INTERVIEW: Why Nigerian doctors are leaving country to other climes – NMA President
Francis Adedayo Faduyile is the new president of the Nigerian Medical Association. He was elected in the recently concluded 58th Annual Delegates Meeting of the association to serve for two years. He is a consultant pathologist and an associate professor.
In this interview with PREMIUM TIMES‘ Ebuka Onyeji, Mr Faduyile speaks on why Nigerian doctors are leaving the country in droves and how they can be made to stay and work at home. He also addressed the issue of incessant strike in the health sector, why doctors are opposed to demands of other health workers and how the dispute between both parties can be resolved.
PT: Why are Nigerian doctors leaving the country to other climes, what are the factor responsible for this?
Faduyile: The major factors here are poor remuneration, poor facilities and working condition, and job satisfaction. Many of our health professionals are over worked. A doctor is supposed to see a maximum of 20 patients a day but they are seeing about 150 in a day. Certainly by the time he gets to 50 he is already exhausted. Even a nurse that is supposed to see about four patients has to take care of 50 patients in a ward, certainly he/she will get tired. The truth is that in Nigeria the working environment for many doctors is very hostile. Many doctors see patients that they can treat or intervene on their issues die in front of them because the hospitals they are working in does not have the necessary equipment to take care of them. Many patients in dire need for help don’t have enough money for the kind of services they need at that particular time. I can tell you many doctors are spending fortunes on patients that they are not related to because it’s painful to see patients die.
So, if we have our NHIS fully functional and we can always treat any patient, I can tell you many doctors will have job satisfaction because at the end of the day you have saved so many number of lives. But by the time you don’t have that, you will be dissatisfied. The remuneration of doctors is very poor, if you go to other climes, what we are paid here is just 10 per cent of what they collect and they respect doctors, they put you in that right position where you feel very important. We don’t have good funding maintenance for hospitals in the country. The few doctors that we have are over worked and are not appreciated, these are some of the reasons why so many of them are leaving unfortunately.
PT: How then can we keep our doctors from leaving?
Faduyile: First is when you appreciate your doctors, it will make them to stay. Government needs to bring more equipment. We need to have more fund for health. The NHIS is one way to resolve this issue. If we have more enrolee and funds to it then there will be enough money to maintain the hospitals and to bring in equipment, to buy drugs and for doctors to be retained.
PT: There are issues of internal migration inside the country. Doctors seem to avoid the Primary Health centres in the villages (PHC) and opt for the tertiary institutions in the urban areas due to the terrible state of facilities and standard of living in the grassroots. An investigation by PREMIUM TIMES revealed how many PHCs in the country operate with no doctors. How can this issue also be addressed?
Faduyile: The major reason is that the government does not give additional compensation to doctors working in the rural areas. What is in the national health act is that doctors working in the PHCs should be compensated more. However, most PHCs are ran by the states and even the normal payment for doctors, many states are not even paying. Many states are owing doctors and other health workers an upward of nine months. Many are being paid half salary for an upward of 18 months. So every human being naturally will look at those places where they will be much more appreciated. Until the state government key into payment structure of the health system and bring a pay that will make doctors and other health workers comfortable wherever they are, that is only how this issue can be addressed. This is why NMA is asking for universal applicability of CONMESS to all states and everywhere. If that is done enough pay will come for even the workers in the PHC which is initially structured to take care of 70 percent of Nigerians. 70 percent of our ailments but unfortunately, that area (PHC) is almost dead and we don’t have any other option than to revive it if we want to achieve Universal Health Coverage. This one percent consolidated allocation on basic health fund will go into the NPHCDA and we believe that with that it will strengthen our primary health care.
PT: Why Has NMA repeatedly and vehemently opposed to the demand of salary adjustments by other health workers?
Faduyile: There are so many demands they put forth, but the one on the front line is about their salaries and it’s unfortunate that we are leaving the main reason why we are on the health sector to talk about mundane things. There is a special salary scale for medical doctors as well as other health workers and in that doctors earn a particular leverage over and above other health workers. And we must understand that in this JOHESU we have the cleaners, the drivers, the typists, we have the administrative staffs, we have the hospital engineer, we have all other type of people who are supportive staff.
What JOHESU is asking is not just increment in their salary, they are asking for parity with doctors. We have been disadvantaged for more than 12 years in the health sector until 2014 when the government realised this and readjusted our salary scale which is CONMESS. We had an agreement with government through collective bargaining and they begged us to reduce the relativity and we have reduced it from 3.3 to 1 ratio to 1.5 to 1 ratio. This means over 50 per cent reduction and in our lower level we have appropriated relativity. In 3 steps out of the 7 steps that doctors are paid in the service, there is parity of 1 is to 1. So what we are saying is that it is getting out of hand. Before like I said, the salary ratio of doctors and other health workers used to be 3.3 to 1.0 but today we have cut it down to 1.5 is to 1.0 so that peace will reign; but they just want it to be at par. But we are saying we have given so much to that level of 1.5 and we can’t go beyond that.
PT: But if government finally adjusts the salary of other health workers, will it affect the salary of doctors?
Faduyile: No, it will not affect our salary but it will be a bad morale to us. I am working as a doctor and I’m collecting N5; another person in service who did not go through the kind of training I went through and is not working as much as I do will still be collecting the same salary. Why am I going through all these stress then? In America even among doctors, there is relativity. An anaesthetic doctor can collect up to five times the salary of a pathologist.
When CONMESS was implemented, JOHESU went and made up their own salary scheme which is CONHESS. They transferred all the figures and salary steps in CONMESS into CONHESS and that means parity. Doctors have to go back to government and tell them we have been short-changed. And in 2014 when the government realised their mistake they readjusted our own salary and it is that same readjustment that the JOHESU is asking from the government.
