THE LAGOS STATE HEALTH SECTOR CRISIS AND VIOLATION OF DOCTORS’ RIGHTS
In September 2009, following several years of negotiations between the Nigerian Medical Association and the Federal Government, the Consolidated Medical Salary Structure circular SWC/S/04/S.410/220 (see attached) was released by the National Salaries, Incomes and Wages Commission. The main principle of CONMESS is to serve as a minimum universal scale of remuneration for all doctors in Nigeria regardless of location or employer, in order to curb internal brain drain. CONMESS is also intended to correct the wage disparity that has seen doctors' salaries being progressively reduced relative to other professionals over the years following repeated wage reviews.
The Medical Guild started agitating for implementation of CONMESS by the Lagos State Government since 2009 through several letters and representations to government. The government refused to initiate any form of discussion on CONMESS and this led to a 14-week industrial action between August to November 2010. The Lagos State government dragged the Medical Guild to the National Industrial Court in August 2010 challenging the legality of our strike action. The President of the court, Justice Adejumo, however ruled that the Medical Guild did not err as it had given the government sufficient notice through several letters and meetings with government. The government later withdrew the case from court to allow for a negotiated settlement with the Medical Guild.
In November 2010, the Lagos State Government agreed to pay CONMESS as approved in the Federal Government Circular stated above and committed itself to same via a document dated 19th November, 2010 and signed by the Head of Service (ref LGS/HOS/06/Vol.VI/30). This document specifically indicated government's acceptance to pay and also not to place Lagos State doctors at any disadvantage whatsoever relative to their colleagues anywhere else in the country (see attached). Effective date of implementation was January 2011. Based on this document, the Medical Guild suspended its strike action to allow for implementation of the agreement.
In January 2011, the government released a circular for a new wage regime in which it demoted all doctors to steps 1 and 2 across all grade levels. It also excluded GL 10 and 12 doctors from earning teaching allowance. The Medical Guild immediately opposed this document and later resumed it suspended strike action in February 2011.
In March 2011, following the intervention of the NMA National President Dr. Omede Idris, a detailed calculation of the cost implication of implementing CONMESS in full without any demotion and with payment of teaching allowance to GL 10 and 12 doctors. This calculation was done by the Medical Guild and amended by the relevant government agencies. The Head of Service presented a memo containing the cost implication of implementing CONMESS in full to the Governor for approval. His Excellency the Governor of Lagos State, Babatunde Raji Fashola, promptly approved this memo for full implementation of CONMESS. This memo was seen by the Lagos NMA chairman, Dr Temiye and the Medical Guild chairman Dr. Williams. The government however refused to release a copy to the Medical Guild because, in their words, it could cause agitation by other health workers if circulated.
The Medical Guild refused to suspend the strike without a signed agreement and the strike continued for another two weeks. At this point the former governor of Lagos State Asiwaju Bola Tinubu intervened and took it upon himself to provide documentary evidence of commitment to implement CONMESS in full by the Lagos State government. On 24th March 2011, an agreement was signed by Asiwaju Bola Tinubu, leader of the Action Congress of Nigeria, Sir Henry Ajomale, Lagos State ACN chairman and Dr. Jide Idris, Lagos State Commissioner for Health (see attached). The Head of Service and the commissioner for Establishments, training and pensions also gave their commitment to implement the agreement. The Medical Guild suspended its strike action in good faith, despite the earlier reneging of the Lagos State government, in order to allow government implement the agreement.
The Lagos State Government however failed to honour the agreement and however chose to implement only certain aspects of CONMESS. For the past one year, the Medical Guild has been writing, meeting and pleading with government to correct the shortfall in implementation of CONMESS. The government however only chose to shift and default on its promises.
The outstanding issues on CONMESS implementation include the following:
1. Demotion of all doctors to lower steps on each grade level, thus leading to loss of seniority and income. According to the civil service rules and according to the agreements made with government on CONMESS, all doctors are supposed to be laterally converted from the previous salary grade level and step to the corresponding salary grade level and step on the CONMESS scale. The agreement on CONMESS signed by the Governor in March 2011 which led to our suspension of the strike included the cost implication of implementing CONMESS in full with lateral conversion of all doctors from the old (CONTISS) scale to the new CONMESS scale, level for level, step for step, without any form of demotion in step. Annex II of the CONMESS circular (see the attached) is very clear on conversion from CONTISS (the previous salary scale) to CONMESS. All over the federation, migration to the CONMESS scale is level for level and step for step. Even the attempt to demote officers by steps has been fraught with serious errors and caused total distortion in hierarchy, such that senior doctors now find themselves below their juniors. The Medical Guild had written severally to government to correct these anomalies yet nothing was done about it.
2. Demotion of GL 15 specialists (Consultants) from step 4 and above to step 1. Entry level for specialists is GL 15 step 4 according to the civil service rules. However, specialists in Lagos State who were employed on GL 15 step 4 were demoted to step 1, and newly employed specialists are being placed GL 15 step 1. This is contrary to what obtains in the CONMESS circular and the extant civil service rules.
3. Employment of new consultants on GL 15 step 1: Points of entry for various cadres into the different salary scales are determined by the National Salaries and Wages Commission, which also determines salaries for holders of political office. The entry point for consultants has been stipulated as Grade Level 15, step 4. The Guild regards this as sacrosanct. Dropping this cadre to step 1 will amount to setting back the profession three years. This is not acceptable to us.
