As you are reading this article, more than twenty federal government-owned hospitals are closed down and activities were paralysed by the industrial action of resident doctors under the leadership of Association of Resident Doctors. For those who don’t know, resident doctors are doctors on postgraduate training in a specialised area of interest anchored by the National Postgraduate Medical College of Nigeria and the West Africa College of Surgeon or Physicians. Graduates of such training are appointed as specialist consultant. They form the bulk majority of work force in the tertiary health institution and hence the strike of such body invariably cripples health care deliveries.The economic implication of industrial action in our hospitals cannot be overemphasized. Let’s look at it in simpler terms. Assuming a typical teaching hospital in Nigeria has 150 outpatients per day in all the speciality clinics including general outpatients departments. If each patient pays 500 for consultation and registration, this will amount to N75000. If half of the patient will do laboratory test of 1000 each, another 75000 is generated. If a quarter of them will undergo imaging test at 2000 per patient, another75000 is generated.
Again, imagine 100 patients buy drugs at 1000 per patient, that would be 100000. Overall, based on this minimum assumption, an average of 325000 naira is lost every day, 2.27million per week, and 9.75milion per month per hospital. For the two month strike in about 25 centers, 487.5 million is lost. Remember this is just the minimum estimate. I didn’t include payment for operation, deliveries, and ambulance services. Others are special services like Intensive care unit, physiotherapy and dialysis.
The revenue loss is quite huge. Additionally, some food canteen, recharge card sellers, shuttle buses and local okadas suffered income strangulation due to the strike. The biggest loss is that of human life. The most unfortunate thing is the fact that these hospitals are referral centres, meaning difficult cases are referred from lower hospitals to these centres where they can have expert management. There are patients on life support machines, patient with brain injury, cancer patients and patient with tuberculosis.
These are patients that need close and continuous monitoring. Rich patients don’t have problem because they jet out to receive care outside the country leaving the indigent patients dying silently at home. The health workers in Nigeria jettison the Hippocratic Oath and put self interest ahead of patient’s life. The whole problem boils down to money with moral and ethics of the profession thrown in the dustbin. I can’t remember any strike embarked by health workers in Nigeria demanding government to improve working condition, equip the hospitals or provide essential drugs. It has always been about one salary increment or one omitted allowance.
On a deeper thought, the health workers are not to be blamed alone. The government too have their share of responsibility in the crisis in health sector. The problem mainly arise at the time of negotiation with government officials during strike where in a desperate move to cajole the striking workers back to work, the official will make unrealistic promises backed by circular instead of negotiating on a realistic terms. The failure of the implementation of the agreement will now lead to another round of strike action. Another problem in our hospitals is inter-professional rivalry. The other day non-doctors in the health sectors vehemently opposed the appointment of surgeon general by the federal government. Similarly, doctors opposed appointment of non doctor as consultant in the hospital. There is no inter-professional tolerance.
There is need for total reorientation and reorganisation of our health system. Health worker need to be given a job description at the time of employment including details of career progression. The health professional need to remember the Hippocratic Oath and think of human life first before anything. The regulatory bodies of health profession including the Medical and Dental Council of Nigeria, the Nurses and midwife Council of Nigeria, the Pharmaceutical Council of Nigeria and the Medical Laboratory Council of Nigeria need to be more proactive in addressing quackery, indiscipline and unethical practices within the health sector and government should look at feasibility of merging all the regulatory bodies into one single organ like is done in advanced nations like United Kingdom. The federal government needs to show genuine interest in solving the crisis in the health sector.
We can’t afford to have our highest level of health care in total disarray because the crisis is very avoidable.
Source:Medical News Nigeria