If that is done, then it means we have gone back to that position where we were disadvantaged. They are asking that everything in CONMESS point for point, level for level must be the same thing with CONHESS. Nobody is against them from having increment in salary. What we are saying is that it will not be at the same level with doctors. Government should follow its own agreement. In every institution in the whole world and in all international best practises, relativity begins with salary of doctors and other health care professionals.
(Editor’s Note: CONMESS is the salary structure for medical and dental officers in the federal public service while Consolidated Health Salary Structure, CONHESS, is the salary structure for pharmacists, medical laboratory, nurses and other health workers in the health sector of the federal public service.}
PT: JOHESU have always argued that they are not asking for same pay with doctors and that relativity suffices at point of entry into service since doctors enter service at grade level 12 while others enter at 8 or 9. What can you say about this?
Faduyile: That they enter service at grade level 9 and we enter at 12 is not relativity, it does not appear here. Can a degree holder that enters service at grade level 8 and a PHD holder that enters at level 10 earn the same salary? No. A PHD holder should get more gratification and enter service at higher grade than his degree counterpart. The relativity we are talking about here is not on the point of entry, point of entry is just about the degrees and level of education. We are talking about the ratio in the salary scale.
PT: How much does a doctor earn at entry level?
Faduyile: Doctors collect about N150,000. I am a consultant, I’ve been a consultant for more than 10 years and my salary is just a little above N500,000. With all the taxes, the money is even lesser while my counterpart in other African countries collect well above that and even a higher salary than Supreme Court judges. The judges collect nothing less than N2 million and for your information a neuro-surgeon in America collects more money than their president and we are working here, a typist is saying I must collect same salary with doctors.
PT: What do you make of this other demand by JOHESU for a chance to vie for the position of Chief Medical Director (CMD) in health institutions in the country?
Faduyile: In NNPC for example, can a doctor working there say he wants to be the group managing director of NNPC? There are clinics in the ministry of justice which doctors and nurses run but can they say they want to be the attorney general because they and the lawyers work in the same ministry? So what question are we asking? The representatives of the cleaners and the administrators now want to be CMD that will not go well for the health industry.
NMA: What are your objectives and target over the next two years?
Faduyile: My first target is to see how we can resolve all these issues of strike and disharmony in the health sector. It is a lot of distractions creating unnecessary deaths all over the country. We want to see that we direct our efforts to how patients are well taken care of in Nigeria. We want to strengthen our hospitals working method because a lot of hospitals are not working appropriately. We want to make government responsible to the health of the populace. The national health act is the law that has certified what government should do for the citizenry in terms of health care provision. Thank God that the Senate for the first time in history included in the 2018 budget the one per cent of the consolidated revenue fund in the allocation to the health sector. That one per cent will go into revamping the Primary Health Care system and the National Health Insurance Scheme, NHIS. It will stop out of pocket spending for health delivery. It is one of the greatest things that can happen. We want to plead with the president to quickly give assent to this budget and ensure it is well spent.
PT: How Do you intend to use your office to curb incessant strike in the health sector and by extent settle this perceived disaffection between doctors and other health workers?
Faduyile: My predecessors already started that, he had series of meeting with other professionals in the health sector. And when this current dust settles, I will call them so we can work out a plan that will benefit us all. And once we can work in harmony, there will be unity and improvement of health delivery. On the part of NMA, we are being proactive to avoid issues that can cause or degenerate to industrial action. We are trying to nip issues at the bod and that is why you see NMA is coming in on this JOHESU issue to let the government know that there is an agreement.
PT: There has been lots of cases of medical negligence and bad attitude of health workers towards patients. How is NMA working towards curtailing this trend?
Faduyile: You also have to understand and consider the plight of health workers on this. Some of them can be over worked like I said earlier and some of these attitude can stem from exhaustion. But regardless, we need to up our game in terms of professionalism. We have all sort of people coming into the system today with lots of behaviour that are unbecoming. On our own we are going to educate our members more, we will continue to pressurise the government to always put in the appropriate number of personnel needed; both doctors and other health workers. I think when we have that, all these harassment will reduce.
PT: How do you plan to check quackery in the health sector?
Faduyile: The first thing to do is to educate the public. You must be able to make the public to understand that your health is the most important thing you can lose. A lot of people will go and meet quacks who they know are quacks but they do so because they will tell you they don’t have money to go to hospitals. But if they are wrongly treated and they lose their life, what is now more expensive than that? We need to do a lot of education in this. We need to put pressure on our government to see that the Medical and Dental Council of Nigeria (MDCN) is set up.
The MDCN has not been up for more than three years now; it means that medical profession is likely unregulated in Nigeria. Once the council is in place, then we can enact laws to strengthen our security operatives in beating these quacks. On our own, we are going to raise the awareness and work with security agents to be able to pick those quacks and ensure that they are taken to court for impersonation. A quack anywhere is a threat to everybody. I don’t know where my sister or brother is now, they may be somewhere and it is a quack that is treating them. He can kill them or cause a lot of damage them.
PT: What is your take on Public Private Partnership (PPP)? Don’t you think it will further impoverish Nigerians by increasing out-of-pocket spending?
Faduyile: If you go outside Nigeria, most hospitals are private and that is why they are having good services. For you to enforce professionalism and discipline, it will be difficult within the public. If you go to India, most hospitals are privately owned. Government only supports because government cannot enforce professionalism and a whole lot of things because it is public. PPP is good and NMA supports it. On whether it will impoverish Nigerians, that is if we are still talking of out-of-pocket spending, we are now working towards changing the spending system through the NHIS where people can spend less