By Nwandugbom JOK
1. The Abia State Chapter of Nigeria Medical Association (NMA) recently embarked on an industrial action ostensibly to seek the payment of outstanding salaries owed its members at Abia State University Teaching Hospital (ABSUTH) and Hospital Management Board (HMB).
Naturally, because of the important role played by medical doctors in the health management chain, it is expected that popular sentiments will be in support of the striking doctors and weighed against the government more so when arrowheads of the strike timed it to coincide with the forthcoming general elections that some desperate opposition politicians are ready to attempt to win by hook or crook.
2. But the question to ask is if those medical doctors actually worked for the months of arrears they are demanding payment for or should pay the government and people of Abia State for receiving more salary than they have worked for.
3. According to Abia state commissioner for information, since the inception of the Ikpeazu administration in 2015 the medical doctors have been on strike for 35 months. This yet-to-be disputed fact suggests to me that those working under Hospital Management Board (HMB) that are demanding for 13 months arrears of salary may have received salary for at least 22 months they did not take care of any single patient in Abia State General Hospitals while those working with Abia State University Teaching Hospital that are demanding for 22 months arrears of salary may have received salary for 13 months that they did not attend to any patient.
4. In simple terms, those doctors who are members of NMA earned salary for doing no work yet they are back on strike again to force the hands of government to pay them even more for work not done. Unless they have contrary facts to prove that the assertion of the state government on 35 months of no work is false.
5. Now let’s talk about the root of the current wage management challenge in HMB and ABSUTH. Please, patently follow my narration and demand for answers from any of those involved before accepting my position. Don’t believe me, just verify as Mazi Peter Obi will say.
6. In 2015 I was personally in the room when the then new Governor Okezie Ikpeazu met with management and union leaders from ABSUTH at the government house in Umuahia. The meeting was called to stave off a planned strike action by the doctors and the crux of their presentation to the Governor was simply that he pays off the arrears of salary owed them and they will from thenceforth make revenue to fund their regular salary payment. They also requested for support with more modern equipment for their operations and later in the life of the administration asked for ABSUTH road to be fixed.
7. What struck me then in 2015 was the simplicity of the demand from the good doctors and as someone who was then new in the public sector I wondered why that would be difficult to agree with: pay us what was owed us and leave us to make money to pay ourselves going forward. As can be expected, I was very optimistic and concurred with the Governor when he promised to do as they demanded.
8. Governor Okezie Ikpeazu went ahead to pay them 11 months salary arrears in one tranche that same year. For those medical doctors earning N500,000/month they received alert of N5, 500,000.00 in one day per person.
9. Two months after receiving the jumbo alert, the management of ABSUTH and some of the union leaders returned to the Governor to plead that they be given subventions to continue paying salary while they adjust operationally to build on their IGR and commence running independently. Governor Ikpeazu obliged them again.
10. Interestingly, shortly after the jumbo pay by the government, many of those medical doctors “invested” the money on improving their private clinics or renting and equipping new clinics. And as they ensured that their personal businesses were booming ABSUTH’s fortunes continued to depreciate.
11. In the midst of all that they came back to the government with fresh demands including reconstruction of the road leading to the hospital and provision of new power generators. Governor Ikpeazu reconstructed ABSUTH road using rigid pavement technology, provided the new power generator, supplied two container load of new medical equipment and supplies to the institution.
12. Private clinics of the doctors boomed even more and rather than generate more revenue to at least pay themselves, their IGR continued to dwindle from what it was in 2015 till date. As we have now read, they have racked up 35 months of strike without work yet are making demands that the government must pay them for those months they were on strike.
13. Regarding doctors in HMB, the story is even more interesting and straight forward. Most of the doctors in the payroll of HMB work with state owned general hospitals scattered across the 17 LGAs. In my community, Abiriba, for example, there is Akahaba General Hospital with medical doctors and other HMB staff payrolled as working there but since 2015 that I joined the government that hospital has not, to the best of my knowledge, functioned continuously for 30 days. What that means is that those doctors and others that receive salary from Abia State Government as workers in Akahaba have been taking money from Abia State Tax Payers through the Ikpeazu-led administration for at least 91 months without doing any work. If you subtract the 13 months HMB staff currently claim they are being owed, it means that they actually owe the people of Abia State 78 months in salary. Assuming any of them was earning up to N500,000 per month, it means that that person owe Abians N39,000,000.00 received as salary without doing any work or caring for a single patient.
Chineke para tule!!!
