How healthcare system collapsed in Osun – NMA chairman

The chairman of the Nigerian Medical Association (NMA) in Osun State, Dr Tokunbo Olajumoke, in this interview by OLUWOLE IGE, speaks on the ultimatum recently issued to the state government, the demands of the association, the state of health facilities in the state, among other issues. Excerpts:

There have been agitations on the part of doctors in the employ of the Osun State government regarding payment of salaries arrears and other issues. What exactly are your demands?

As you are aware, our association has given the Osun State government a 21-day ultimatum, which is going to lapse on 17 September, 2017. The issues that actually warranted the ultimatum are two. One is about the general healthcare system in the state and the other is about the welfare of the health workers, especially doctors. What we have in the state now is that the healthcare system has been grounded. If you go to public hospitals, you will see that most of them are not functioning optimally. Most of the general hospitals are functioning as primary health care centres. I keep saying that where you find about five doctors doing the work of 50 doctors for 24 hours, making sure that patients are okay, then something fundamental has gone wrong. That is the situation we have in Osun State hospitals now.

The doctors toil but there are no facilities to work with. Most of the equipment needed for investigation and management of ailments are lacking in virtually all the hospitals in the state. The situation is so pitiable that when patients go to the hospitals for urgent medical attention, their relatives have to buy fuel to power the generators. That is unimaginable in public hospitals. Patients are made to buy fuel for government generators. When they even go out of their way to do all these things and they see the doctors, what would they be given? They will just be given the common drugs like paracetamol, analgesic and multivitamins. This is because most of the essential drugs are not available in the hospitals. This is why patients are dying every day. Today in Osun State, the mortality rate is unprecedented. We have never had it this bad. People are dying every now and then. The health sector has been neglected. It is not on the priority list of the government of the day.

The other issue is about the welfare of caregivers and doctors in particular. Doctors are essential caregivers anywhere you go and as such, their package, remuneration and allowances are special and separate. But in Osun State, as we have it today, caregivers are not the priority. It is quite unfortunate because caregivers are supposed to work for 24 hours. You can’t equate them with other workers that report for duty in the morning and go home by 12.00 p.m. or 3.00 p.m. We just woke up sometime in June, 2015 and heard the news that our salaries had been mutilated. They (government) call it modulated salary but it is mutilated salary. Modulated salary is not known to medical practice anywhere in the world. We told them that we are members of NMA, the Nigeria Labour Congress (NLC). Any issue pertaining to the welfare of doctors has to be channelled through the NMA. But, strangely, we were not called for any discussion. We told the government that we are open to dialogue; that we should go to the roundtable and discuss as NMA and government. You cannot force the agreement you had with the NLC down the throats of the NMA members. It is not acceptable. Since June 2015, the government has been paying doctors about 30 per cent of their monthly salary. That is more than two years ago.

The issue of tax is another bone of contention. There is what they call PITAX, which means Personal Income Tax. It is a national document that stipulates what every salary earner must pay as tax. Taxes are negotiable and I have seen that done. Where people are being paid full salaries, workers can still engage the government for tax relief and they can discuss how much they can pay as tax. In Osun State today, we are being paid 30 per cent of our salary and government is deducting full tax from that salary. What they do is that they take the whole package and divide it into two and deduct the full tax and pay the remaining as stipend so that doctors would not die. That is quite unfortunate. If somebody went to university for seven years and acquired additional training and such a person comes to Osun State to work and the best they can have is 30 per cent of their salary, it is very disheartening.

The third issue is that there is a circular, which is the correction of the revised circular and this circular stipulates what every doctor should collect as salary for all the cadres throughout the country. This has been implemented since 2014. That was about three years ago. That is when people have been collecting what is called revised CONMESS. That is the salary of doctors all over the country. When we got this circular, we went to the Osun State government and informed them that this was not a new law but a correction of the anomaly of what was present in the former circular, they told us that there was no law that compelled them to pay what the Federal Government was paying. They said they were at liberty to pay their workforce, including their doctors, any amount they deemed fit. Then, I quickly pointed out to them that their position amounted to double standard. If  a tax regime could be released by the Federal Government, which is a national document and Osun State was so glad and so quick to embrace and implement that tax law to maximum level without any relief, how come the same government released a document stipulating what every doctor should be paid nationwide and Osun State government is saying they can’t pay such amount? That is purely simply double standard. Available facts show that Osun State doctors are the worst paid in Nigeria and they are the ones paying the highest amount of tax. If we compare our pay slips to other doctors in the country, what we are paying as tax is three times more than what other doctors are paying elsewhere, and where they are being paid full salary.

