The Nigerian Medical Association, NMA, an association of all medical doctors in Nigeria on July 1 embarked on a nationwide strike.
With the NMA strike, doctors working in government-owned hospitals have boycotted work, leaving majority of sick Nigerians stranded. In an open letter to the Secretary to the Government of the Federation, Pius Anyim, on June 11, the association listed a 24 ‘minimum point’ demand which it expected government to meet before its members would return to work.
The letter was titled “Facing the Challenges in the Health Sector”. However on Thursday, President Goodluck Jonathan ordered the sack of all resident doctors in Nigeria. Mr. Jonathan directed the suspension of all Residency Training Programme and the hiring of part-time medical officers to replace the doctors. The inadequate funding of the Residency Training Programme is one of the reasons the NMA is aggrieved.
Below is a list of the challenges faced by the NMA:
1. A demand that seven Deputy Chairman Medical Advisory Committee, DCMAC (four for Teaching Hospitals and three for Federal Medical Centers be appointed to assist the Chairman Medical Advisory Committee, CMAC. The association noted that the CMAC is presently saddled with statutory responsibilities that are too heavy for an individual to handle. The DCMACs is expected to have the same qualifications as the CMACs. The NMA also argued that directors in other government establishments are supported by deputies and sees no reason while that of the CMACs should be different.
2. The association opposed the appointment of directors in hospitals. The position, it said, distorts the chain of command and induces anarchy while exposing patients to conflicting treatment and management directives with mostly negative consequences.
3. A demand that grade level 12 (CONMESS 2) in the health sector be skipped for medical and dental practitioners.
4. The association also demand that the title ‘Consultant’ should not be assigned to non-doctor personnel. Arguing that consultant describes the relationship between a specialist medical doctor and his patients, the association said that giving the title to a non-doctor personnel will only lead to anarchy and chaos in the system.
5. The immediate implementation of a January 3, 2014 circular and immediate payment of the arrears for 22 years during which members were short-changed. It also demand an adjustment of doctor’s salary to maintain the relativity as agreed.
6. The acceleration of the passage of the National Health Bill and extension of the Universal Health Coverage to cover 100 per cent of Nigerians rather than 30 per cent as currently prescribed by the National Health Insurance Scheme, NHIS.
7. Appointment of a Surgeon General of the Federation with immediate effect.
8. A correction of entry point of a health officer to CONMESS 1 Step 4 as originally contained in MSS/ MSSS while the Registrar/ Medical officer is moved to CONMESS 3 Step 3.
9. Call duty allowance for Honorary Consultants should be increased by 90 per cent.
10. An adjustment in the specialist allowance as contained in the 2009 collective bargaining agreement. Also all doctors on CONMESS 3 and above must be paid specialist allowance or its equivalent, not less than 50 per cent higher than what is paid to other health workers.
11. Hazard allowance for medical doctors must be at least N100, 000 per month. The hazard allowance for medical doctors is said to be at N5, 000 per month presently.
12. Immediate release of the circular on rural posting, teaching and other allowances which must include house officers.
13. An immediate withdrawal of a circular by the Central Bank of Nigeria, CBN authorizing Medical Laboratory Science Council of Nigeria, MLSCN to approve licenses for importation of In-Vitro Diagnostics, IVDs.
14. Immediate release of the circular for the retirement age for medical doctors as agreed with the Federal Government.
15. The FG through the health ministry should formalize and implement the report of the interagency committee on residency training. The FG is expected to release the uniform template on the appointment of resident doctors in line with earlier agreements. Also a concrete funding framework for residency training must be established while the overseas clinical attachment must be fully restored and properly funded in the interest of the nation.
16. That in the interest of harmony in the Federal Medical Centre, Owerri, the government should pay the salaries of our members in the center as agreed on October 21, 2013.
17. Immediate concrete steps must be put in place for the reintegration of our members back into the IPPIS platform.
18. All attempts to coerce house officers not to join NARD must stop.
19. The orchestrated intimidation, harassment and physical assault of our members in the departments of pathology (Laboratory medicine) by laboratory scientists and tolerated by the Federal Ministry of Health must stop.
20. The endless circle of incomplete salary payment of our members in many hospitals in the name of shortfalls in personnel cost must stop.
21. Universal applicability of all establishment circulars on the renumeration and conditions of service for doctors at all levels of government must be granted.
22. Government should as a matter of urgency set up a health trust fund that will enhance the upgrading of hospitals in Nigeria.
23. The position of the Chief Medical Director/ Medical Director must continue to be occupied by a medical doctor as contained in the Act establishing the tertiary hospitals. This position remains sacrosanct and untouchable.
24. The NMA henceforth shall not accept the continued violation of any of any of the terms of the 2009 Collective Bargaining Agreement. This is exemplified by the payment of the Medical Physicist and Optometrist with OD (who are on CONHESS) call duty allowance using CONMESS circular. Similarly, the phrase, “Ministries, Departments and Agencies”, MDAs in the said agreement should replace “Federal Ministry of Health and other Federal Health Institutions” as contained in the 2009 CONMESS circular.
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