Ajala Olugbenga is the chairman of the National Association of Nigerian Nurses & Midwives at the Lagos University Teaching Hospital (LUTH) Branch. In this interview with Chuks Nwanne, the trained nurse spoke on the many challenges of health professionals.
How has situation been here since the doctors embarked on nationwide strike?
WELL, basically the situation on ground is such that medical doctors could not attend to patients coming here. However, it has nothing to do with our own job; the nurses are on ground. We are doing the best we can to alleviate the sufferings of patients on bed and also do as much as we could for new ones those who are coming in.
Does that in anyway put pressure on nurses as a group?
Well, the fact, which the doctors have refused to understand, is that all of us in the health industry compliment each other. Based on that, I will say that there's no way a group will be out of service and it will not affect the others. So, if you look at it from that angle, then I can say the pressure is on other workers on ground.
The feeling outside it that the current strike by doctors has something to do with the recent salary increment for health workers in Nigeria by the government, how true is this?
Basically, it's an issue and I would actually blame government. We are in the same ministry rendering about the same service and you are having dichotomy in salary scale? There should be one unified salary scale for everybody; it might be the point of entry of each professional that will be different. But when you have two salary structures in one ministry, it is an aberration. That's the genesis of the problem we are having in the ministry today. Today, this group will say, 'review our salary,' and the other group will say, 'you must review our salary too.' But if it is a single salary structure scale, the review will be done once and everybody will be fine; nobody will complain about anybody and we won't be talking about this disparity.
Where exactly does this disparity exist?
In the heath ministry, we have two salary structures; the Consolidated Health Salary Structure, which is basically for nurses, pharmacists and other health workers. Then, you have Consolidated Medical Salary Scale, which is for doctors only. So, going by these structures, the doctors earn far better than the other health workers.
Who designed the pay structures?
It is a government design, if not, they won't have approved it in the first instance. When there was a unified salary structure, doctors pulled out, insisting they want a salary structure of their own and government granted it. This is one of the problems in the health sector, the dichotomy in salary scale.
How do you feel about this as a professional?
Initially, everybody knows where his/her interest lies in the health sector; everybody knows what profession he/she wants to pursue. So, because somebody has gone to read pharmacy or nursing or radiography does not make the fellow a less cerebral person to doctors. On that ground, we all come out as graduates and we are all in the field of health; no one can do it all. Only nurses cannot do it, only pharmacists cannot do it, only doctors cannot do it; it's teamwork. When we begin to see ourselves as a team, then it's easier to have a team leader because in every team, there must be a team leader. But in a situation where we all operate without respect for one another, with somebody just claiming that 'I'm the one that knows it all, I should be a leader,' we say no! People appoint leaders; leaders don't appoint themselves. We work in the same industry; we are exposed to the same hazards in the hospital. Though we work different hours, we work under the same condition, same environment. Now, what should determine the difference in salary structure? And what should say, it must be this fellow that must continue to lead the group? We have been asking and the NIC (National Industrial Court) has said that we should discuss with the Ministry of Health and the government to reach some agreement and some of the agreements have been reached.
Could you let us into some details on the agreements reached?
One of the things we are asking for is that the head of the hospitals, teaching hospitals, federal medical centers and other hospitals, does not have to be only doctors. It is an administrative post and any professional in the health industry, who is administration inclined and qualified in his field, should be allowed to head the hospitals. It does not have to be a doctor; it could be a radiographer, a lab scientist, a nurse, a doctor... it is not the birth right of any member of the group. And we are equally saying that the leadership of such hospitals should come from the core staff of the hospital; they don't have to come from the Colleges. As we have it here, we usually have the CMDs coming from the Colleges to be the Medical Director of the hospital, whereas there are professionals in the hospitals, who understand the challenges in our terrain. They will not allow them to rise to that post, and those that come from the academics, most of the times; they mess up the system and still go back to where they came from and earn fat salaries. This is one of the issues that have created problems severally.
As an association, how far have you gone in ensuring such challenges are eliminated in the sector?
Well, the case is being handle at the national level by the Joint Health Sector Union (JOHESU). The federal government has set up a committee to look into such requests, but we are yet to get the comprehensive report on that.
Is it true that the doctors are not comfortable with the decision by the government to narrow the gap in salary structure based on the recent increment?
