It’s no longer news that the National Association of Resident Doctors in Nigeria have been on strike since the 2nd of August, 2021. On the 31st day of the industrial action, the Medical Mirror Correspond spoke with the immediate past National Secretary General of the association, Dr Bilqis Muhammad – who is also the first First Female Secretary General Nationwide. She gave an insight into the reasons for the ongoing strike, issues surrounding the national brain drain, poor health indices and sharing the way forward.
Q: With the recent resolution to continue the strike which has lasted over 30days, what would you say is the motivation to tarry this long?
I think it’s the usual nonchalant attitude of the government and her representatives to the plight of the average Nigerian. No serious country would allow any part of her labour force to be out of work for this long, let alone the healthcare work force. From time to time they consistently show that they have no regards for the general citizens of Nigeria, let alone the essential workers. You would agree with me that the infrastructure in the health care sector generally is at a very low state, just using the WHO indices of healthcare performance evaluation; either cancer care, perinatal mortality, under five mortality, or maternal mortality, we are persistently ranked low – peri hundred – despite the huge amount of money being said to have been appropriated to cater for these areas. Even the HIV/AIDS management that has been funded Internationally, the FG is still not ready to take over treatment; as there is still heavy reliance on donor agencies. For instance the phase 3 of the PEP-FAR project, the two state pilots (in Taraba and Abia) for country take over has failed. Meanwhile success is achievable as currently fewer people develop AIDS even in the hospitals and as a result of these intervention from donor agency, management of HIV has even proven better than hypertension or diabetes in some people in Nigeria. Till date, this just shows a vicious circle of the country where the health care sector is not a priority to her government.
Q: What exact promises – MOUs, MOAs and the rest – have been signed in the past and are yet to come to pass? Also, are there any actual action in sight to make them happen?
The FG keep playing tricks on intellectuals. In 2017 we had the Memorandum of Term of Settlement (MOTS), which wasn’t implemented. Then we moved to the Memorandum of Implementation (MOI) which also failed. Then to Memorandum of Expedited Action (MOEA), another Memorandum of New Agreement (MONA), and also a Memorandum of understanding (MOU). They all failed or where not implemented. Recently, in April 2021 another Memorandum of Actions (MOA) was brought up after a 10-day strike by the same government with the same set of representatives. All failed promises, not one kept, none implemented!
Currently, we have doctors who have been receiving near 30percent of their salary from January 2021 till this moment at various teaching hospitals in the country. Why do they have to continue drawing up different memorandum and would not keep to it. It took an Industrial action to make them pay House Officers after over 4 months of work done without pay. In a hospital, this extreme financial hardship has cost the life of a pregnant doctor. She – a doctor – died because she couldn’t afford to pay for medical bill as the FG refused to pay her salary; even in death this same government is still owning her. Doctors are tired of borrowing!
Tell me who will continue to lend to a debtor that has being borrowing and not repaid since January, no place to even borrow anymore, because they can’t repay loans they have borrowed. This FG have turned doctors into failed children to their parents, failed spouses to their wives and husbands, failed parents to their children! In spite of the hardship and increased hazards we face from the global COVID pandemic and national outbreaks – Cholera, Ebola, Marburg and the likes, under working conditions tagged as the “most unconducive” you can ever think of. Yet the FG have refused to still pay; punishing us for demanding to pay owed doctors.
If the FG is going to punish us for demanding to pay doctors they’ve been owning for 7 months, then what would be their own punishment for work done without pay?
Q: We realised it’s only the Minister of Labour – who happens to be a medical doctor – that has been all over the news speaking on this issue, since the beginning of this strike; what is the stand or contribution of the Minister of Health towards initiating, sustaining or calling off this long overdue industrial action?
