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Doctors want to be our employers, they want to determine our salaries –Biobelemoye, JOHESU National Chairman

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The National Chairman of the Joint Health Sector Union, Mr. Josiah Biobelemoye, tells GBENRO ADEOYE that the government and doctors should be blamed for the crisis and unhealthy rivalry among health workers in the health sector

The Joint Health Sector has been on strike for over five weeks now and it is biting harder. When are you likely to call it off?

As soon as the government begins to think that human beings are important and that discriminating against one group of health workers is bad. And more especially, I think all this will be over as soon as the Minister of Health (Prof. Isaac Adewole) stops seeing himself as the President-General of the Nigerian Medical Association or Minister of Doctors and decides to be the Minister of Health and treats everyone equitably in a manner that will see him as a father of the system.

Also before now, you accused Adewole; the Minister of State for Health, Dr. Osagie Ehanire; and the Minister of Labour and Employment, Dr. Chris Ngige, of suppressing your legitimate demands. What have they done to warrant such criticism?

At every point when we tried to get a solution to the problem, the Minister of Health would stand as a wedge between the union and the legitimate demands. He would come up with a position that will take us back. He also instructs in that direction his Director of Hospital Services, who is presenting himself as the President-General of the National Association of Resident Doctors of Nigeria and Secretary of the NMA rather than seeing his office as a position of neutrality. Whenever we moved towards achieving something, these two men and the Minister of Labour and Employment, who is also a medical doctor, would meet with the NMA and bring what the NMA told them to the meeting the following day.

But what we hear is that all this is about your selfish demands.

No, they lied that we were asking for salaries equal to that of doctors and we have proved beyond reasonable doubt that we are not asking for equal salary with the doctors. They are taking comparative analysis of salary to mean just the basic salary, no. Today, what they refer to as basic salary is not even the basic salary, it is a consolidated salary where rent, transport, utility are all embedded and in the civil service, when they say transport is X amount for a particular grade level, it means whether you are a doctor, an executive officer or technician, once you have reached that level, transport is the same for you all; that is how it is done. If an engineer enters the service at GL9 and an executive officer gets to GL9, the same basic goes for them. It might take nine or 10 years for the executive officer to get promotion to that GL9 whereas another person just gets to the level upon appointment to service, the basic salary will be the same. What make the difference are their allowances. When you look at the allowances, the doctor’s salary is miles away from our salary. And they don’t want to consider allowances as part of the salary. Your take home is determined by everything that is paid to you.

Another issue is that when we started discussion, they made an offer of 20 per cent, we rejected it. We were asking for 50 per cent. Then they made an offer of 25 per cent and we said it was not good enough. I’m just using one grade as an example. So they said we should justify why we felt that the 50 per cent should be given to us. We made a two-stage PowerPoint presentation to them and everybody in the hall, apart from the doctors, saw that we proved our case. And among them, the Minister of Labour and Employment is the fairest. He said, “Fine, now go and give us three options.” We submitted the three options. For the sake of peace, we shifted grounds and went downwards so that they would not say that it was kobo for kobo (with the doctors’ salary) for the basic. The least option, we brought it down to 45 per cent and the last offer made to us was 25 per cent. A good negotiator would have added 25 to the 45 and get 70. And the midpoint of that is 35 per cent. So a good negotiator would have said ‘let me offer them 35 per cent’. By offering 35 per cent, the person you are negotiating with can say let us take 40 per cent and agree on that – that’s a willing negotiator. But rather than offer something above that 25 per cent offered to us before, they now brought it down to 15 per cent – lower than what they had even offered. So that angered us.

So we decided that they were not serious and withdrew from all negotiations. While we were contemplating whether to return to discussion or not, then the news that they had gone to get a court injunction came. Some journalists asked us about it and we said we were not aware of it. So we thought that was why they did what they did so that at the meeting, they could present that. We withdrew from all negotiations. We cannot pretend that we are talking and you are going elsewhere to do a different thing.

