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Committee for a Workers' International

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Socialist Democracy March - April 2005

The public health sector in Nigeria will be thrown into turmoil again if the government does not fully resolve the issues around short fall in the payment of emolument in 2004 that was at the centre of the dispute which led the physicians, under the auspices of National Association of Resident Doctors (NARD) and other health workers into a six-week old strike. The workers were paid only 60% of their salaries. The strike was called off on January 23 after the government had announced the release of N8 billion to pay the short fall.

The doctors have issued another threat of strike to protest the lack of commitment of the government to the payment of outstanding salaries and arrears. According to NARD, weeks after the suspension of the last strike, the health workers in most of the teaching hospitals and federal medical centres have not been paid. The workers are also contending the anti-workers policy of "no work, no pay" as they were only paid few days out of the period of the strike.

From the antecedent of the government, this indication of looming industrial action may not be taken serious. Almost two months before the last major strike, the doctors had made their plan to embark on the action known to the government and the public if the anomalies were not rectified. In fact, they were on a two-day warning strike between November 8 and 9. According to NARD, no fewer than 20,000 persons died at various hospitals as a result of the six-week strike. This loss of lives out of sheer irresponsibility of the government is condemnable. Yet, it may not mind another strike that would result into another human disaster.

It will be recalled that for more than 2 months, between last year June and September, the health workers at Lagos University Teaching Hospital, LUTH, except medical doctors, were on active strike that paralysed activities while it lasted over issues around welfare package, working conditions and decaying infrastructures. Hardly had they called off the strike when their counterparts at the National Orthopaedic Hospital, Igbobi, Lagos and Yaba Psychiatric Hospital embarked on industrial action that lasted closed to a month for similar demands.

The incessant strikes by doctors and other health workers are a metaphor of the unending crisis associated with the sorry state of the Nigeria health sector. The health care in Nigeria is embarrassingly ramshackle like every other social service like education, electricity, etc, in spite of the abundant wealth of the country. The workers are not well paid their emoluments and there are no adequate and functional facilities in hospitals to work with. The working conditions are not only terrible but also hazardous. There is increasing exodus of medical practitioners for greener pasture and enabling working conditions outside the country. The Guardian Newspaper sometime in February reported that Nigerians in the border towns with Niger Republic have to visit the neighbouring country for medical attention since they could not get any, even slightest medical treatment in their own motherland. Sadly, no hospital in Nigeria has facility to diagnose curable diseases like hepatitis at early stage until it becomes terminal in form of cancer. The decaying trends of our health institutions are still far worrisome than what we might have imagined with the recent withdrawal of the accreditation of surgery programme from Lagos University Teaching Hospital (LUTH), born out of the declining quantity and quality of surgical operations being performed over a period of time. According to the Nigeria Medical Association (NMA) President, Wole Atoyebi, LUTH is the referral hospital with the largest number of surgeons and facilities in the country and yet, it has suffered much neglect.

Given the egregious decay and gloomy picture of the Nigerian health sector, it is no surprise, albeit shocking, that in the World Health Organisation's ranking of countries' health indicators, Nigeria, coming up 187th among 191 member states, is only ahead of some war-ravaged and crisis-laden countries like Democratic Republic of Congo, Central African Republic and Sierra Leone. In overall, Nigeria's health status is worse than the average for sub-Saharan Africa. Yet, the poor state of our health sector has never made those in government to lose sleep. How could they when they have sleazy money looted from the treasury to foot the bill of medical treatment in America and Europe even for slightest ailment?

Whereas, the question is not whether there are resources or not to support the provision of adequate, qualitative and functional public health care. Recently, Nigeria foreign reserve hits all time high $20 billion and the excess crude oil revenue is not less than $6 billion. The health sector is under-funded as a fall out of the commitment of the government to IMF/World Bank inspired neo-liberal policy of cut in social and public spending. The policy is to ensure that there is adequate portion of the country's wealth to take care of the economic interests of the imperialists and their agencies as well as to satisfy self-enrichment urge of the government's officials. For instance, Ngozi Okonjo-Iweala, the finance minister, the vice-president of World Bank on sabbatical leave in Nigeria, revealed a shocking fact of Nigeria spending just one-ninth of the allocation for debt service to the imperialist agencies on health care. (Punch February 14, 2004). Moreover, instead of committing the windfall to the functional provision of social service, as at February, the government has shared N318 billion of the money among its officials even without being appropriated. Yet, there has never been any noticeable development in the infrastructure to improve the lots of the working masses across the country.

Besides the meagre character of the budget allocation to health, there is progressive decline in the allocation year in year out. Last year, 6.5 % was allocated to the health sector while in the 2005 appropriation bill, yet to be passed, 5.5% is proposed. This is in spite of the fact that the 6.5% resulted in N8 billion shortfall that was at the centre of dispute between health workers and the government. Worse still, according to the government, N5.5 billion out of the N8 billion to offset the last year short fall will be charged on this year allocation of 5.5%. This implies that the seeming solution the government has proffered for the current dispute with doctors and other health workers will contribute to the worsening of the crisis in the sector.

The refusal of the government to adequately fund health sector from the enormous collectively owned wealth of the country is an indication that for a pro-capitalist/pro-imperialist government like that of Obasanjo, the interest of the poor working people ranks among the least of its priorities. As the panacea to the unending circle of crisis in the sector, the health workers, as they are fighting for improvement in their lots and working conditions, have to join the overall struggle of the working people to dislodge the current capitalist government and put in place a workers and poor farmers' government with rounded socialist programmes.

Socialist Democracy March - April 2005