It is very true and also more to that. One, when the two salaries were approved, there was an understanding between the workers and the government that, each time the two salaries will be reviewed, the disparity should be maintained; that's what the government has been doing over time. Now, the doctors are feeling that we should not earn as much as we are getting today. Two, they are asking for the post of Surgeon General of the Federation; that's a post that they also want to be the only ones to fill. As at today, the post of Surgeon General is not what we required to turn around the health industry; it's not what is required for the common man on the street to have quality health care; it is not what is required to reduce the mortality rate of the Nigerian citizenry. As at today, the World Health Organization (WHO) has said that the life expectancy of Nigerians has dropped to 54. What we should be doing now should be things that will increase the life expectancy of the people. Even this post of Surgeon General, in develop countries like America and Britain, the post of surgeon general is limited to the military. I want to tell you that as of today, in the United States of America, the Surgeon General in the military there is a nurse. So, they (doctors) are saying that they must get this post of Surgeon General and it must be limited to doctors only.
They are also saying that they are the rightful owner of the name 'consultant' and no one else should bear 'consultants' in the health industry with them. Now tell me, who is a consultant? A consultant is a fellow, who is a specialist in his own field, who deserves to be consulted by a novice in that field when the need arises. So, why should people just be asking for things that are unnecessary; these are not what will bring quality healthcare to the citizenry. Other professionals in the health industry should be able to get to the post of a consultant; what we should be talking about is what qualifies one to become a consultant. Presently, government has approved the appointment of two consultants in UCH Ibadan that are nurses and this is making the doctors to be so restless. They are claiming they are the ones that know it all, but no one knows it all; you are a consultant in your own field.
Are you saying this strike has political undertone?
That's the point; it's partly political and administrative issue. However, that should not be the reason why a group should say, 'if you allow these people to become consultants, the whole industry will be on fire. If you allow these people to become the heads of hospital, there will be fire; if you don't give us the post of Surgeon General, there will be fire.' I keep saying it, on each hand, God has created five fingers; there's no one you take away one that the hand will function properly. The five fingers so much respect themselves and they work in unity. Until we replicate that in the health industry, there will continue to be problem. I must say that the ministry is not helpful and we are not surprised that they are not being helpful.
All the professionals in the health sector are supposed to be under the Ministry of health, to what level has the ministry intervened?
Look, you can go to the ministry of health, the bulk of the directors there are doctors and when decisions are going to be taken, they are the one to do so. Definitely, if you are not there, you cannot be there. So, definitely, they will make decision in their own favour and pass it down the line. And we are saying, 'it cannot continue.' It was only four years ago that nurses were allowed to reach directorate carder in the ministry of health nationwide and it did not come on a platter of gold; it took law suites before we got that position. So, what the doctors are very good at doing is trying to subdue the other professionals in the ministry.
With such 'bad blood' and politicking in the sector, health care delivery will surely be affected?
Well, once a decision is wrongly taken up, it trickles down. So, all the actions that follow the decision would not yield quality service. The ordinary man on the street is not bothered how you do your bureaucracy, all he needs is quality care; how you save his life is what matters to him. But where the doctors are taking decisions because they are in the majority at the decision taking level, without taking other professionals into consideration, there will surely be problems. For instance, you as a pharmacist cannot decide about me being a nurse; you can't decide how I do my job to give patients quality service. As a nurse also, I cannot decide how you do yours too. So, if somebody had taken that decision on our behalf and the decision is wrong, definitely quality healthcare delivery will be affected. That's why doctors are creating unnecessary vacancies for themselves in the hospitals, duplicating posts to continue to have power. It is not done; you don't expect other professionals to fold their hands and watch.
What's the feeling among nurses about this existing disparity?
Under the current dispensation, the law does not permit non-doctors to get to the directorate level in the ministry. As a person, such decision makes you feel low. You know too well that you can perform in such position, but you are not allowed because a particular group has monopolized it. Even at that, there are lots of errors. That's why there's a huge agitation that all professionals in the health industry that are qualified administrative wise, should attain that position. For now, people are feeling that someday, the opportunity will come for us to make our own contribution. Don't forget that some years back, a pharmacist was made the Health Minister and as much as he tried to improve the sector, he was kicked out; his being kicked out was the handiwork of the doctors.
Are you saying his exit had nothing to do with underperformance?
It had nothing to do with that; he did not perform below expectation at that time. We've had doctors in the past that performed far, far below that; we know doctors, who came and created chaos in the industry. It's just because a group is claiming they are the 'alpha and omega' as far as the health industry is concerned.
What does this strike say about us as a people?
It says we are not united and also that we are not tolerant. It equally shows that we are joking with people's lives. If because you wanted a post of Surgeon General, you don't want somebody to bear 'consultant' and for that you down tools, it's unacceptable; it's uncalled for, it's unnecessary.
CLICK HERE TO ATTEND: Offshore/ Onshore Medic HSE Certificate Course for Doctors, Nurses, Paramedics and Healthcare Professionals
GET THE AMERICAN HEART ASSOCIATION FIRST AID CPR AED CERTIFICATE
Join the Medicalworld Nigeria Telegram group for latest Medical updates, news and jobs!!