Health workers have been on the frontline of the fight against COVID-19. But while the federal and state governments have been applauding them, their workplace safety and welfare have not been given due priority. This has led to waves of strikes and protests in the sector since March.
These started with pressures from below, blossomed into state-wide strikes led by united fronts of workers in the health sector, and separate state-wide and national strikes by the doctors, culminating in a emergent pattern of joint action by all sections of the health workforce as one body. The progression of these interlocked waves shows both the need for, and emergent possibilities of unity in action for workers in the health sector to win improved working conditions and funding for healthcare delivery
The first of these waves was defined by rank and file nurses’ protests from below. The trade union bureaucracy, in the form of the state councils’ leaderships of their union rebuked these protests. Nurses at the Enugu State University Teaching Hospital (ESUTH) on Parklane in the Coal City took to the streets at the end of March. Their grouse was over the non-provision of adequate personal protective equipment (PPE).
As they marched through the streets, they were commended for their efforts in battling the pandemic by working people who expressed concern that these health workers were being made vulnerable with lack of protective clothing. Videos of their protest went viral on social media.
ESUTH management dismissed the protesting nurses as just “a few who were apprehensive of their front-line status in the Management of COVID-19 pandemic”. This was with a statement issued by Prof. Hyacinth E. Onah, Chief Medical Director of ESUTH and Dr. Ogechukwu F. Amadi, Chair of the Medical Advisory Council of the hospital.
Innocent Ezema, Chair of the Enugu State Council of the nurses’ union, the National Association of Nigeria Nurses and Midwives (NANNM) and Ben Asoswa, Chair of the state’s council of the Trade Union Congress, equally co-signed this condemnation of fellow workers.
Similarly, in Kwara state, rank and file nurses protested poor working conditions, including the lack of PPE. And the NANNM State Chair Alhaji Shehu Aminu sanctioned them publicly. He went further to threaten any member of the union who went on a wildcat strike, as that would not only be a contravention of the public service rules, but also in his view, could dampen the morale of the state governor whom he claimed had been doing so much to make Kwara great again.
By May, it was impossible for the trade union bureaucracy to repress the boiling anger from below. A new wave commenced which swept across states, with leaderships of health sector unions forced to act. The contentious issues included cuts in salaries as several states’ governors, imposed COVID-19 deductions in wages. This second wave mainly involved jointly organised state-wide “warning strikes” by several unions on one hand, and indefinite national and state-wide strikes by medical doctors on the other hand.
They were faced with blackmail and intimidation by government, condemned as not caring for patients in a pandemic. But governments actions and inactions either spurred these strikes in the first place or stoked the fires of resistance through stubborn refusal to heed the workers legitimate demands.
In Kaduna state, the government deducted 25% of public sector workers salaries in April. The health workers protested in vain, noting that they were rather to be paid hazard allowances as they were working around the clock, and with infection and prevention measures not being fully put in place by government and hospitals management. After the government’s refusal to heed these demands, fourteen unions teamed up as the “Joint Workers Union”. These included all cadres: doctors, health technologists, nurses, radiographers, physiotherapists etc.
They demanded refund of the amounts deducted, payment of hazard allowances and safer working conditions including adequate provision of PPE. Despite the government’s threat to sack them all and have them replaced; they organised a 7-day warning strike in May which saw all 110,000 health workers in the state withdraw their services.
The Ogun State University Teaching Hospital (OSUTH) branch of the National Association of Resident Doctors (NARD) also organised a warning strike in May. Their demands included: implementation of salary review consequent upon the national minimum wage, payment of hazard allowance, appropriate entry level for placement, and life insurance for members.
The following month, they began an indefinite strike. The state government was sharp with its condemnation of their action despite its refusal to respond to their demands before and after the warning strike. A Centre for Society Health Advocacy (CSHA) also echoed the government’s blackmail, a sign of things to come in a more violent manner in Kogi state – the state’s blackmail finding echo in a few sections of civil society, with some ties to the state. By the beginning of July, the state government brought in volunteers to take some of the striking doctors’ positions in the hospital.
The first phase of the Ogun state resident doctors action dovetailed into a national strike of the National Association of Resident Doctors (NARD). They were protesting the shortage of PPE and poor renumeration, even as they put themselves at risk of contagion with heavy workload and inadequate occupational safety and health measures. The government hurried to meet their demands, releasing N4.5bn for disbursement to the 31 federal tertiary health institutions in the country. This covered payment for hazard and inducement allowances for the month of April and May.
Doctors on the platform of Association of Government General Medical and Dental Practitioners (AGGMDP) commenced an indefinite strike which lasted over a month in Ekiti state, on 30 June. And the National Association of Nigerian Nurses and Midwives (NANNM), Medical and Health Workers Union of Nigeria (MHWUN) and the Nigerian Union of Allied Health (NUAHP) came together, forming the Joint Associations and Unions of Ekiti State Healthcare Workers (JAUESHW) to organise a 3-day warning strike, a few days later.
In an interview with Socialist Worker, Comrade Femi Ajoloko Chair of both MHWUN and the JAUESHW spoke bitterly on the travails of health workers in the state.
