Rejoinder to Kathleen Ndongmo’s ‘A doctor a day’: A con(solidated) mess

by Joachim MacEbong

The dispute between Lagos state doctors and the state government took a dramatic turn on Monday, as over 700 doctors were relieved of duty, and the move to put their replacements in place started in earnest. The root of the dispute is over the implementation of the Consolidated Medical Salary Structure (CONMESS), which was approved by the Federal government late in 2009. So far, the best the state government has been able to do is 75% of CONMESS, but that was not acceptable to the doctors who embarked on an indefinite strike on April 24, after a warning strike between April 11-13.

A recourse to figures will put this matter in its proper perspective. The least paid doctor in Lagos earns N173,000. Before the sacking, Lagos had 1,474 doctors in its employ. Over 12 months, they will get a minimum of N3.06 billion. Bear in mind that this is an absolute minimum because those at higher levels will earn more. The total health budget for Lagos in 2012 is N33.9 billion, and the salary of those doctors makes up 9% of that figure. Furthermore, recurrent expenditure for 2012 is N233.6 billion, and the salary of these doctors makes up about 1.3% of that recurrent. The total personnel cost is N81.6 billion, and N3.06 billion represents 3.75% of that. Note, these are all minimum figures. It is also necessary to point out that N173,000 at entry level is more than most can hope for. Nigeria’s per capita is about $2,500 and they get just under half that a month at the minimum. Simply put, in a poor country like this, the Lagos state government is not doing a bad job in terms of valuing its doctors.

We must also consider the impact of increasing salaries on the wage bill. 1,474 doctors for a population of 15 million is far from adequate, and more would certainly need to be hired to bridge the gap. Lagos is not quite where it was in 2007 in terms of infrastructure, but it still has a long way to go. There are so many sectors that need heavy investment to bring them up to the required standard, and to commit an ever-increasing amount to wages will be ill-advised. At this moment, much of the money should be going into provision of basic amenities.

A lot of people will point to the perceived wastefulness of the government as justification for the agitation for higher wages. Nothing could be more childish and irresponsible. What those who say this mean is: since so-and-so is helping himself, we the people should also help ourselves to higher wages, and not bother who dies or whose illness gets worse in the process. Not a peep has been heard from the doctors about improving facilities, or patient care, or any of the several issues wrong with our health sector. All that matters is cleaning out. It is now nearly impossible to distinguish them from the leaders they seek to fight to a standstill. If the problem is those who are looting, by all means protest, but to use the salaries of political office holders as a barometer for more money is greed by another name.

Another angle to all this is the fact that new wage structures legislated from Abuja and imposed on the states is not practical. Each state has its own set of challenges and should be able to negotiate its wages with its workers in like manner. If a person does not like the deal being offered in a certain state, he or she should be free to go somewhere else in Nigeria to seek employment. That is the way it should be.

The Lagos state government is not blameless in all this. A timeline of this whole saga reads like an exercise in delay tactics. Governor Fashola should have said he could not implement it, but political expediency carried the day, as it often does with politicians. He could not afford a prolonged doctors’ strike in the middle of a re-election campaign. That said, to assume that it was easy for the governor to dismiss 788 doctors is wide of the mark. Even if he was heartless, surely he must have considered the implications. Many are think that there should have been further negotiation, or he could have taken the doctors to court. Those are good suggestions, were it not for the small matter of the many who will die waiting for treatment. It is not a pretty outcome, but 373 doctors who will work and save some lives in the process, are better than 788 who will not. Therein lies the gap between activism and real leadership: hard, unpopular decisions are sometimes necessary.

Labour unions in Nigeria only protest when money or pump price of petrol comes up. Just like the NLC has become a pump price negotiating congress, the Medical Guild is also becoming a CONMESS negotiating guild. It brings to mind the events during the fuel subsidy protests in January. On the streets, the discussion had expanded to include government waste and corruption, but they stuck to the only item they know: pump price. Strikes in this country are only good for wages and petrol, while nothing really changes. It is more of the same in this case.

What is really sad is that even if 100% CONMESS were implemented tomorrow, patients will still die because of lack of blood, oxygen or some other avoidable circumstance, but that is not worth a strike.

