Lagos sacked doctors: Patients at the receiving end

When two elephants fight, it is the grass that suffers. Right from the day members of the Medical Guide, an umbrella of doctors under the employ of Lagos State, commenced a three-day warning strike, it was evident that crisis was looming in the state's health sector.

The warning strike, which brought healthcare services in the state to its knees, set off a chain reaction.

Intended to be followed by an indefinite strike to press for the doctors' demands, the warning strike was called off on schedule, but as people would heave a sigh of relief, the uncertainty in the sector worsened as the striking doctors were queried and summoned to appear before a disciplinary panel, this move the doctors did not respond to.

Investigations by BusinessDay reveal that the beehive of activities that is often associated with health institutions in the state thinned out. The state teaching hospital and its satellites have become ghost towns. This same scenario is visible in virtually all State-owned hospitals in Lagos as hapless patients have had to cope with a semblance of health care services without doctors at their duty posts.

With this development, hundreds of patients unable to access medical care and more disturbingly, the rising death tolls, misery and desolation mildly describe the precarious situation at most hospitals in the state since the uncertainty which enveloped the health sector began over the last two weeks.

It is no longer news that doctors employed by the Lagos State government have embarked on industrial action on several times within the last three years over issues bordering on the Consolidated Medical Salary Structure (CONMESS) for medical doctors.

While it is difficult to calculate the number of times the Medical Guild have down tools since the present administration of Governor Babatunde Fashola, Lagosians are wondering why doctors and the state government cannot reach an amicable agreement as responsive stakeholders in whose hands they have placed their health needs.

Why doctors were sacked - Lagos State Govt

The Lagos State government on May 8th, 2012 explained the rationale behind the sacking of 788 doctors under its employment saying the decision was not a palatable one for the government adding that the government had not foreclosed the issue of negotiation.

Fielding questions from journalists during the state Ministry of Health annual ministerial briefing to mark the first year of Governor Fashola's second term in office in Lagos, Jide Idris, state Commissioner for Health, justified the action of the government.

According to him, "the bottom line is that you have people who entered the civil service under specific rules and regulations. The state government reserves the right to evolve policies for all civil services but once you allow people to behave the way they like, there will be chaos and disaster."

Idris who acknowledged that the sack was not an end to strike in the health sector, added that everybody had the right to strike while the government also had the right to sack.

He said: "What we are addressing now is the emergency services. We have the responsibility of providing healthcare and that is our priority now. The hospitals are not totally paralysed as some doctors are still working. We still have over 1,000 doctors in service including the new ones.

"The new doctors had their orientation and are currently being deployed to the various hospitals. We have plans to recruit more as a good number of doctors from other states have signified interest to work with us. We do not know any other state that pays as much as we are doing right now. This government has bent over backward. That is why the government was forced to publish what they are being paid. If you look at all their grievances, the first one, they demanded that the house officers and medical officers on Grade Level 12 must be paid teaching allowance."

The commissioner added that "As at the point of discussion, we did not say we will not pay. But a circular provided by salaries and wages commission, Abuja to the minister, specified the category of health workers that are entitled to teaching allowance."

NMA, doctors react

Following its inability to reach an understanding with the Lagos State Government, the Nigerian Medical Association (NMA) has said it will take the dispute between its members in Lagos and the government to an emergency meeting of its parent body.

The NMA representatives and state officials who met last week Thursday failed to reach a compromise, prompting the association to decide on a national approach to ending the deadlock.

According to Osahon Enabulele, President, NMA, the body will convene an emergency National Delegate Meeting of 36 states of the federation and Abuja to review the current situation regarding the indefinite strike embarked upon by the Lagos doctors under the umbrella of the Medical Guild and take a national position.

He noted that "After four hours of engagement with Adesegun Ogunlewe, Lagos State Head of Service, the commissioner for health, Jide Idris, permanent secretaries and other officers of the State Government, the initiated dialogue ended in a deadlock occasioned by the fixation position of the Head of Service that the Lagos Government had resolved to disciplined its doctors and that the matter was beyond him."

While rejecting in its totality the sack of doctors, publication of their salaries and their eviction from government quarters, Enabulele maintained that the Lagos branch of NMA would continue to explore all options, including dialogue to make sure the state implement the Consolidated Medical Salary Structure (CONMESS) as the non implementation of CONMESS would put Lagos doctors at a comparative disadvantage with their counterparts in other health institutions.

He said: "The doctor-patient ratio in Lagos State is one to 14, 545. This is far from the African standard of one to 10, 000 and the global standard of one to 1, 000. The current ratio will be worsened due to reduced medical manpower and poor access to health care and as such ensures poorer indices in maternal infant mortality rates, under-five mortality rate."

Enabulele said the body would not take it kindly with state government for casualising the medical profession as exemplified by the purported locum (casual) appointments offered by the Lagos State Health Service Commission.

The NMA has however filed a fresh application in the National Industrial Court, Lagos last week Thursday with No: NICN/ LA/ 158/ 2012 asking the court to reverse their dismissal and recall all their members. They also argued that the decision of the government to sack them is in violent violation and sabotage of the rule of law and utter disrespect for the dignity of the honourable court. The doctors further argued that their application is in the interest of justice, respect for the rule of law and sane industrial relations practice.

Solving the impasse

Following the loss of lives recorded during the current crisis, the Association of General and Private Medical Practitioners of Nigeria (AGPMPN) has appealed to both the government and the sacked doctors to sheath their swords and negotiate for an amicable resolution to the dispute.

Briefing journalists after an emergency meeting of the association, Anthony Omolola, national president, AGPMPN, said processes were already on to bring both parties together, saying that the interest of patients and the image of the medical profession were of importance to the association.

"We are ready to sacrifice to bring succour to patients. This is a moment of reflection, a moment where we need to have a re-think about the happenings in Lagos State. We in AGPMPN are not happy about the current strike and all the attendant problems in the state," Omolola said.

Meanwhile, the Nigerian Bar Association, NBA, has offered to mediate in the face-off between the sacked doctors in Lagos State and the state government. According to Taiwo Taiwo, branch chairman, NBA, "The branch believes that it was better to play a mediation role between the parties in order to find a solution to the problem in the interest of the poor people of Lagos State who obviously will suffer more than any other person in the state."

While the face off continues, both sides should abandon their entrenched positions and return to talks without preconditions. Unless this is done, it is the state's health service that will suffer.