So with the ruling of the National Industrial Court that you should resume within 24 hours of the judgment, are you saying that is not binding on you?

Well, it is not binding on us until it is served to us. As of now, we have not been served or got any notification that our lawyers have received such. That case that is being brandied about, we were not even notified about it and if we were not notified, how would we even have been in court? And if we were not in court, how would they even have served us? So as far as we are concerned, we don’t know anything about a court order.

Also, we won a court judgment that mandated government to implement skipping for us, but it was not fully implemented for us. If you look at the public service table, you will see that others not in the health sector have a structure of GL 1 to 17. Between that 1-17, there are skipping levels. They don’t have GL 11. From 10, promotion takes them to 12. So we said our structure ought to have a skipping like other structures and that we would want to skip GL10 so that from 9, we’d get to 11. They said it was not possible and we went to court and after some years, the court ruled in our favour. While we were in this case with the government, the NMA was against us. We won in 2013 and the ministry refused to implement it. So they even lack the moral right to say that court has given us order when they have refused to obey about nine orders from court. Now we won that skipping in 2013 and the ministry refused to implement it until 2017 because they wanted to implement it for doctors who were not party to the case, who the court said were not entitled to benefit from it and that only JOHESU members should be rewarded because the judgment was for them only. The government that is claiming it wants to do the correct thing implemented the skipping for doctors against the advice of the National Salaries, Incomes and Wages Commission. And for JOHESU, as we speak, it was done haphazardly. It was not implemented for all our people, but they implemented it for doctors. They also started paying them arrears by providing N1.5bn every month for the arrears while they have not considered arrears for us – the owners of the judgment. They say there is no money. Even to adjust this salary now, NSIWC said it would cost N22.6bn, which is about N1.8bn a month. The ministers and all of them are saying government doesn’t have that money. Initially, they told us they had sent a memo to the President and that he had asked them to source for the money. That was the story we were telling our people since December 2017.

But why are you competing with the doctors? The NMA said there used to be a relativity ratio of 3.3 to 1 and that they agreed to reduce the disparity to 1.5:1, but that you want it to be at par.

Their stock in trade is lying; they have lied so many times against us and they are still doing so. The minister raised this and I said, in the 60s and 70s that you are talking about, what was the qualification of a nurse as of that time? And what were the qualifications of the people in the dispensary? Measuring a doctor’s qualification and salary with that of a nurse at that time is like a graduate at that time weighing his salary against that of a clerical officer. Today, those people you are talking about are graduates and not just graduates; they are being trained for seven years while doctors are being trained for eight years. A graduate nurse gets academic training for five years, goes for internship for one year and youth service for one year, while a doctor gets six years of academic training, one year for housemanship and one year for youth service, which makes it eight. Optometrists have academic training for six years, internship for one year and youth service for one year, making eight years’ training like it is for doctors, yet he is not entering service on the same GL as a doctor. So these are people that have come of age and even at that, we are not saying that the salaries should be the same. Even now, the salaries are not the same. A graduate doctor was getting N260,000 when the highest paid health professionals in the JOHESU group like optometrist would get N160,000 and nurses, N118,000. Now, the salary for doctors was moved to N312,000. All we are saying is that we had gap, which we were not complaining about before and you have now increased the gap, restore that gap, please. Increase ours also to restore that gap. If the gap was N140,000 and you have moved it to N200,000, please restore that N140,000 gap.  That is in the simple terms. That is the equity we are talking about.

 But the situation is more complicated now as the NMA has said that if the Federal Government should meet your demands, it would also go on strike.

