Unjust and Unsustainable Choices for Physicians in Nigeria
Social media in Nigeria bristled with outrage and grief in April 2019 on news of the death of Dr. Stephen Urueye, a 25 years old graduate of the University of Lagos, Nigeria. He died at Lagos University Teaching Hospital (LUTH) where he was undergoing his internship training as a newly qualified medical doctor. Stephen had just graduated a few days before he met his untimely death at the hands of hoodlums who attacked him after a long day’s work. Insecurity in and around the LUTH environs has been a cause for concern to all who live and work in that vicinity for a long time. The severity of the insecurity problem has not been meted with commensurate measures that adequately assure the hospital’s health workers of their safety and protection during and after work. Resident doctors have decried to the hospital’s management several times for more comprehensive and coordinated solutions, but these requests generally fall on deaf ears.
I didn’t know Stephen personally, but I remember his amiable personality from my brief encounters with him while I was still a medical student at LUTH. He would have been an exceptional doctor but instead had his life and career cut short tragically. Stephen was just one of countless victims of a society and health system that increasingly has no regard for the wellbeing and safety of the very same people charged to restore hope and health to the lives of patients.
Providing and ensuring optimal working conditions for health workers is also paramount to ending these unnecessary incidents and/or deaths of health workers. Many health workers in Nigeria work in facilities without electricity, clean water or even hand gloves and other personal protective equipment (PPE). This for example partly explains why the infection and death of health workers during infectious disease outbreaks is becoming a norm rather than the exception. Incidences like that of Stephen will only encourage the exodus of health workers in droves from their countries of training to Europe, North America, Australia and the Middle East. In 2017, a survey conducted by Ngozi Okonji-Iweala Polls (NOIPolls) in partnership with Nigeria Health Watch revealed that 8 out of 10 medical doctors in Nigeria were seeking work opportunities abroad for a myriad of reasons ranging from low work satisfaction, poor salaries and emoluments to poor working environment and insecurity. Without these skilled health workers, Nigeria cannot make significant progress in achieving the sustainable development goals and targets slated for 2030.
Political leadership is crucial to devise an urgent plan of action in tackling this ongoing human resource for health crisis head on before it completely cripples the entire health care system in the country. The solutions to the health workforce challenges in Nigeria and indeed sub-Saharan Africa or the world are not far-fetched and there are numerous evidence-based recommendations by different multi-lateral organisations that provide a blue-print for addressing the various challenges. The World Health Organization’s Global Strategy on Human Resources for Health recommends that Member States optimize health worker motivation, satisfaction, retention, equitable distribution and performance by adopting gender unbiased attraction and retention policies for job security, a manageable workload, family and lifestyle incentives, hardship allowances, housing and education allowances and grants. The UN High Level Commission on Health Employment and Economic Growth has recommended that all countries adopt an intersectoral collaborative approach to ensure the protection and security of all health workers and health facilities in all settings and advocates for more fiscal investments in creating decent working conditions for health workers.
Central to the success of these recommendations however is the acknowledgment that health workers have fundamental rights that must always be protected and upheld. These rights are espoused in various international and regional conventions and treaties like the Universal Declaration of Human Rights, African Charter on Human and People’s Rights, International Labour Organization’s (ILO’s) Convention and Protocol on Occupational Safety and Health and ILO’s Declaration on Fundamental Principles and Rights at Work. This rights-based lens is crucial in devising an action plan which should include a revision of the Nigerian labour laws because they are outdated, flawed and do not comprehensively protect the rights of the health labour workforce in Nigeria.
The Trade Unions Act (TUA) from the Laws of the Federation of Nigeria is one of many such obsolete labour laws that requires urgent revision. This Act prohibits Nigerian health worker trade unions (who are classified as providers of ‘essential services’) from engaging in industrial strike actions with some other caveats. Laxity of the TUA emboldens public and private employers of healthcare labour to strong-arm their employees with coercive tactics or punitive measures that prevent them from exercising their labour rights as health workers. For example, medical interns and resident doctors at LUTH have clauses in their employment contracts with the hospital prohibiting them from participating in industrial actions because they are undergoing postgraduate training.
Resident doctors in some other teaching hospitals in Nigeria must agree to not participate in strikes for the first 2 years of their training. This is a blatant infringement of the rights of these health workers to collective bargaining. Many of them are forced to endure working with unpaid salaries for three, sometimes five, or even eight months. Many are denied emoluments they are entitled to receive with advancements in their training and pay grade levels and many others must endure working in unsafe and poor working conditions.
Fixing these issues is essential for strengthening the Nigerian health system because the health workforce is at the very core of health service delivery as they ultimately deliver care to patients and they will continue to do so for the foreseeable future.
About the Author
Ezekiel Boro is a Nigerian medical doctor and global health professional who is passionate about leveraging innovative technology tools for health systems strengthening and improving access to quality health care for marginalized and underserved communities in low-and middle-income countries, especially in sub-Saharan Africa. He is also broadly interested in global health policymaking and advocacy.