IRIN Focus on the malaise in the health sector

Doctors in state-owned hospitals in Nigeria have been on strike for three months to get the authorities to resolve key issues they believe must be dealt with for the health system to survive, especially poor pay and conditions of service. A combination of threats and cajolery by President Olusegun Obasanjo has so far failed to resolve the impasse, which reflects a deepening crisis in the health sector of Africa’s most populous country. When Minister of Information Jerry Gana told reporters in Abuja two weeks ago that the government had approved a 100-percent pay increase for medical practitioners grouped under the National Association of Resident Doctors (NARD), he also announced a deadline of 6 December for the doctors to end the strike or lose their jobs. Gana even hinted at their possible replacement by Cuban doctors. “The strike action will continue,” Ikpeme A. Ikpeme, NARD president responded, expressing the doctors’ resolve not to bow to the pressure. He accused the government of deliberate misinformation and subterfuge, and of not addressing the doctors’ key demands. Accurate figures on the effect the impasse has had throughout Nigeria are not available. However, a senior medical official was quoted by local newspapers as saying about 2,500 people died in the southern states of Rivers and Bayelsa in the first six weeks of the strike, including victims of a clash between protesters and security forces at an oil facility. The situation is unlikely to be very different in other parts of the country since state-owned hospitals are the only health institutions to which the vast majority of Nigerians have access. “A strike by doctors is certainly an epidemic of sorts,” Joe Akigwe, a resident doctor at the Lagos University Teaching Hospital, told IRIN. “But doctors grouped under NARD consider their action a strong medicine necessary to prevent a more devastating plague: total collapse of the health system.” Nigeria’s health system has been facing severe problems over the past decade. In the early days of independence, hospitals were built and medical personnel trained as the new authorities sought to develop their nation. As additional funds became available to governments in the oil boom years of the 1970s and early 1980s, more money was invested in expanding existing health institutions, building new ones and providing medical training. Things changed when Africa’s biggest oil exporter suffered the first oil shocks in the mid-1980s. Military rulers who overthrew elected civilians early in 1984, quickly moved to impose economic austerity programmes. Health and education budgets were among the first to suffer cuts. The decline of gains made in the health sector since the early years of independence was accelerated by the introduction of a structural adjustment programme by the regime of General Ibrahim Babangida in 1987. Its main features were the devaluation of the national currency, the removal of subsidies and other measures that tended to erode both the income of medical personnel and the funds available to run health institutions. Doctors and other professionals with fixed incomes saw their real earnings dwindle and conditions in their workplaces deteriorate. Many sought better paying jobs abroad. Most of the health professionals who left to destinations in North America, Europe, the Persian Gulf states and Southern Africa were among the brightest and best experienced. According to a World Bank estimate quoted in Nigerian newspapers, some 20,000 Nigerian medical doctors were practising in the United States alone. Officials of the Nigerian Medical Association estimate that over 28,000 Nigerian doctors are practising abroad compared to a mere 14,000 at home. In the past decade doctors under NARD or the umbrella Nigerian Medical Association have used strikes and strident protests to draw the attention of successive governments to the decay in the health sector. While Nigeria was ruled by the military, all they attracted was increasing repression. NARD members saw Nigeria’s return to civilian rule under Obasanjo as a good opportunity to deal with most of the critical health sector issues that could not be resolved with the former military rulers. “What we didn’t reckon with is that it is still the same people who ran the health ministry bureaucracy under the military who are there now,” one doctor said. “They’re stuck with the old ways of doing things.” Among the strongest supporters of the current doctors’ strike are university teachers and other academics whose fortunes ran a similar course in the past decade and half. The Academic Staff Union of Universities (ASUU), grouping the country’s university lecturers, has issued a statement calling on the government to come to terms quickly with the striking doctors. “In a country that ranks among the worst in the world in the ratio of doctors per citizen, where there is a dire need of doctors, they should be drawn to the public sector and encouraged to stay there,” ASUU said. “The public needs the doctors. Most Nigerians cannot afford services at private hospitals. The government’s stance should be re-examined.”