 Now, why can’t the government seek to do the right thing and ignore the one doing the wrong thing? Will you now deny those who have legitimate rights and allow their strike to go on because of those on the wrong side? A system should be on the side of what is right. Another reason why we cannot rely on them is this: they got this figure (N22.6bn) in December and the minister went to defend the ministry’s budget in February but surprisingly, it was not included in the budget. So where is the sincerity in trying to meet the agreement? And this agreement was meant to have been concluded in five weeks but because of the compassion we have for Nigerians, we waited patiently for six months for something that should have been done in five weeks. And so that we could find a way to sit down and avert this, we gave 66 days’ ultimatum. But in 66 days, they were unable to call us to discuss but between when we started strike and now, they are claiming they have sat with us six or 10 times or whatever they are claiming, but if they had started sitting with us within the 66 days, we would have averted this strike action. In order to avert it, we still gave conditions. On April 12, 12 days to the expiration of the ultimatum, we told them that the same time last year, doctors had an agreement and within 15 days, you were able to get approval from the President and implement it. Now ours was supposed to be five weeks, you have not been able to do it. In December, you pleaded. You gave us a document that showed the cost had been calculated to amount to about N22bn. We showed our people that but you did not do anything. If you say the President had asked you to source for the money, 12 days is enough for you to source for the funds. We said, yes, N22bn is a lot of money but it is only N1.8bn per month. So why not get N3.6bn for two months and pay one month’s salary into our members’ accounts, that will enable us to suspend the commencement of the strike. Within the next month, you pay us the remainder while you find a way of getting the money. That was done for the doctors.

We gave them another option: one, you are paying illegal money to the doctors as skipping, stop that skipping. We are told that implementing the skipping costs the government over N1bn monthly. So rather than continuing to pay an illegal money to these people, stop that illegal man’s pay and convert it to pay the legitimate one that you are saying you don’t have so that there will be peace. But they prefer paying the illegal one and depriving us of our rights because they are doctors and we are not doctors.

Some people say the doctors are the most critical to the health sector and the kind of training they have is superior to what others in the sector get. So why are you always using the doctor as the standard to determine your salaries?

That is a misrepresentation of the facts. There is no time that we have compared our salaries to theirs. When we go for negotiations, we go for ours, but every time we are achieving something, they would come in to say that if you give him this, we will not agree. They negotiated for Consolidated Medical Salary Structure; we didn’t negotiate for them. We negotiated for Consolidated Health Workers Salary Structure; they didn’t negotiate for us. And one point to note is this: the last adjustment they did, which introduced the ratio 1.5 : 1 that they are claiming, they went in without our knowledge, used our salary as the basis of comparison and started doing the increment. They never thought that there were some of our people, whose ratio even in 1991, was higher than theirs at some levels and that is what we showed to the ministry in our presentation. There were certain levels that our own people had higher basic (salary) than theirs, so why didn’t they try to maintain that sequence? All the cases where ours were higher than theirs, they made them lower and the ones that they were higher, they maintained them, but we were not there. Why would you shave our heads when we were not there? If the government wants to find a solution to that matter, they would have invited us. That was in January 2014, so we said this is injustice. This is the only time we have gone to say ‘do what you have done for them for us, adjust our salary too’. Doctors are still entering service with their first degree certificates but universities have provided training that is good enough for first degree to some of us now and they spend not four or five years but six years for such training.

So with that job evaluation, a new order was made to harmonise all salary structures. In 1998, NSIWC came up with the harmonised salary structure. It harmonised public service salary structure for the non-health group and the non-tertiary group. Then it harmonised tertiary institution salary structure for the tertiary group where the health people in the tertiary also belong. When it came, the doctors opted for the harmonised public service salary structure. We accepted the Harmonised Tertiary Institution Salary Structure, also known as HATISS. Later, doctors discovered that our basic was better than theirs, they said they wanted to join ours. We didn’t prevent them, so they joined. In essence, we have never been the problem. After that HATISS, then came Consolidated Tertiary Institutions Salary Structure. It put in some items which are generally things that you can give to every officer on a particular GL like transport, utility, and other administrative allowances.