Well, the answer is obvious. Someone who knows he’s the primary cause of a problem and is constantly failing in his role will continue to hide his face behind the constant failure of his administration. Also, because he doesn’t seem to have a clue of what is going on, which he proved by saying on national TV (when asked) – that the NARD was on strike because of state issues and not problems emanating from the FG. This was very untrue because it is his ministry – the ministry of health – under the FG that has refused to process the funding for the “death in service benefit” for the family of the 19 doctors that died from COVID-19 or pay the salaries of doctors working for the federal government. Also, it is his ministry that has refused to fund the residency training in Nigeria, for the 2nd consecutive time (in 2020 & 2021) by not including it in his budget – the honorable minister of health – for the national budget. It was after much complaint, the honorable speaker had to make sure it was captured under the supplementary budget at both times. All these are issues at the level of the FG and not the state.
Q: We saw the turn up from a lot of medical associations at the just concluded Nigerian Medical Association National Executive Council (NMA NEC) Meeting in Edo state – which is the second highest decision making body for doctors; what would you say is the compliance level and contribution of the different associations with the ongoing strike?
As it is so far; from our affiliate bodies, we have their solidarity. Their leadership have made declarative statements and proclamations showing this solidarity. However, currently, NARD is the only association on strike but there is a notice to the FG by NMA – the parent body of NARD that has given an ultimatum of 21days to also join in the strike and call for a total shutdown of the system if actions ate not being taken to implement previously passed memorandum. This is largely because In August 2021, the FG with the same set of representatives took up another Memorandum of Understanding (MOU) of which NMA was a signatory to but NARD refused to accept it. Insisting the ones existing should first be implemented and salaries paid. Failure to attend to all of these requests will then compel NMA to call for an Emergency Delegates Meeting – where all members can participate – to determine a way forward.
Q: Despite the ongoing strike, we see the news of doctors leaving the country in doves, what do you have to say about the situation of the Brain drain in Nigeria?
It is really bad. Let me give you a clear picture; when you clock 60 years the Saudi government doesn’t employ you into her work force anymore, but do you know some medical elders have to mitigate this (some changing their age) just so the Saudi government would employ them. That’s how bad it is. Brain drain is a global phenomenon, but worse in Nigeria with poor health indices and inadequate recommended personnel according to WHO because the FG has the wrong hands manning the Health care sector.
The elite class particularly this government makes the average Nigeria doctor feel or look incompetent. The president and his cabinet members, all on tax payer money, go to Europe for the slightest of medical check up and care. When they get there, are seen to be treated by Nigerian doctors over there. They continually take away resources and money that should have been invested into the Nigerian health system. And should I say, for you to be cared for in those sophisticated European health systems they run to, abandoning theirs, Medical insurance is needed. This medical insurance cannot be gotten, if you do not live, work or own properties in Europe, meaning they patronize the private facility in those places which are way more expensive than even the regular public health institutions. Massively, contributing to the medical tourism and healthcare sector of those countries, while they leave theirs to rot and deprive the average Nigerian of healthcare.
At the Abuja declaration, all member countries including Nigeria signed to appropriate at least 15 percent of their annual budget to health, but 20 years down the line, Nigeria is yet to implement this. Before, it was “poor infrastructure and career fulfillment” to study standard medicine as seen in our medical textbooks that take doctors out of the country. Right now, what tops the list for why doctors leave in numbers, are “poor remuneration and insecurity”; because one tick on your door could kill you. For example, we just had a pregnant mother of 2 (a staff in my facility) shot dead because she said she couldn’t work. Her swollen decomposing body was found 3 days later along the road side. Likewise, about 40 days before, the only psychiatrist in my facility was kidnapped and released 40 days after – unconscious, with a GCS score of 9, bed sores and we are still managing her until today.
We (doctors) are being traumatised – remuneration wise, psychologically, mentally, even physically. We can’t sleep in our houses with our eyes closed because even in the university campus, they have gone to kidnap nurses and there is still a government in power doing nothing about all these.
Q: Now, we know Nigeria is generally in debt but what is the state of funding for healthcare sector? Any recommendations?
Nigeria have policies, i.e. the National Health Act, Basic Healthcare Fund, that they have refused to implement. All the “Malaria”, “Malnutrition” and all tropical illnesses killing on the side and causing us to drop on the world health ranking can be handled at the level of the primary healthcare. Hence, let the FG Strengthen the primary healthcare and they would see a significant improvement in the Nigerian Healthcare system. Also, ensure industrial harmony, improve infrastructure , increase security and remuneration for healthcare workers.