14. Sometime in 2016, Governor Okezie Ikpeazu paid an unscheduled visit to Isuikwuato General Hospital and met the gates wide open without a single medical doctor or worker in sight. He drove round the facility and left. I remember he gave directives for appropriate sanctions to be meted out. But of course if you understand civil service rules you will know that a Governor cannot sack a civil servant without following seemingly unending due process. I am personally not aware of where “due process” ended the matter. I will rather ask NMA and HMB to confirm if anyone was finally punished but I know that if you go to Isuikwuato General Hospital today the situation may not have changed significantly. Those from Isuikwuato can share with us their experiences and eye witness account.
15. According to the state commissioner for Information, “despite being willfully absent from work for a whooping 35 months between 2015 when Governor Okezie Victor Ikpeazu took Office, and now, a total of N11,444,043,333 (Eleven Billion, Four Hundred and Forty Four Million, Forty Three Thousand and Three hundred and Thirty Three Naira only) of Abia Tax payers money has been paid to Doctors in ABSUTH”.
As Eze Njemanze will say “na kwa echeki, Inakwa agbako”.
16. Abia State NMA is also yet to dispute the fact presented by the Abia State commissioner for information to wit: “few days ago, Government yet again provided N420,000,000 (Four Hundred and Twenty Million Naira) representing 3 months of the salary arrears they (ABSUTH doctors) mostly did not work for, yet, instead of resuming work in the interest of our dear citizens and ailing ABSUTH, these unpatriotic folks are bent on blatant blackmail at the expense of Abia lives”.
17. I personally do not want to engage on issues of political motivation for labor recalcitrance at this time, even though I can personally attest to at least 3 executive members of Abia NMA attending a political rally in Aba organized by an opposition party. I simply want to invite Abians to dispassionately discuss this issue of taking salary for work not done and still demanding for more while at the same time strengthening your private clinic.
18. Even if at any time the doctors work at the public hospitals and charge patients for services rendered, the question one want to ask is, where does the money go to since these hospitals do not remit anything to the coffers of the state government, do not pay their salaries and do not procure equipment? Who is diverting the funds generated, if any, from the supposed work done that the government is yet to pay associated wages? These are some of the hard but necessary questions the doctors have to provide answers to if we must make progress in the health sector.
19. It is fair to say that all the private clinics owned by members of NMA in Abia State operate and grow from money made from patients in the course of daily operations. Obviously, those doctors charge and receive money from patients but expect Government to pay them even without working at the government hospitals. They even expect that they can divert patients that come to government owned facilities to their private clinics where they will bill them appropriately or inappropriately and still be paid by the state government for diverting those patients.
20. Obviously none of the concerned NMA doctors is treating patients at their private clinics pro-bono hence will not in good conscience say that government should not charge fees at state owned hospitals. Even government owned medical facilities abroad where they might want to ‘japa’ to still charge for consultations, surgeries and drugs. The only difference is that in many developed countries it is actually the health insurance company that pays for consultation, some rudimentary drugs and minor surgeries but surely the patients pay insurance premiums which means they are actually pre-paying for services received.
21. Similarly, medical doctors in developed countries are paid according to the number of hours they work weekly. That suggests to me that if it were abroad that our doctors at Akahaba and Isuikwuato General Hospitals stayed away from work they would have received zero salary in the past 7+ years because they didn’t work.
22. In February 2017, Mike Ogirima, a Professor of Orthopaedic and Trauma Surgery, who was then the President of the Nigerian Medical Association, NMA, and President of Nigeria Orthopaedic Association, patriotically proposed that Doctors in public hospitals should not be allowed to run private clinics. In that interview that was published by Premium Times of February 19, 2019, he said among other things “ It is an abuse of the system. The MDCN allows a consultant to own a clinic. What we mean by clinic is a small place where you can see a patient and recommend treatment plan.MDCN code of ethics states that if you are working in a public hospital, you cannot manage in-patients in your facility. So you cannot run a hospital. But the mentality of Nigerians, the people are not knowledgeable to know the difference between a clinic and a hospital. I will support a situation where the government will come out clearly and make directive that those employed under the public hospitals (government services) are not allowed to have a clinic. Then we will work by the rules to curtail excesses.“
23. I am waiting to read from the Abia NMA Chairman that his members do not own or work in private hospitals or have in-patients in their supposed clinics. Please, draw his attention to this and let’s see how he will respond under oath.
