A Consolidated Mess

The dispute between Lagos state doctors and the state government took a dramatic turn on Monday, as over 700 doctors were relieved of duty, and the move for their replacements started in earnest. The root of the dispute is over the implementation of the Consolidated Medical Salary Structure (CONMESS), which was approved by the Federal government late in 2009. So far, the best the state government has been able to do is 75% of CONMESS, but that was not acceptable to the doctors who embarked on an indefinite strike on April 24, after a warning strike between April 11-13.

A recourse to figures will put this matter in its proper perspective. The least paid doctor in Lagos earns N173,000. Before the sacking, Lagos had 1,474 doctors in its employ. Over 12 months, they will get a minimum of N3.06 billion. Bear in mind that this is an absolute minimum because those at higher levels will earn more. The total health budget for Lagos in 2012 is N33.9 billion, and the salary of those doctors makes up 9% of that figure. Furthermore, recurrent expenditure for 2012 is N233.6 billion, and the salary of these doctors makes up about 1.3% of that recurrent. The total personnel cost is N81.6 billion, and N3.06 billion represents 3.75% of that. Note, these are all minimum figures. It is also necessary to point out that N173,000 at entry level is more than most can hope for. Nigeria’s per capita is about $2,500 and they get just under half that a month at the minimum. Simply put, in a poor country like this, the Lagos state government is not doing a bad job in terms of valuing its doctors.

Waiting for the doctor.

We must also consider the impact of increasing salaries on the wage bill. 1,474 doctors for a population of 15 million is far from adequate, and more would certainly need to be hired to bridge the gap. Lagos is not quite where it was in 2007 in terms of infrastructure, but it still has a long way to go. There are so many sectors that need heavy investment to bring them up to the required standard, and to commit an ever-increasing amount to wages will be ill-advised. At this moment, much of the money should be going into provision of basic amenities.

A lot of people will point to the perceived wastefulness of the government as justification for the agitation for higher wages. Nothing could be more childish and irresponsible. What those who say this mean is: since so-and-so is helping himself, we the people should also help ourselves to higher wages, and not bother who dies or whose illness gets worse in the process. Not a peep has been heard from the doctors about improving facilities, or patient care, or any of the several issues wrong with our health sector. All that matters is cleaning out. It is now nearly impossible to distinguish them from the leaders they seek to fight to a standstill. If the problem is those who are looting, by all means protest, but to use the salaries of political office holders as a barometer for more money is greed by another name.

Another angle to all this is the fact that new wage structures legislated from Abuja and imposed on the states is not practical. Each state has its own set of challenges and should be able to negotiate its wages with its workers in like manner. If a person does not like the deal being offered in a certain state, he or she should be free to go somewhere else in Nigeria to seek employment. That is the way it should be.

The Lagos state government is not blameless in all this. A timeline of this whole saga reads like an exercise in delay tactics. Governor Fashola should have said he could not implement it, but political expediency carried the day, as it often does with politicians. He could not afford a prolonged doctors’ strike in the middle of a re-election campaign. That said, to assume that it was easy for the governor to dismiss 788 doctors is wide of the mark. Even if he was heartless, surely he must have considered the implications. Many are of the opinion that there should have been further negotiation, or he could have taken the doctors to court. Those are good suggestions, were it not for the small matter of the many who will die waiting for treatment. It is not a pretty outcome, but 373 doctors who will work and save some lives in the process, are better than 788 who will not. Therein lies the gap between activism and real leadership: hard, unpopular decisions are sometimes necessary.

Labour unions in Nigeria only protest when money or pump price of petrol comes up. Just like the NLC has become a pump price negotiating congress, the Medical Guild is also becoming a CONMESS negotiating guild. It brings to mind the events during the fuel subsidy protests in January. On the streets, the discussion had expanded to include government waste and corruption, but they stuck to the only item they know: pump price. Strikes in this country are only good for wages and petrol, while nothing really changes. It is more of the same in this case.

What is really sad is that even if 100% CONMESS were implemented tomorrow, patients will still die because of lack of blood, oxygen or some other avoidable circumstance, but that is not worth a strike.

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