Democratic Socialist Movement

For Struggle, Solidarity and Socialism in Nigeria

By - DSM



On Monday the 5th of January 2009, doctors in the employment of Lagos State government, under the aegis of the Medical Guild, embarked on a total and indefinite industrial action. This followed a 21-day ultimatum which was duly issued to the Lagos State government on the15th of December 2008, seeking a solution to three key issues: the deplorable state of hospitals in the state, the poor welfare package and working condition of doctors, and the non-implementation of the CONTISS salary scale for doctors employed by the state.

It is crucial that the citizenry be rightly informed about the origins of this current impasse. At various times over the past two years, the leadership of the Medical Guild has drawn the attention of the state government to the various anomalies persisting in the health sector of the state. The government has widely publicised that health care in hospitals in the state is free, especially for accident and emergency victims. Patients are therefore usually incredulous when they get to a state government hospital and find that virtually every service has to be paid for, both in cold and emergent cases. This often leads to desperate patients and their relations unleashing their anger and frustration on the personnel at the point of service, in most cases the doctor. Such scenarios have been known to lead to physical assault of hapless doctors.

Another consequence of the so-called free health care is that patients troop in daily from all parts of Lagos and indeed the country. Not a bad development in itself. But because of the outrageous doctor-patient ratio – the state government has in its employ a paltry 800 doctors to cater for a population of 18 million – an average doctor sees between 80 to 100 patients per day. This is a very conservative estimate, by far in default of World Health Organisation recommendations for resource-poor countries like Nigeria, results in interminable waiting hours in dark, hot and stuffy hospital corridors before patients can see a doctor. The inundated staff have barely enough time to take a patient’s history, examine, make a diagnosis and prescribe treatment. This bizarre scenario inevitably jeopardises the quality of care of patients.

Truth be told, the average doctor in Lagos State service is being worked to death. In civilised societies, doctors by regulation cannot work more than 30 hours at a stretch – a doctor may even be sanctioned for working longer, as it is assumed that his concentration, attention span and judgement would be compromised and this may lead to unsavoury outcomes for patients. In some Lagos State hospitals, call hours are unbelievably long – at times as much as 48 hours or more. To compound this, instead of the standard practice of seeing only emergent cases during call hours, doctors are often required to see cold cases on a 24- hour basis. Clinics may run even on weekends and public holidays!

All this goes on against a backdrop of collapsing infrastructure. Even in a towering edifice like the state teaching hospital, basic necessities like sphygmomanometers, stethoscopes, swabs, gloves, face masks and basic operating instruments are often unavailable. Running water is a luxury, and many hospitals are unlit at night, with the result that patients are either unattended or they have procedures, including major surgical operations, done under poor illumination. Consulting rooms are largely in a state of disrepair, and there are instances where male and female patients are required to share wards and emergency rooms, leading to indecent and dehumanizing exposure.

Over the years, doctors in Lagos State service have soldiered on, in keeping with the mores of the profession, in the face of these overwhelming odds. Not only are they frequently harassed, insulted and even assaulted by uninformed service users, motivation in the form of remuneration is poor. Newly employed medical officers and house officers may be asked to wait several months before being paid, and even when paid receive a fraction of what they are due. The disparity in pay with other equally qualified doctors is also discouraging. For instance, a doctor in Lagos State service for upwards of four years may earn less than a newly employed house officer in a federal institution. This is a consequence of the non-implementation of the CONTISS salary structure which was introduced by the federal government in January 1997 and which has since been introduced in several states of the federation.

The consequence of this is that many young doctors see Lagos State service as a stop-gap measure – something to do before you get a better paying job or travel abroad. That is why even though the state government holds employment exercises periodically, the number of doctors working for the state has not appreciated. General Hospitals on the other hand keep proliferating, leaving more work for those who stay within the system.

The Lagos State branch of the Nigerian Medical Association (NMA) is the umbrella body of all doctors working in the state, including not only those in state and federal employment, but also those in private practice. On Saturday the 3rd of January, the executive committee of Lagos State NMA held a press conference at the State secretariat, primarily aimed at finding a solution to the looming strike action of Lagos State employed doctors. The Chairman of the State branch of NMA, Dr Adedamola Dada, pointed out that a strike is bound to be devastating in a heavily populated state like Lagos, especially among the vulnerable groups – the poor, the young, and the elderly. The NMA, according to him, is the custodian of the people’s health hence the effort to find a quick and just resolution to this crisis.

It is indeed saddening to note that despite the long notice and opportunity offered to the leadership of the Lagos State Ministry of Health to resolve these issues at no pain to the people of Lagos, the ministry is yet to open any form of negotiation with doctors, and even a parley organised by the Ministry of Establishment with the doctors was shunned by the Ministry of Health.

It appears uncertain if the dispensation of government as we have it today has a solution to this or indeed any major problem facing Lagosians.

NIRAN OKEWOLE is the Deputy Secretary, Nigerian Medical Association, Lagos State Branch.