 The Nigerian Medical Association has given the federal government 21 days to address the issues of the National Association of Resident Doctors, or else they will maybe also join the strike. We're going to be joined by the Secretary General of the Nigerian Medical Association, Dr. Philips Ikbe, who's joining us now. Good morning, Doc. Thanks for joining us. Good morning. Thank you. Alright, so it's a 21-day ultimatum. Quickly tell us about that and why the NMA has taken this stance. As you know, the Nigerian Medical Association is the umbrella body of all the doctors in this country, and we operate with affiliates. Affiliate means that different bodies. The Nigerian Assignment Resident Doctors, not, is part of the affiliates of the Nigerian Medical Association. And you're aware that before now, they've been negotiating with the government. They've had the memorandum of understanding. They have the memorandum of action. Unfortunately, the government have not met up these demands. Even the ones they managed to meet up, they did that half-hasn't met. As such, I mean, and in all these negotiations, the Nigerian Medical Association sent representatives, sent observers, you know, go with them. I particularly have been going with them. The government did not close its eyes while it was signing these agreements, this memorandum of action. And they actually put it online when they discussed that, okay, after such a time, this is what we're doing. But I'm telling you, since almost we cannot be here more than four or five months now, I mean, we should not be here. And so looking at it properly, I think the action of NMA is legitimate. Because of that, we discussed it in our national advisory council meeting. I realized that it is time probably to give the backing to NMAID. But look, government, you need to sit up if you realize the head case system in the country is currently in shampoo. Because NMAID is a very vital part of the system, of the head case system. If NMAID is not working, especially in public institutions, it is the functioning capacity of those institutions with less than 50%, less than 30%. And the Nigerian people are suffering because they need to be treated, they need to take all their health as such. And then we, you know, feel that, look, let us put our weights behind NMAID in this position. Probably that will help government or make government to sit up and fulfill the demands of NMAID. Thank you. Alright, you said that you had joined in the negotiations over time. Can you share with us what that conversation really is like every time that the doctors meet with the federal government? What vibe do you get from those discussions that has eventually led to failure to adhere to their promises? Well, the truth is that government appeared to be honest and there is usually cordial discretion to say what can be done and what cannot be done. And at the end of the day, they come to an agreement. And they may begin to try to implement. But immediately, not because of their strike, government will relax and nothing is happening again. And that is why today you will have that up to now some doctors are working and they've not been paid. Some doctors worked for three months, four months, six months and they've not been paid and so many other issues. The agreement and of course the demands by NMAID, what would your response be to people who say that they are probably asking for too much? And right now the Nigerian government is pretty tight on funds and cannot necessarily release that amount of money. Would that explanation make sense to you? Nigerian governments have not said that they are tight for money, therefore they cannot meet up with demand. No. They even said they have the money and they can meet up with demands. Let's look at the medical residency training fund. The other ones, the salaries of those workers is already in the project and that's supposed to be paid. So I don't think there is no time that the Nigerian government said, look, we don't have enough money. Remember that there is COVID-19 allowance that was supposed to pay. They told NMAID, we don't have enough money. Let's just discuss how to improve the general hazard allowance in the salary structure. And now the government and NMAID agreed. So it's not about NMAID being very difficult, you know, saying that they don't have the money. No. We are working together. We all agreed with government. They knew what they have before they reached those agreements there. We didn't make phone calls. They reached out to people and they all agreed that this is possible. And so why are you not doing it? I also believe that government has to put its act together. There are problems with bottleneck and logistics. I mean, you see that the means of labour are not about great uncertain issues. Then by the time it comes to implementation, either by one model or the other, it's not been done. And it's taking too long. I mean, it's not like not finish this negotiation and go to sit down. Not follow it up to see what is going on. And they see that eventually there is something wrong, especially from the, you know, until they say something not majorly sometimes from the head of service, that is the head of civil service and the federal department, you know. So those are the issues. Okay. And are there things, you know, seeing where we currently stand with this, are there things that the federal government or you would expect that the federal government will be able to suggest that they can immediately implement? It may not be the whole spectrum of demands from the NARD. But are there things that they maybe can start with, you know, that might make the NARD and the NMA, you know, decide, okay, let's, you know, handle or, you know, manage what, you know, the government is offering for now and we can negotiate further? You know, as you know, resident doctors and NMAs are very reasonable. We know the one that takes a whole lot of processes and we know the ones that should not take processes, you understand. And with that is why sometimes, from time to time, we review it. For instance, the medical residency training for should be paid. Those doctors who were being paid on give me, I suppose we migrated to what they call IPs, they should be paid. And those remaining house officers, about