Healthcare workers in Nigeria have finally had enough.
Frontline health and social care workers have borne the brunt of the pandemic across the world, and that is especially true in the most populous country in Africa.
Nigeria has one of the lowest doctor to patient ratios in the world, with an estimated one doctor for every 2,755 people. A World Health Organisation study reported last year that Nigeria had one of the highest rates of COVID infection among health workers on the continent. With a hazard allowance of just NGN5,000 (£10) a month for healthcare workers, many have been unable to afford their own treatment, with some resorting to crowdfunding.
Unpaid salaries dating back were the final straw, leading to a nationwide strike of thousands of doctors, nurses and interns in April.
“Nurses have not been paid in over four months in our centre,” Dabota Omubo-Pebble, a nurse at the University of Port-Harcourt Teaching Hospital in eastern Nigeria says. “All the nurses employed in 2020 are yet to be captured and enrolled into IPPIS. We got our last payment in December 2020, and it's been crickets since then. Yet we have to show up for work and smile.”
The IPPIS is the Integrated Payroll and Personnel Information System, a computerised accounting system created by the Federal Government of Nigeria to effectively pay salaries of employees on its payroll. Similarly, resident doctors on the Government Integrated Financial Management Information System (GIFMIS) plan have not been captured on the IPPIS database nor paid for over four months.
“It is painful what is going on,” Daniel, who graduated from the Jos University Teaching Hospital in central Nigeria last year, told VICE World News.
“We are at the frontlines of healthcare in the hospital, and also in the middle of a pandemic,” said Daniel, who spoke on the condition of anonymity in order to speak openly. “The workload is crazy, and the only respite we have is our salaries, yet we are being denied that. I have so many debts hanging over my head, yet I always have to show up for work.”
The strikes were led by Nigeria’s National Association of Resident Doctors (NARD) in protest at missing payments that include hazard pay for doctors working in COVID-19 isolation centres and wards, as well as payment of death-in-service insurance to health workers who died as a result of COVID-19 and other infectious diseases.
The strike was called off ten days later, yet the demands are yet to be met. “While I have been paid all my outstanding arrears, some of my colleagues have not been paid,” Nana Abdul Kadir who has just finished her one-year internship program at the University of Ilorin Teaching Hospital said. “There's still an outstanding one-month payment for most interns. For some, it’s the January salary while for others it’s the February salary that hasn't been paid."
Dr Uyilawa Okhuaihesuyi, the president of NARD, said in a statement that the decision to suspend the strike for four weeks was a result of a new agreement reached with the federal government. He mentioned that other demands were being worked on.
According to the Nigeria Centre for Disease Control (NCDC) there have been over 165,000 official cases of COVID in the country, with over 2,000 deaths. Nigeria’s low doctor-to-patient ratio – the WHO recommends a ratio of one doctor to 600 patients – falls further each day with the brain drain of trained doctors to other countries, creating an administrative bottleneck in the middle of the COVID-19 pandemic. Most doctors are overworked and there have been reports of interns collapsing in the middle of long shifts.
“I work crazy hours every week,” Daniel said. “Because the units are often understaffed, I sometimes do the work of two people. During night calls in the medicine department, I often cover the two inpatient wards, and the Accident and Emergency unit. That means I have to climb multiple stairs up and down in the middle of the night to attend to patients across the units. All for delayed pay.”
“What’s more,” he said, “there is a lot of intimidation and bullying by medical elders if you complain. I believe we are the most abused professionals.”
Others are similarly unhappy. “Doctors here still have to pay out-of-pocket for their own treatment, and sometimes you can't even afford health care where you work,” Dr Abdullah Sanni, who practices in a hospital in Ibadan, a city in western Nigeria, said. “We have had to do crowdfunding for medical doctors so many times in recent times and it is just so frustrating that this is likely to go on for a long time. They are not ready to pay doctors their appropriate dues, they won’t tell us why they’re not paying us yet. Just false promises of ‘you’ll be paid soon’.”
The coronavirus pandemic in Nigeria coincided with an outbreak of Lassa fever – an acute, life-threatening viral hemorrhagic disease – in many states. With the number of suspected Lassa cases reaching 3,735, and in at least 26 out of the 36 states in Nigeria, doctors had their hands full in infection management and control, as well as public sensitisation.
“As a medical intern, I was the first on-call in Lassa fever wards,” Dr Toni, who spoke on the condition of anonymity to speak openly, said. “Sometimes we had to donate blood while on night call because some patients needed an urgent blood transfusion or they might die. The wards were full of patients and at some point, we had to use tents. It was an intense period.”
The Nigerian health sector has been grossly underfunded for years, with strikes being a common occurrence in the country. At the peak of the pandemic in June 2020, the NARD went on a strike over the lack of PPE and the grossly inadequate hazard pay, especially for doctors working in isolation centres. The strike was called off to give the government time to fulfil the demands and also because the lack of doctors working at full capacity might affect the ability of the country to fight the pandemic as numbers kept rising.
“The same thing keeps happening over and over again,” Sanni said. “We are not just the front liners in this pandemic, we are the last line of defence. If this defence comes down, as it is likely to be given our current situation, then it's over. We are lucky to not have what is happening in India here, but our government needs to take the welfare of health workers seriously. The families of doctors who died from coronavirus have even received any insurance benefits yet. This lack of deserving benefits for health workers is the main reason why young medical graduates and doctors keep writing licensing exams in other countries and leaving.”
“With the precedent being set in the treatment of doctors in this country, I do not look forward to practising as a clinician in Nigeria,” Ayodeji Todeji, a medical student at the Lagos State University College of Medicine said. “I look forward to holding public positions that will put me in the position of authority as regards policy-making and reforms in the health sector instead.”