is not a person that sees the sufferings of people and looks the other way round, if it has to be so, he wouldn’t have solved aviation matter. Aviation matter lingered for decades before his coming. For him to dig up about N26 billion, I think the total is about N40 billion thereabout, for him to do that means that he is ready to reduce the sufferings of people. So, the health cannot be out of his telescope certainly, I believe he will do something great.