one and 14 of them, they have several issues. They should be paid. And of course, they should begin to also show commitment in the shortfall of 2014, 2015, and 2016. And then the circular for house officers. I mean, that one is the most obnoxious part of it because, I mean, it's like everybody is doing well. It just went down, it's part of the circular that is going through that upset, that did upset the system. So I think he was able to do these things I mentioned. The enemies were able to prevail on that. So they've done this, they've done this, they've done this. I mean, let us, because Nigerians are so full, let's go back to work. But as I'm telling you, all these things that I mentioned, I've not been done. Although, they're going to be working on it. But how long is it going to take? How long is it going to take? We need to see evidence of commitment. You know, this is not the first time government have been reneging on their agreement. And that is why now there is no trust. Even if, as I am, I believe they're telling me they're going to pay tomorrow. I won't believe it until I see it. When they tell me they're paying on Wednesday, I won't believe it until I see it. Now, look at it. This strike has been going on for 21 days. And it's not like there are new agreements. This agreement has been signed long time ago for two more, three months. So that means that if not, that call on their strike probably on the 2nd and the 3rd or the 4th, up till now they wouldn't have been able to, to even fulfill this agreement. They can't understand my logic. They understand. You know, this is 20, 20, today's what? Today's 30th or any? Today's 30th. So this is four weeks. And those demands, which, you know, remember last strike started on the 2nd. Right? So those demands by now should have been, you know, maybe before even 15th they should have fulfilled the demand. But unfortunately, even the federal government have not also lived up its expectation. You, at all, always, all the time, you go back to negotiating table. No matter the situation, whether you are in court, whether there is anything, you try to find a way. But I mean, they're not doing enough. All right. I want you to also share from a doctor's perspective, what does it feel like working for months, you know, on end, without getting paid? It is really very terrible. I particularly, I mean, if I have to work in any establishment and within three, four months and not paid, I don't see the reason why I should have met them. But unfortunately, the situation is such that they are in training. They can't walk away. I mean, if you understand, I mean, if they could, they will somehow be able to walk away. You can see what's happened with the interview to Saudi Arabia. They all took there and are going to take them. I was going to do doctors, our heart end doctors. It's very, very painful. You know, these doctors can't even pay school fees for their children. They can't even pay their house rent anymore. I mean, it's a bad situation for them. At the same time, they are women. They know that Nigerians are suffering. They wish they can go back to work. They even appeal to government. That is why, I mean, they also reached out to end the base. They please appeal to government for us as an umbrella body. They also reaching out to the, who is in the Nigeria, they reaching out to the different department, different ministers, and they reaching out to house percent, national assembly, the speaker, they reaching out to the head of, not the head of service now, secretary to the government information that look, this is an emergency situation. It's time to intervene. People are dying. You can imagine your security man, whose wife is pregnant, and now there is fitout distress or there is a problem as she misses her answer. It is only government hospital that she can afford, and now she gets there, things cannot be done. That is the truth. All right. I want you to talk about the, I think sometime last week there was news of a court ruling asking the doctors to go back to strike. What's your response to that and will that be enough to take the doctors back to work? I'm not aware that there is a court ruling asking doctors to go back, to go back to call off the strike. What I know is that the court ruling adjourned till 15th of September and we know, and the court stated that they have to hear from the doctors. It's not just hearing from the government. They have to hear from the doctors so that the justice will be served. And that means they gave an ample latitude for government to renegotiate. So that, I mean, by the time you get back to industrial court, these issues will have been resolved. And it's impossible because the court adjourned till 15th of September as soon as it should be possible. Governments should be able to sit down with NME, negotiate with NME, and then fulfill not demands and means such that all of the strike. Nigerians are suffering. I don't know if they understand the burden of what is going on. For those who are negotiating for the doctors, we can take care of ourselves, not a problem. But we are talking about Nigerians, the population, the Nigerian people, you know, not the elites. We are talking about people who go to the hospital daily. Nigerian women, maternal mortality is going to increase even with this action. Government have to be sensitive. You mentioned Saudi. I'm going to, you know, also bring in other angles on the, you know, state level. But you mentioned Saudi and it's some other thing. It's one thing that also made headlines sometime last week. Doctors immigrated to Saudi Arabia. Share with us, you know, why that is happening and, you know, what the working conditions, you know, seem like from people that you might know in Saudi Arabia. A lot more Nigerian doctors looking at the option of leaving. Well, let's look at it this way. I mean, I'm sure you're aware of the health issues in the world. I went and here I started. And out of about 191 countries, Nigeria is ranking 187. That is to let you know that our health care system is a bit small. Not in rural resources, but in facilities and a working environment and second sciences, but welfare, you know. The doctor is poorly paid. They don't have enough facilities to work. I mean, government, like what is going on