The Nigerian government have the answers to these problems but chose to play politics with everything and everyone. Really, politicians have no place heading sensitive areas such as the healthcare sector, even the labour sector and you expect to have any real advancement. Remove politician from the core positions, get technocrats to handle those aspects and see the work get done.
Q: As the first female NARD Secretary General, how would you describe your experience on the team so far?
Well, I would say that it has been quite stressful. Asides been the first generally before the pandemic, I also happen to be the first in a pandemic. Before the pandemic, it was moving smoothly and every thing going easy but once the pandemic hit, it became really demanding. Especially, working with a government that is not forth coming and having to follow-up rigorously for things as simple as provision of basic PPE for the health work force was quite stressful. Even though, sadly, we still lost some Healthcare workers to the pandemic, despite all efforts but it was quite an experience for me.
Q: What are your thoughts on the current percentage of women in positions across the various medical associations?
Generally, the participation of women in politics and position of power is abysmal low. We presented a paper at Medical Women’s’ International Association Near East and African Regional (MWIA NEAR) Congress in March 2021 on “Female in Leadership” and the data we got for the paper was really discouraging. For example, in the NMA national since inception in 1960, we have only had one national female chairman – Late Dr. Abiola Oshodi from 1988 to 1990. And I must add, she secured the only land NMA has till today in Maitama Abuja. She has shown the light and opened door for other women, but till now, no other female has emerged National chairman while we have just 1 female state chairman of the 36 plus 1 states of the federation. Also, of the current ministers, we only have 6 females of 44 nationwide and no female officer on the national NMA team. Likewise on the national NARD committee, we now have 3 female heads; as at last year I was the only one and 5 female president at the local ARD chapters (Rivers, Bayelsa, Asaba, Igbobi and Ebute meta). Even in ABU Zaria that existed long before my birth, it was in 2018 I became the first female ARD president there. In all, looking at statistical evidence, I would say we have not gotten there yet, but it’s improving than what it used to be and can get better.
Q: What are your advice towards increasing female participation and aspiring young doctors in politics?
People who are highly motivated, with a strong sense of purpose, and capacity can always delve into politics. We also should give adequate support to those we have identified with requisite capacity and things would get better.
Q: Any final note?
Of course, the FG under the leadership of President Muhammadu Buhari needs to do a shake up; put the right peg in the right square hole because he currently doesn’t have the right people representing him, especially in the health care sector. He needs to get the right people to get the job done, to ensure stability in the Health care force. Also, he (they) need to pay people for the work they have done and not bringing up – to implement – a draconian policy of “not paying doctors for work done” as opposed to the “no work no pay policy” that is being paraded or they are painting it to be. The law can only be applied if and when the employer has done all he is statutorily mandated to and the worker then withdraws his service.
About Dr. Bilqis Muhammad:
Dr. Bilqis Muhammad is a Nigerian trained doctor from the prestigious Madonna University, Rivers State with a Masters in public health from the Ahmadu Bello University, Zaria and a member of West African College of Surgeons (faculty of Anaesthesia). She has worked and practiced medicine within and outside Nigeria in different capacities. Most recently as a member of the COVID-19 Response Team at Ahmadu Bello University Teaching Hospital, Zaria (ABUTH), where she is a Senior Registrar in the department of Anaesthesia and critical care and teaches the art of airway management and life support to post-basic nursing students.
As an active political enthusiast, She was the Coordinator, Young Doctors Forum, Medical Women’s Association of Nigeria (MWAN biennium 2017 – 2019), rose to become the first female (2-time) President of ARD ABUTH Zaria (2018 – 2020) and the first female immediate past NARD Secretary General. Currently, serving as the Chairman, National Youth Service Corps committee of Nigerian Medical Association (2020-2022). She has received many award of excellence and recognition for service.
Dr. Bilqis has a special interest in quality representation and provision of affordable sustainable health care. She is happily married to a practicing pharmacist/pharmacist entrepreneur.