Archive for July, 2014

Health Workers and Industrial Action

Doctor and healthcare worker strikes are a global phenomenon with the potential to negatively impact on the quality of healthcare services and the doctor-patient relationship. Strikes are a legitimate deadlock breaking mechanism employed when labour negotiations have reached an impasse during collective bargaining. The right to strike is considered a fundamental right whose derogation would be inimical to the proper functioning of employer/employee collective bargaining in democratic societies.

According to the World Medical Association (WMA) Statement on the “Ethical Implications of Collective Action by Physicians” adopted by the 63rd WMA General Assembly in 2012, in Bangkok, “Physicians may carry out protest action and sanctions in order to improve direct and indirect working conditions that also may affect patient care. If involved in collective action, National Medical Associations should act to minimise the harm to the public and ensure that essential and emergency health services, and the continuity of care, are provided throughout a strike.”

In essence, it is both legal and ethical for Physicians to go on strike, contrary to what many claim. Physicians are however encouraged to minimise the harm to the public, where a strike has been embarked upon. This writer however, puts doctors on a pedestal, and therefore finds it difficult to swallow that doctors would take up industrial action for the reasons stated for this current strike, (though within their legal & ethical boundaries).

 

Our Complex Situation

The Federal Government (FG), the Nigerian Doctors and the Nigerian Allied Health Workers appear to be blindsided by one of Nigeria’s worst kept secrets – Our health system is on the brink of total collapse. How else can one explain this mire of incompetent handling of negotiations by the FG, and recurrent strikes from both doctor and allied health worker groups?

The Nigerian health indices are among the worst globally, and our health services in the public sphere, are not nearly as good as it could be. Whilst recognising the efforts that have been put in by the FG and all healthcare workers, over the years to strengthen our health system, the current warring of the factions, does more to undermine the efforts of all these groups over the years, whilst leaving us with a huge gap that still needs to be met, in our health status.

The current industrial action by the Nigerian Doctors, is part of a complex situation broadly involving four stakeholders, that has been on-going for longer than some of us care to chronicle. This four-way situation involves the Doctors, the Allied Health Workers, the FG and the Nigerian Citizens. The complexities of this situation, make any attempts to simplify, laughable.

The FG have botched the debate, every step of the way. They have made some agreements that are difficult to implement, especially in the context of current practise and existing policies. They have made promises to both sides. They have left a lot unratified. They have underinvested in Health. The FG have ultimately not done what is expected of it, in ameliorating this conflict or in fostering the health of citizens.

The Allied Health Workers want better recognition, better entry levels and navigation within the civil service, and ultimately, the opportunity to also lead the tertiary hospitals and the health sector. Arguments have been put forward on the mismanagement of the health system by Doctors in leadership over years, as well as examples of the leadership models of other countries, many of which do not have Doctors at the helm, but are ultimately doing well. The Allied Health Workers blame the Doctors for everything wrong with the Health System and blame the FG for always indulging Doctors.

The Doctors want to preserve their statuses as leaders of the tertiary hospitals and the health sector, want to limit the use of certain terminologies that connote ownership of patients to doctors alone, want to preserve a salary relativity that structures earning within the health sector, want the FG to provide better financial support to working doctors, and are making certain key demands that will uplift health service delivery in the country (including passage of the National Health Bill). The Doctors accuse Allied Health Workers of trying to undermine their ownership of patients, leadership in the provision of care to the patient, and for most other issues surrounding the conflict. They also blame the FG for indulging the Allied Health Workers.

The FG gets the blame from both sides, obviously. And no one else is willing to take responsibility for their own shortcomings.

The Nigerian Citizen, the fourth stakeholder in this complex situation has become little more than mere collateral damage. I would like to point out that there is significant evidence, that contrary to popular belief, withdrawal of services or strike actions by doctors and healthcare workers will not automatically lead to an increased number of patient deaths or total failure of healthcare service delivery. However, all the research that provide this evidence, were conducted in mid-to-high income countries, with well established emergency services and relatively advanced health-seeking behaviour. In context therefore, it is within reason to say that the Nigerian citizens are at risk of loss of lives and deformation, in the event of strikes by any of the groups of healthcare workers.

The citizen, who all the health workers swore to look after, has become collateral damage in the squabble. This is at best, completely unacceptable.

 

Leadership in a Crisis
“We understood perfectly that the life of a single human is worth a million times more than all the property of the richest man on earth. And we learned it; we, who were not of the working class nor of the peasant class. Social medicine demands that it be well understood that far more important than a good renumeration is the pride of serving ones neighbour. That much more definitive and much more lasting than all the gold that one can accumulate is the gratitude of a people. And each doctor, within the circle of his activities, can and must accumulate that valuable treasure, the gratitude of his people.” Dr. Ernesto Che Guevara

 

As a Physician in training many years ago, I was magnetised by the will and wisdom of Dr. Che Guevara, a doctor who became part of a revolution, following his experience as a doctor, witnessing illness, hunger, and poverty. He became a man defined by his need to push for the benefits of the masses. Such need to help the masses, continues to drive many to become physicians today. While recognising that we cannot create a utopia, it is important to point out that being a doctor is more than just a job and doctors, must remember this.

Doctors, are stakeholders in this society. Doctors cannot absolve themselves of all responsibility, in the mess that is our health system. They cannot pitch the people against the Allied Health Workers and Government, in the hope that they will come out of the situation, smelling of roses.

When we decided to become doctors, we made a choice to live a life of sacrifice, with the intent to foster humanity. I hope we never lose sight of that. I hope we can take leadership of the health sector, and be the example. I hope we can look past the squabble and see the big picture, with a focus on building a better health system for our people. Our demands, no matter how reasonable they may seem to some, should not have to come at the cost of the lives of the poor, who are the ultimate victims.

Let us lead, in a crisis.