now with the strike, with the NAP strike, you know, government is not the living up expectation. And of course, the economy is so bad that, you know, even surviving is a problem. There are a lot of doctors who are also roaming the street of Nigeria. These needed doctors, that government need to employ, get them employed, you know, but they're not being employed. So that is why they're leaving and they're leaving to places where the conditions are better. For any doctor that leaves Nigeria to Saudi Arabia, the salary is going to increase by about 10 to 20 times. So you understand that? That is over 1,000 to 2,000 percent increase. You know, even these salaries are not taxed and they're not taxed, especially for Saudi Arabia, they're given a accommodation, they pay for their vacation and they're working in a decent environment, not just that. You know, the pressure on them will be reduced. Here in Nigeria, the doctor to patient ratio is about 1 doctor to 6,000 patients. And that is why you see that a patient comes in the morning around 8 o'clock, you may not see a doctor to around 4, unless it's a emergency that we don't begin to try to see such a patient. These are not very good conditions to work. And so, is the reason why they're all tripping down to Saudi Arabia? Of course, they will be there, but I mean, I can see that, actually, they're patriotic, they want to bring their country and work. And that is why I say that NAD is looking, look at it, these are the problems. This is why people are living. So these things and let us, I mean, so that people will not live. But the government is not showing good enough commitment because this is months now and they've not filled the demands of NAD or the negotiation that is signed with NAD, the number one of action. So that is it. Dr Ekme, would you encourage a doctor in Nigeria to leave? Well, nobody's happy. I mean, at the level of, you know, it's not just about the doctors, but also about Nigerians. Even if I leave, who's going to treat my mother? Who's going to treat my sister? So it's not like we're encouraging them. But the environment is supposed to start. It's not good enough. You understand? So that's why we are in this impasse. That's why we are discussing whether that's what we're showing this action for government to realize because it seems they're not even aware. So I imagine especially when you think that oh, doctors are surplus. Just don't get me wrong. At no, at any time there will always be migration, you understand? You just like, as it is in other fields, I've told you that sometimes that also people migrate to Nigeria to go and give services. But this, this time around, these in droves, you remember that the, the, the interfere at the hotel over 500 doctors. Do you know what that means? Do you know what it means for Nigeria to lose services? I know their lives have saved. Even in the night, 1 a.m. I tried to maybe to go and do some kind of such to save life and they are letting me go. Tell me, you don't have value for me. And I'm not going to go into the job like that. I discuss with you and I've told you that this is you know, we agree that really these issues are very important. Government have not said that demand of angry with the people in between. I mean the people who are supposed to make sure that the process is done fast for it to be done, you know. So it's not an issue of not as high-handed or enemies high-handed. It's not an issue of their demand. It's not legitimate. It's an issue that government is not living up to their expectation because of bottlenecks. All right. Now, let's now talk about the other levels of you know, this whole story and that is from the chief medical directors to the state level also. What would you want, you know, to be done on that level to make the working conditions for doctors better? Well, first of all, you know, Nigeria should increase its budgets for health. The WTO recommendation is saying 15%. The highest Nigeria has gone is 6%. For this year it's even I mean 4%. And even at that 4%, it is not totally implemented. If you go to a hospital, you see that if we don't have enough pet space, the work is so much, they are not even employing enough. You can imagine that, you know, as these doctors are living, what is going to happen to all the patients? You see a doctor, I mean, I was interacting with a friend who is currently in Saudi. He sees just four to five patients in a day and it takes time. But here a Nigerian doctor may have to see up to 50% every day. Even at that, you know, he will be exhausted and Nigerian doctors are very good at doing their best. And then you find that at one time or the other, there's no equipment that is working enough for them to work with. The facilities are not okay. And then you now add a poor generation to it. And not this demand. This demand is not just about salary. It's also about research. It's also about improving the place. So the part but also the need government support because they see and they don't act on their own. All right. I was, what happens after 21 days? Dr. Phillips, let me Yes, by 21 days the National Health Council of the Nigerian medical session we meet and take a decision. Right. Is there any insights as to what that decision might be? Would the people like enemies optimistic that we are still going to meet the government who are going to discuss with them? Because it's not about whether strike or no strike or dropping tools or no dropping tools. We don't want to get there. We want the demand of not to be fulfilled. And that is why we are pushing. Even as of yesterday if you look at my eyes very well I've not really slept either because of one meeting or the other trying to make sure to put pressure on that look get this thing done and say, oh, this should be happening I believe that we may not really get to that to one day. So I think we shouldn't be discussing to one day we should be discussing how to fulfill not demand. I'm telling you even on Saturday in the night there were meetings of different persons in government functional areas but I think that government have to break some protocols. From minister of health to head of service to project to IPs and back to the general to finance and back on the resident or even if they have to do that they should be briskly I