4. Pegging of GL 12 doctors in LASUTH on lower steps compared with their counterparts in the Health Service Commission (HSC) who are placed on higher steps. Normally, entry level of Medical Officers and Registrars is GL 12 step 2. Entry level for LASUTH registrars was fixed at step 1 and all registrars were pegged at steps 1 and 2. However, Medical Officers in HSC were appropriately placed on step 2 as entry level and higher according to the number of years in service. Therefore, GL 12 doctors in LASUTH have been at a disadvantage for the past one year.
5. Teaching allowance for House Officers(GL 10) and Medical Officers/Junior Registrars (GL 12): the cost implication for the above was calculated in detail and approved for payment by His Excellency, the Governor of Lagos State in March 2011 as part of the agreement with which we suspended our strike. We are therefore surprised that cost implications are still being recalculated 13 months after implementation should have started. This allowance is being paid by other state governments as contained in the CONMESS circular. Attached are payslips from another institution in Lagos and the CONMESS circular (annex VII) to back this.
6. Excessive tax paid by doctors: part of the agreement with government for suspending our strike last year, was that the excessive taxation will be reviewed downwards. Contrary to this agreement, from October 2011 the tax paid by doctors was increased. Initially we attributed it to the bonus added to our salaries between October and December 2011. However, following return to our normal salaries in January 2012, the amount of tax we have been paying has remained at the inflated level. Despite our complaints about this anomaly no rectification has been made.
The association was forced to seek other available and legal means to ensure that government implements CONMESS in full. Bearing in mind the prolonged suffering an indefinite strike action would cause Lagosians, the association opted for a 3-day warning strike between 11th and 13th April 2012. This was intended to put pressure on government to do the needful and to alert the public on the unresolved issues.
However, instead of government initiating moves to resolving the outstanding issues in the interest of industrial harmony and welfare of Lagosians, it embarked on a vendetta to punish the doctors by issuing queries and threatening to sack doctors for participating in the warning strike.
On receipt of the queries on 16th April 2012, we promptly informed all our members not to reply them since our strike was a labour issue and not an administrative matter. The association replied the queries on behalf of our members stating clearly to government that the strike was legitimate as it was a resumption of our suspended strike action of March 2011 since the issues had not been resolved. Another query was issued by government on 18th April 2012 threatening to discipline our members for not replying the first query. Still our members did not reply the second query. Furthermore, on Monday 23rd April 2012, the government invited all doctors to appear before Personnel Management Board meetings (disciplinary panel) at the Health Service Commission on Lagos Island and in LASUTH, Ikeja on Tuesday 24th April 2012 and Thursday 26th April 2012.
The association immediately instructed all the invited doctors not to appear before any of the panels. We however mobilised all our members to appear together at the Health Service Commission on Lagos Island on Tuesday 24th April 2012 at 8 a.m., in solidarity with our members that are being victimised on account of the 3-day warning strike.
On Tuesday 24th April 2012, the Medical Guild filed a case at the National Industrial Court for an injunction restraining the Lagos State government from carrying out any punitive action against any doctor on account of participation in the warning strike.
On getting to the venue of the disciplinary panel at the HSC on Tuesday 24th April 2012, we were turned back from the venue by a heavy detachment of armed mobile policemen and armoured vehicles. We were also reliably informed that LASUTH had been flooded with policemen and armoured vehicles. We had to relocate to the car park of the General Hospital Lagos across the road to hold our general meeting. While peacefully conducting our meeting, armed security personnel were moving in and out of our meeting with loaded firearms. At a point, they even disrupted our meeting by approaching our chairman, Dr. O.P. Odusote, while he was addressing the crowd, and invited him for questioning at their office in Lion Building in Lagos. While at the meeting, we got messages that government had finalised arrangements to begin the systematic sack of doctors. At this point our members became agitated and resolved to immediately resume our suspended strike action until CONMESS is fully implemented and government withdraws all queries, disciplinary panels, threats of sack and security personnel from the hospitals. The indefinite strike commenced on Tuesday 24th April 2012 and has been on till date.
The Nigerian Medical Association, Lagos State Branch, at its emergency general meeting on 25th April 2012 supported the strike action embarked upon by the Medical Guild and warned that if any doctor is victimised through sack or otherwise on account of the strike action, the NMA Lagos will also join the strike action.
On Monday 7th May 2012, the Lagos State Government issued letters of dismissal to all members of the Medical Guild for participating in the 3-day warning strike. The letters were dated 4th May 2012. The government thereafter commenced recruitment of post-NYSC doctors on locum basis to replace the sacked doctors. On Wednesday 9th May, the hearing of the case filed by the Medical Guild was adjourned by one week due to ill health of the judge assigned to the case.
On Thursday 10th May 2012, the government started forcefully evicting house officers and other senior doctors from their quarters. We opposed this action vehemently on the grounds that it was inhuman and a breach of the Lagos State tenancy law which prescribes at least a six-month quit notice to be given to tenants before they can be evicted from their houses. Furthermore, the Medical Guild filed a case at the National Industrial Court challenging this forceful eviction.
The newly elected NMA President Dr. Osahon Enabulele came to Lagos on Thursday 10th May 2012 in an attempt to broker peace. He met with the Governor and other high ranking government officials, but the meeting ended in a deadlock.
The NMA Emergency General meeting held on Friday 11th May 2012 decided that in the event the crisis is not resolved in favour of the doctors, all Federal hospitals in Lagos State will embark on an indefinite solidarity strike from Friday 18th May 2012.
We urge the government to immediately withdraw the sack letters and all queries issued to our members as it is totally in breach of labour laws since the warning strike was legitimate and a resumption of the suspended action of 2010/2011. Government should instead hasten to ensure implementation of the agreement and demonstrate its good will by promptly paying the appropriate salaries.
Dr. Olumuyiwa Odusote Dr. Idris Durojaiye