24. Of course, federal and state legislators can help our people by making appropriate laws to ensure that doctors working with government do not work or own private hospitals. As stated and defined by Dr Ogirima, consultants can still be allowed to own clinics as clearly defined for obvious reasons. In my view, they should also be paid for number of hours they clock in monthly as against receiving full pay even when they do not work at all.
25. If we adopt this method of earn-as-you-work, it will only be a matter of weeks before government owned hospitals become the preferred treatment places for our people. It is my view that the hospitals will make much more money to pay workers, procure needed equipment on their own and generally run efficiently.
26. Many will surely want to know how Abia has coped with provision of healthcare to the people given the highlighted challenges with state-owned secondary and tertiary health care facilities. My ready answer is that necessity is the mother of invention. While Governor Ikpeazu tried hard to pacify members of Abia NMA this past 7+ years, I suspect that it was partially his experience with them that made him innovate to solve our healthcare problems. Of course, he functionalized 4 new General Hospitals in the state including the ones in Obehie, Obingwa, Ikwuano and Arochukwu as well as resuscitated Aba General Hospital and the Infectious Disease Hospital (IDH) both in Aba, delivered modern testing facilities in Umuahia and Aba and is currently constructing an ultra modern diagnostic center in Isuikwuato.
27. Yet, by far, his most successful intervention remains the deployment of cutting edge telecommunication technology to solve healthcare challenges in the state through Abia State Telehealth Initiative. In simple terms, he innovatively deployed telecommunication platform to connect all the primary health care (PHC) facilities in the state, numbering over 770, to a control center where they can relate with qualified Medical Doctors to attend to none severe situations requiring while those with severe situations are advised and referred as appropriate. In addition, he procured modern fully equipped ambulances under the Abia State Emergency Medical Services that can deliver patients requiring secondary or tertiary attention to relevant facilities and is capable of even surgery on the go.
28. The way the Telehealth facility operates is simply that when those working at our well equipped PHCs receive patients they can’t manage within their skill level they will dial a doctor at the 247 Telehealth Center located in Government House Umuahia to consult and get guidance on what to do next. (See attached video for demonstration) In addition to that, women who deliver at our PHCs are attended to free of any cost, receive free birth pack and get a token for transport back home after successful deliveries. Others who need further urgent physical attention are ferried via state-owned ambulances to nearby facilities in the 3 geopolitical zones where qualified personnel attend to them.
29. In addition, Governor Ikpeazu built and equipped the first of its kind Children Specialist Hospital in Umuahia, along Bende Road, opposite Police Area Command, to attend to women and their children who may require specialist care.
30. In effect, Governor Ikpeazu provided innovative alternatives to the regular general hospitals even while working hard to satisfy the doctors in HMB and ABSUTH that he seemingly could not satisfy considering their absence of patriotism and devotion to their professional oath.
31. As a citizen of Abia State, I have highlighted these issues not necessarily to blame anyone in the ongoing dispute but to provide politicians and citizens with necessary information so as to take advantage of the ongoing impasse to generate and debate solutions that will end the nagging issues in a sustainable manner. For the avoidance of doubt, these frequent industrial actions by Abia NMA has been the story long before Dr Ikpeazu was inaugurated as the 4th Executive Governor of Abia State. In this period of election, it is easy to sponsor and celebrate strikes in the belief that it helps your cause as a politician. APC successfully did that at the center in 2015 and Nigerians are still crying in 2023. What we need in Abia is to hand over leadership to those who are patriotic and have solutions as against those who are so desperate for power that they can sponsor and use all negative circumstances to play politics.
32. I call on all Abians to demand factual response from the NMA in Abia to the issues highlighted above. Let us know if the government was right that the members have spent 35 months at home while claiming 13 and 22 months unpaid salaries respectively. This will at least enable us decide if the government was right in invoking the “no-work-no pay” rule. We should also demand to know if t is true that they have private clinics that are thriving and where they work 24/7 while expecting salary from government for doing nothing.
33. Most importantly, I think it is now time to revisit the proposal by forner NMA president that doctors working in government establishments should not be permitted to own or work in private hospitals. It is my personal view that codifying this will help Abia citizens to get better value for tax payers money in our secondary and tertiary health facilities.
34. Every conflict should end in permanent solutions to society’s challenges and even this conflict between Abia State Government and Abia NMA is capable of generating right solutions if we all remove our political caps and wear our thinking caps.
I come in peace!!!
-Nwandugbom JOK is a concerned citizen of Abia State