mean so that we pass the stage. One of the things that has been mentioned over time is the hazard allowance for doctors which they have you know asked that it should be improved on. Can you share with us you know what type of hazards doctors have to deal with at their workplace every day? You know it is very very many I mean let's just give an example when this COVID-19 pandemic was at his peak I mean why people were isolating at home doctors were there at the forefront working exposing themselves you know we lost price of doctors I mean even now we tell you we lost price of doctors I can tell you there are some people that I know that I cry today that we lost you know we lost so that is one major hazard with this because there is pandemic I have to know it how about to back losses how about what it is being how many just how about HIV that so many hazards that doctors go through I mean how about accident on the road I mean I told you just now that sometimes one day I was driving back from the National Hospital I missed the road you know there was no light on the road there was no light and you know a bunch of bars you know there is a way it divides almost run into the bush so these are hazards you understand these are still hazards that they go through I mean you are helping HIV patients they don't say no because patients HIV positive a lot we do operate and sometimes we preach ourselves that's why the father would try to take the precautions you know what the hepatitis be that eventually causes cancer of the liver I mean you know if these things you know are a lot of hazard that we go through the infection is coughing and all the rest of that I mean they may not be transmitted you know these are all the hazard they go through but why we are in the office why we are sitting at home we are not going to go through all that hazard so doctor is like in the war front trying to make sure that the head of NGOs are good at the same time risking their home life risking their own health because I mean you know he is like I mean a military man defending the country he may die too so that is what you know I mean of the doctors because of the pressure because of the pressure because of the you know the system one thing that has been mentioned a few times by critics you know for the NAR the NMA is that a lot of doctors have their own private practice you know that keeps them going and you know it may be you know it's a thing of greed that's what makes them continue to make these demands would you have something to say to that thank you very much you know let me put it this way if government is leaving up to his expectation I don't think many doctors want to go into private practice because let's look at Abuja I live in Abuja if you depend on salary alone with what government is paying it's difficult you may not be able to pay your rent you may not be able to view the cost of living so it is part time work they are doing you know you close around the 5 you are not on call you go to work elsewhere just to make ends mix it's not like I mean they have CMDs and they are there they are watching us we work so it is unfortunately that they are bringing up that issue that doctors are being really know it is a private sector that actually treats is treated by 70% 70% of Nigerians because the private sectors are not also not so developed because the environment is most high the economy is bad I mean 1 dollar is about 500 Naira you can imagine what it costs to buy equipment from outside and that is what government have to you know be open about in particular I mentioned about four areas number one is health health and health and health again number two is security security is also important and that is one of the ones I did not mention it's one of the reasons too why some persons you know most of our health workers are living in the country the security challenge is just too much it's just much you know I mean we know doctors have been killed by you know and we also know doctors who have been killed I mean if that should happen to you would you want to say for instance now Nigerians are no longer at the they are having to have been by road now people are not forcefully travelling via air even when they cannot afford it because of insecurity people are just drive from there to Kaduna either you are kidnapped or you are killed you know this is an issue of not feeling safe it's also one of the reasons that I live in but going back to your question I don't think doctors are greedy even the private hospitals how much is even it paid to be targeted because of private hospitals no I mean government hospitals should just it's what the the doctors working there how many of them are trying to work in the private hospitals they only do part time I assure you they only do part time they are always at work I mean going to a national hospital when they without this strike we see the doctors at our places go to each the investment we got you we go to a lawsuit I mean you see them working I mean we have sent patients there and they see them working so I don't think it is true that the issue is about private parties we should the doctors government augmenting the private parties because government does not have enough facility they will handle the Nigerian patients they don't if but sometimes the patient comes to to maybe a a hospital you find that the bed is full you refer to another hospital the bed is full refer to another hospital the bed is full they end up landing the private hospital that is not even affordable government has to be serious on health insurance it should be mandatory I mean the only about less than 5% of Nigerians you know even who are in government I haven't covered they understand the essence look that is the way to go health insurance health insurance all right doctor all right secretary general Nigerian medical association Dr. Phillips thank you so much for your time thanks for speaking with us I wish you a great Monday ahead thank you thank you all right from challenges in the health sector we move to challenges in the power sector we are going to be speaking next on the Nigerian electricity regulatory commission and of course a proposed message to increase electricity tariffs from the 1st of September that comes up next after the short break