They complained that because of the harmonisation, they had lost some balance. So NSIWC compensated them.  At that time, their entry point was GL 10 after youth service so NSIWC said they should start from GL12. Original relativity between doctors and other graduates in the 1970s was that they and lawyers entered service at GL9 while others entered at GL8. Then they said they had trained for a longer period, they said they should start at GL10. That was how it was till salaries were harmonised. They know how to arm-twist government, after harmonisation, it moved them to GL12 and that alone is enough compensation. And in all our negotiations, NSIWC mentioned that it compensated them with additional relativity entry point to GL12. But they were not satisfied. Now that we skip, they said they must also skip. The ruling was not for them but the government allowed them to skip CONMESS II so they are now on GL13 and not even GL12. So it takes some of us nine to 12 years to get to the GL where they enter from. And after we have spent 12 years to meet a fresh doctor who is just coming in, the total emolument of their salary is still higher than ours. We showed them the tables. A doctor just coming into service is going home with N312,000 and highest among us after spending maybe six years to get to where they enter from, will be going home with N255,000, by the adjustment we are asking for and that is optometrist. Currently, they get N160,000.

But are you not bothered that people are dying because of this strike?

You said they (doctors) are the most critical to the health sector. Now that we are out, let the critical people prove to the world that we are nothing because that is what they think.  What they sell to the world is that they are the most relevant and that we don’t even have anything to do in that place. Is it true that  we don’t deserve anything and therefore nothing should be done for us? Okay, fine, since we are not relevant, now we are out. We waited for six months and in their own case in 2014, it was approved and done for them within 16 days. In 2017 again, we signed an agreement, theirs was done for them within 15 days and ours is still dragging. So now, the press should rather question the Ministry of Health and then educate the public that these people have endured from 2014 till now. And even you say you signed an agreement last year, they endured for six months, so why did you not prevent this to happen? Maybe they believe that whether we leave or not, there will be no effect so they never bothered about us, so it is not about us.  Our operational code has been 4Cs- consultation, consolidation of the consulted result, compromise and confrontation. I was begging them all along that they should not allow us get to the fourth C; we were begging them. Are we not compassionate enough? If they can do for others in 15 days, what is wrong in doing ours in six months plus 66 days? This is where you can say we are making comparison.

But we asked you a question, are you not bothered that people are dying?

Why shouldn’t we be bothered? That is what I was telling you. We were bothered; that was why we refused to embark on strike initially. That was why we proposed possible solutions to avert the strike and even when it started, I told them that look, it has started but if you are willing, we can call it off soon. Get N3.6bn and pay us; let us get the alert and then we suspend and sit down and discuss all other issues.

Ebola is back in the Democratic Republic of Congo and with the ongoing strike, it will be catastrophic if it should get to Nigeria again. Are you not worried about this?

That is the reason why the government should have treated this as an urgent matter and with honesty. I’m not talking about the President. The Minister of Health, who thinks he is the NMA President, and the Minister of Labour and Employment are bent on preventing us from meeting with the President because there are certain things that we will tell the President that will cause a lot of problems for them.

Last year, NARD was on strike, they took them to the President to get a direct order and they solved the matter in 15 days. NMA had problem, they took them to the President. We have requested many times that they should take us to the President. If you say explaining the problem is an issue, then take us to him so that we can solve this matter once and for all. Why have they not taken us to him?

Do you agree with people who say that there is an unhealthy rivalry in the health sector and that it is seriously affecting it?

When people fail to look at the truth, then they are not ready to solve the problem. We have said it many times that we are not competing with doctors, we are only asking for what is due us but to them (doctors), what is due us is too much for us. They want to determine their salary and determine other people’s own. We are not their employees and neither are they our employers. We are all employees of the federal, state or local governments and why should another employee arrogate to himself the title of the employer of other employees? All we’re saying is that government should treat us fairly. Even the cleaner is important but where you say other graduates like you, professionals and so on, are nonentities, do you want peace? I asked the minister, I said minister, you have been talking about the importance of doctors as if they are the most important people in the world. What about people who have manufactured planes? Have they trampled on anyone? I said even your stethoscope, one of your basic instruments that give you the pride as a doctor, which  you swing about and people say ‘oh, he is a doctor’, and gives you recognition as a doctor even before any old woman that has not gone to school, is manufactured by a biomedical engineer. Biomedical technicians repair or manufacture them. That instrument that gives you pride is done by somebody else, can’t you give him some respect?