Sometime last year, after pleas from stakeholders, including NMA, for the government to accede to our demands, our affiliates went on strike. As result of the industrial action, people started dying and the mortality rate increased. There was pressure on the NMA to prevail on our affiliates to resume work so that we could stem the mortality rate that time. Because of our responsibility to the state and our love for the masses, we asked our affiliates to resume work. However, we signed an agreement with the state government that within a month of the resumption, all issues raised in their demands would be tackled and there won’t be any punishment for any member of staff that participated in that strike. Can you imagine that eight months after they called off the strike, the issues that caused the strike are yet to be addressed? What is even more worrisome is that their salaries for the period of the strike are being withheld by the state government. They are claiming that they have applied the law of ‘no work, no pay.’ That document actually stipulates what is supposed to be the responsibility of the state government, which is the employer and the employees. The document protects the employer and the employees. It is also stated there that under no condition or guise should an employers pay less than the full salary of workforce for more than six months. But now Osun State government has been paying 30 per cent of doctors’ salaries in the last two years. The state government has violated that aspect of that rule. Once you have violated that aspect, you have violated virtually every part of the law. The government was applying the strict rule of ‘no work, no pay’ and at the same time violating the law that you have to pay your workers full salary consistently for six months. This same government has been paying doctors 30 per cent of their salary for more than two years. That is sheer wickedness and double standard. Those are the issues. The health sector in Osun State is in a deep crisis. Doctors are moving out of the state en masse every day.

There is also something suspicious in the pay package. At the end of the month, when you are supposed to be paid, they will give you a payment advice, which we call pay slip, that will tell you how much you are expecting in your salary. In Osun today, when you take that pay slip, especially in the teaching hospitals, you will see that it is indicated there that you are being paid full salary. When you get to the bank, you will discover that what you will be paid is a small fraction of what is called full salary in the pay slip. We keep telling them that if you are paying a fragment of salary, let the pay slip reflect the exact amount that you are paying. It is just fraudulent.

To me, this 21-day ultimatum is a window for the government to come to dialogue. More than a week into the ultimatum, there has not been any call from the government to us to discuss and I can assure you that at the expiration of the ultimatum, we are going to start a full-blown strike across all our hospitals. Once that ultimatum expires by midnight of 17 September, 2017, all our members will be forced to down tools and that means we are not going to see any patient again until all our demands are met.

 

But the government believes that you are being used by the opposition to paint the administration of Governor Rauf Aregbesola in a bad light, considering the financial incapability of the state government.

We are not being used by anybody. And we run away from politics. We are apolitical. We are not politicians and we are not being used by any politician. Our protest or strike is always far removed from politics and political era.

 

Have you ever had a direct engagement with the government as a body to resolve all the knotty issues?

After some serious engagements, they remained insensitive. At a point, we had to involve our national body. The national president of the NMA, Professor Mike Ogirima, came all the way from Abuja and he met with Governor Aregbesola. The meeting was cancelled about three times before it was eventually held. The governor virtually took over the meeting and at a point, he (Aregbesola) told the NMA national president bluntly that he did not care if we were not comfortable; all doctors that were not comfortable should seek employment elsewhere. He said he was going to get doctors from Cuba.

 

What do you think is the way out?

There are no two ways out of this quagmire. There is only one way and everything boils down to sheer will and prioritising health. If the government of the day has the will to find solutions to the issues and give health the deserved priority, they have a way to solve the problem. The only way to achieve this is to discuss. Doctors are there to save people, not to kill them. Besides, we love of our patients. We hate seeing them suffer or die, but doctors are also dying on duty. Doctors collapse when they work round the clock and they are not well paid. The best thing for the government to do now is to call for a roundtable discussion. Let us discuss the issues and the options available. But if the government is still not ready to discuss with anybody, they are just putting public health in jeopardy. We, as members of NMA, want to avoid that situation and we are pleading with well-meaning citizens of Osun State to talk to our governor. If they refuse and continue to behave as if nothing is going to happen, then let’s wait and see what happens on September 17.

 

The major reason government is adducing for not meeting the demands of the NMA is that there is no fund to pay or settle your demands. Are you not considering the pitiable financial condition of the government regarding your demands?

We are quite reasonable, but when all the cards are not laid on the table and government is not being sincere or giving the right information, what do you expect? There is a lot of falsehood and misrepresentation of issues.

 

You were talking about high mortality rate. Can you compare the mortality rate before this period and what is really obtainable now in terms of deaths recorded in public hospitals?

When there are epidemics like Lassa fever or Ebola, mortality rate can be very high. But when there is no epidemic in town and you still have persistent mortality, it means something is wrong and it calls to question, the healthcare system. Once the government is able to guarantee efficient healthcare for the citizenry, I can assure you it would stem the high mortality rate in the state.

 


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