Comments (8)

  1. Did you check the sequence of events? Warning strike on April 11-13 followed by an indefinite strike in one week only says something to whoever wishes to be objective in this matter. Rather than hear just one side of the story. Why not ask a medical doctor in Lag for the story. But lemme give u a hint as I am not authorized to speak on this matter.
    Will you stay @ work if your employer says to you that you should sign an agreement to always work & not complain no matter the work conditions?
    Surprised? Do you research objectively and be bold enough to say the truth.
    I am saying emphatically and categorically that the ongoing indefinite strike is not about CONMESS (although the warning strike was about CONMESS).
    Also if u do Ur research well, u will understand that Sacking consultants and employing medical officers and telling them you have their health in mind is playing on Lagosians' intelligence. Doctor Jide IDRIS will Neva allow a medical officer attend to him.

  2. Thank [email protected] for analysing the situation and asking pertinent questions.The solution is not in laying blame,get facts and let's work towards restoring sanity to our society.Talk to any of the affected doctors or just any doctor.u'l be enlightened I assure u.

  3. Thank you @Fowora, A good lesson on how not to write a rejoinder.

  4. @fowora: You advocate for something this writer, and sadly many Nigerian commentators today, don't have respect for – the FACTS!!! Well done!

    This piece is sympathetic to Fashola. It's not balanced because it doesn't carry the voice of the doctors but seeks to downplay or discredit all their demands.

  5. I'm not saying doctors are 100% right but this is the fundamental question. Why did Fashola sign the agreement to pay CONMESS in full in 2010 while still campaigning for second term if he had no intention to pay?
    Oh I see he stalled and he is on his second term now and he doesn't bloody care. Unconfirmed reports actually have it that his father was in the UK very recently for a lung problem.
    He then turned around to blackmail doctors. The doctors were working all along and now they are fed up.
    That is a government that lacks integrity. I respect Fashola but he is wrong on this one.

  6. I agree that this article does not fall into the agreed definition of a rejoinder but moving swiftly past that issue, I wanted to ask a couple of questions that both your article and Kathleen's do not ask or answer?

    1. Why was the CONMESS agreed initially? There was a wider debate in 2009 about the brain drain of health professionals from Nigeria to the rest of the world – Think Africa noted that the UK gave 1510 work permits to medical personnel from Nigeria in 2003 alone. There was agreement that in order for Africa (including Nigeria) to progress something had to be done –… hence the beginning of CONMESS. IS that assertion still valid? How many doctors graduate from Nigerian universities each year? How many are employed by the state or by the private sector? Do we have the right salary structure? I am not advocating paying UK salaries to people living in Nigeria, all I am saying is that when we think about salaries for medical personnel – we have to consider the balance of retention.

    2. This question is about your 'if you don't like it, leave' statement – how many doctors have left Lagos state employment since the strikes started in 2010? Does anyone have those figures? Before we state that the doctors should be less selfish etc, are they ones we have now, the ones that have chosen to stay in spite of the fact that they could earn more in other states in Nigeria?

    3. How many states are paying the full CONMESS with the agreed grades from federal government? If there are other states where CONMESS is not being paid in full, why have the doctors not gone on strike? What has the state union and the state government, in any of those states, if they exist done differently?

    4. Dr Ahmed on Channels this morning admitted that Lagos state has its own pay grades so doctors that would be level 12 step 5 at a federal hospital might be level 11 step 2 – does that affect your starting figure of N173,000?

    At the end of the day, what Lagos needs is good quality healthcare to meet issues like HIV/AIDS, malaria, polio, lassa fever etc. We are fighting serious health issues within the state – under WHO guidelines, we need a minimum 1 doctor per 1000 – my maths is pretty poor but I know even with 1000 doctors in a city with a population of 18 – 20 million we are falling far short of where we need to be.

    My final comment is about what what we value in Lagos: we have limited resources and people won't all get what they want: free petrol, no/ low taxes etc but to carry people along, there must be a sense of fairness in the sacrifices that people have to make. Many (I am not including you in this) people live comfortable middle class lives in the private sector and wonder why civil servants provide us with such poor service when we swan in fresh from our airconditioned cars, tweeting about the traffic in Ikoyi. Maybe we should think about that?

  7. I think a "rejoinder" is a misplaced word in this article, I see no difference in what author has said and what Kathleen said. Both will serve as good special advisers to the Lagos State Government they clearly support.

  8. Bravo!

    Your article represents the kind of objective and balanced thinking that is terribly scarce in the village square at the moment.

    Governance & leadership is very much about allocation of scarce resources, balancing the expectations of the people being led and telling some people to go to hell.

    Our labour union leaders need to go and study how labour unions in other countries have evolved into political movements that drive social and economic change. 

    Well done.

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