Francis Adedayo Faduyile is the new president of the Nigerian Medical Association. He was elected in the recently concluded 58th Annual Delegates Meeting of the association to serve for two years. He is a consultant pathologist and an associate professor.
In this interview with PREMIUM TIMES‘ Ebuka Onyeji, Mr Faduyile speaks on why Nigerian doctors are leaving the country in droves and how they can be made to stay and work at home. He also addressed the issue of incessant strike in the health sector, why doctors are opposed to demands of other health workers and how the dispute between both parties can be resolved.
PT: Why are Nigerian doctors leaving the country to other climes, what are the factor responsible for this?
Faduyile: The major factors here are poor remuneration, poor facilities and working condition, and job satisfaction. Many of our health professionals are over worked. A doctor is supposed to see a maximum of 20 patients a day but they are seeing about 150 in a day. Certainly by the time he gets to 50 he is already exhausted. Even a nurse that is supposed to see about four patients has to take care of 50 patients in a ward, certainly he/she will get tired. The truth is that in Nigeria the working environment for many doctors is very hostile. Many doctors see patients that they can treat or intervene on their issues die in front of them because the hospitals they are working in does not have the necessary equipment to take care of them. Many patients in dire need for help don’t have enough money for the kind of services they need at that particular time. I can tell you many doctors are spending fortunes on patients that they are not related to because it’s painful to see patients die.
So, if we have our NHIS fully functional and we can always treat any patient, I can tell you many doctors will have job satisfaction because at the end of the day you have saved so many number of lives. But by the time you don’t have that, you will be dissatisfied. The remuneration of doctors is very poor, if you go to other climes, what we are paid here is just 10 per cent of what they collect and they respect doctors, they put you in that right position where you feel very important. We don’t have good funding maintenance for hospitals in the country. The few doctors that we have are over worked and are not appreciated, these are some of the reasons why so many of them are leaving unfortunately.
PT: How then can we keep our doctors from leaving?
Faduyile: First is when you appreciate your doctors, it will make them to stay. Government needs to bring more equipment. We need to have more fund for health. The NHIS is one way to resolve this issue. If we have more enrolee and funds to it then there will be enough money to maintain the hospitals and to bring in equipment, to buy drugs and for doctors to be retained.
PT: There are issues of internal migration inside the country. Doctors seem to avoid the Primary Health centres in the villages (PHC) and opt for the tertiary institutions in the urban areas due to the terrible state of facilities and standard of living in the grassroots. An investigation by PREMIUM TIMES revealed how many PHCs in the country operate with no doctors. How can this issue also be addressed?
Faduyile: The major reason is that the government does not give additional compensation to doctors working in the rural areas. What is in the national health act is that doctors working in the PHCs should be compensated more. However, most PHCs are ran by the states and even the normal payment for doctors, many states are not even paying. Many states are owing doctors and other health workers an upward of nine months. Many are being paid half salary for an upward of 18 months. So every human being naturally will look at those places where they will be much more appreciated. Until the state government key into payment structure of the health system and bring a pay that will make doctors and other health workers comfortable wherever they are, that is only how this issue can be addressed. This is why NMA is asking for universal applicability of CONMESS to all states and everywhere. If that is done enough pay will come for even the workers in the PHC which is initially structured to take care of 70 percent of Nigerians. 70 percent of our ailments but unfortunately, that area (PHC) is almost dead and we don’t have any other option than to revive it if we want to achieve Universal Health Coverage. This one percent consolidated allocation on basic health fund will go into the NPHCDA and we believe that with that it will strengthen our primary health care.
Primary Healthcare Centre [Photo credit: LinkedIn]
PT: Why Has NMA repeatedly and vehemently opposed to the demand of salary adjustments by other health workers?
Faduyile: There are so many demands they put forth, but the one on the front line is about their salaries and it’s unfortunate that we are leaving the main reason why we are on the health sector to talk about mundane things. There is a special salary scale for medical doctors as well as other health workers and in that doctors earn a particular leverage over and above other health workers. And we must understand that in this JOHESU we have the cleaners, the drivers, the typists, we have the administrative staffs, we have the hospital engineer, we have all other type of people who are supportive staff.
What JOHESU is asking is not just increment in their salary, they are asking for parity with doctors. We have been disadvantaged for more than 12 years in the health sector until 2014 when the government realised this and readjusted our salary scale which is CONMESS. We had an agreement with government through collective bargaining and they begged us to reduce the relativity and we have reduced it from 3.3 to 1 ratio to 1.5 to 1 ratio. This means over 50 per cent reduction and in our lower level we have appropriated relativity. In 3 steps out of the 7 steps that doctors are paid in the service, there is parity of 1 is to 1. So what we are saying is that it is getting out of hand. Before like I said, the salary ratio of doctors and other health workers used to be 3.3 to 1.0 but today we have cut it down to 1.5 is to 1.0 so that peace will reign; but they just want it to be at par. But we are saying we have given so much to that level of 1.5 and we can’t go beyond that.
PT: But if government finally adjusts the salary of other health workers, will it affect the salary of doctors?
Faduyile: No, it will not affect our salary but it will be a bad morale to us. I am working as a doctor and I’m collecting N5; another person in service who did not go through the kind of training I went through and is not working as much as I do will still be collecting the same salary. Why am I going through all these stress then? In America even among doctors, there is relativity. An anaesthetic doctor can collect up to five times the salary of a pathologist.
When CONMESS was implemented, JOHESU went and made up their own salary scheme which is CONHESS. They transferred all the figures and salary steps in CONMESS into CONHESS and that means parity. Doctors have to go back to government and tell them we have been short-changed. And in 2014 when the government realised their mistake they readjusted our own salary and it is that same readjustment that the JOHESU is asking from the government.