Doctors are still working in hospitals, so do you think your industrial action has been effective?

If our strike is not effective, they should allow us to be now. If you have concluded that the strike is not effective, then according to them, why go to court to get an order that we should resume? We have not received it anyway. Allow us to be out and let the doctors do the job. Don’t intimidate anyone.

You have also been accused of intimidating health workers and even the NARD accused you of harassing some of its members. Why are you doing that?

Their stock in trade is lying and spreading propaganda. As soon as the strike started, they came up with a story that incensed the police in Owerri, Imo State that our members had killed 20 babies in an intensive care unit. They made up the story just to get sympathy and pit us against Nigerians. As a result of that, so many policemen were brought to Federal Medical Centre, Owerri and they even harassed our members. As workers, the five unions that make up JOHESU are all registered trade unions. We have the right to go on strike, picket and protest.  We can apply any of the instruments at any time.

But the health minister has said that you lack the constitutional right to harass anyone.

Listen, we also have the right to monitor our members. As far as you are not our member, we have no business with you. That is why we have anti-union and anti-party activity. If someone is found to have engaged in anti-party activities, don’t they reprimand and punish him? So if our member is doing anything wrong and we are having issues with our member, that does not concern a doctor; neither does it concern the (hospital) management. We were monitoring the strike and they raised the issue that we had killed 20 children to incense the police so that they would harass and brutalise our people. The police started harassing our people who were peacefully doing their business. They arrested four of our members in Owerri, beat them up and battered them. We got information and sent our stories to the appropriate quarters and they realised that it was not proper. And our people were released.

Have you heard that our members have vandalised any hospital? No. They made up the story to justify bringing in police. We are out, we are not important, so they thought they could use that to get the police to start brutalising people in the hospital and intimidating us into submission but our members will not relent.

But we hear that you have been locking offices in hospitals, is that not true?

Hospital equipment should not be destroyed even while we are on strike. You were around when doctors went on strike. Didn’t they discharge patients in the wards? Why did they do that? Who told you that at the level the patients were, they could not be attended to by other health workers. The other staff can do a lot in the hospital; that is what you people don’t know. If the NARD members are on strike, what about the house officers? What about the consultants? Were they also on strike? But they decided that they should not also work, so they prevented others from working and discharged all patients. Are resident doctors the owners of the patients? If the head of department like laboratory, pharmacy and so on knows that if he leaves the place open, there could be misuse or other things may occur because corps members and interns in hospitals should only work under supervision. If the equipment available are destroyed, they will say that we destroyed them before we left.  If people have taken measures to safeguard such areas, I don’t think that is a negative intention. Now compare that with NARD going on strike and discharging patients when the consultants and so on were not part of them. The aim is to call the dog a bad name and then crucify him for maybe pepper soup.

Some people have said that you should not be collecting salaries while you are on strike. Do you agree?

They like to misinform Nigerians; as soon as the strike started, the first thing they did, without thinking of how to solve the problem, was to send out circulars saying, ‘No work, no pay’. They stopped salaries for CONHESS earners and left for only doctors. We have not collected any salary since the strike started. Our people have not even collected salary for the work they did before they went on strike. It is not only JOHESU that has gone on strike, other unions have gone on strike and they got their money. It is only in the ministry of health where we have no work, no pay and it is for people who are not doctors. We agree that the law says ‘no work, no pay’, but will you also justify your action when the person has gone through all the processes to notify and inform you of the need to solve the problem, but you refused to talk about it because you have the instrument of ‘no work, no pay’? What they are practising here is nothing short of slave labour. ‘No work, no pay’ should be used when the union refuses to follow the due process and has not engaged the government or notified it of its agitation and intention. But they (people in government) instigated the problem because of their plan to make the strike unpopular and the people irrelevant so that they can suggest to the President that the solution is to privatise the health institutions. They tried it in 2015 and we stopped it.

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