“We have been denied the benefit of receiving hazard allowances for the past ten years”, he said, adding that “health workers have had to buy their uniforms themselves, and without even the allowance for this being paid. In fact, we are also being owed up to three months salaries as I speak. And to add insult upon injury, the state government is deducting from our meagre salaries”.
The doctors had similar demands as well as serious grievance on staffing ratios. There are only 75 doctors for the 19 general and specialist hospitals, while just 12 doctors are responsible for the 100 primary healthcare centres spread across the state’s 16 local government areas.
By August, the trade union centres in the state (Nigeria Labour Congress and Trade Union Congress) as well as the Joint Negotiating Council of Public Service (Trade Union Side) took up the gauntlet with a 3-day strike. They echoed the demands of the health workers and called for the payment of backlogs of salaries and pensions for all categories of public sector workers in the state.
Workers in Cross River state downed tools on 30 June. The strike which lasted a week was called by the NLC to demand the screening and restoration of employment of over 2,000 workers whose names had been dropped from the government’s payroll after a shoddy staff audit in September 2019. Five of the workers had died, from being unable to pay hospital bills when they took ill, as they were jobless and without resources to take care of their health, in a system where the national health insurance scheme is more of a scam.
The Trade Union Congress dissociated itself from the strike, citing the COVID-19 pandemic, though the state governor, Professor Ben Ayade had denied anything like COVID-19 in the state. The Nigeria Medical Association however commenced an indefinite strike immediately after the NLC strike was called off.
They pointed out the dangers their members were facing with the governor’s pandemic denialism. Prof Ayade had lambasted Dr Ikpeme Ikpeme, Chief Medical Director of the University of Calabar Teaching Hospital for supposedly spreading rumours when the CMD informed that five persons tested COVID-19 positive in the state. But the strike forced the governor to accept the reality of SARS-CoV-2, and he eventually allowed the National Centre for Diseases Control’s to set up a COVID-19 isolation centre in the state.
Health workers in the Federal Medical Centre in Lokoja, capital of Kogi state, where the other COVID-19 denialist governor holds sway, equally organised. All the unions in the FMC came together to form a Joint Action Congress. As the JAC got set for a peaceful protest on 1 July, scores of thugs armed with machetes, clubs and other dangerous weapons stormed the place and brutalised the workers. It was obvious enough that they were doing the bidding of the rather deranged governor.
Many were severely wounded and their personal effects, including phones and laptops, stolen. But this did not dampen their resolve. On the contrary, it strengthened it and they immediately flagged off a mass strike.
Earlier on 18 June, health workers in Benue commenced an indefinite strike, after the expiration of a 21-day ultimatum. It was jointly organised by the Joint Health Sector Unions (JOHESU), and the NAGGMDP. They were being owed between three- and five-months backlogs of salaries which they demanded be cleared. Their demands also included: payment of a covid-19 hazard allowance, implementation of CONHESS and provision of PPE.
Doctors organised under the banner of the NAAGMDP participated fully in the planning and execution of the strike, despite efforts of the NMA which they are affiliated to, to thwart this. The state NMA Chair, Joseph Ngbea declared that doctors would not be part of the strike, two days before it began, without saying a word whilst the 21-day ultimatum lasted.
Claiming that doctors were “working very cordially with the state government”, he urged patience with the government. Doctors, he insisted, had to remember the Hippocratic oath of service at all odds, even as he commended the government for the provision of 50 new sets of PPEs and 10 body bags! The strike lasted till the 2nd of August when the government cleared some of the backlogs of salaries.
There have been a number of protests and strikes in several other states, including Ondo and Bauchie states in the last two months. Showing increasing ties between taking over the streets and the powerful weapon of the working-class i.e. strike.
As at the time of writing, MHWUN, NANNM & NUAHP, which together with the Non-Academic Staff of Educational and Associated Institutions (NASU), make up JOHESU nationally, had presented grievances to the federal government, including calls for upward review of the Consolidated Health Salary Structure (CONHESS). Failure of the federal government to meet these could result in a national strike. NARD is also likely to organise a fresh strike after issuing a 21-day ultimatum at the end of July.
This evolution of strikes from below shows the need for stronger collaboration of all unions in the health sector and concerted national mobilisation and strikes. The challenges that face the workers are the same; poor pay, lack of PPEs and equipment, understaffing resulting in burnout and precarious work. We are stronger when we stand together and fight together.
Forging such unity will not be easy, due to years of mistrust and at times conflicting interests between unions in JOHESU and doctors under the NMA. But it is necessary for workers to decisively win in the battles that lie ahead. The collaboration of all unions in states like Kaduna, Kogi and Benue shows that it is possible. Towards this, JOHESU might look more towards deepening ties with NAAGMDP at the national level.
The health unions’ demands must also be more comprehensive, proactive, and concretely tied to achieving health for all as a fundamental human right. We must fight for greatly improved funding, to provide quality universal public healthcare. A place to start is to insist that 15% of all annual government budgetary provisions, at all levels, is committed to public health as stipulated in the Abuja declaration, almost twenty years ago.
Improved funding for health must be used to: massively improve the training and employment of health workers with adequate pay and decent working conditions; build and equip more hospitals and health centres, and; establish a public health system which provides free quality services to all.
by Muda OGIDAN