Background
S/No | Description | Date |
1 | All Imo State Doctors | February 2016 |
2 | Imo State University | March 2016 |
3 | Kogi State University | April 2016 |
4 | University of Lagos | April 2016 |
5 | Adekunle Ajasin University, Akungba-Akoko (AAUA) | April 2016 |
6 | University of Ibadan | April 2016 |
7 | Obafemi Awolowo University | June 2016 |
8 | Federal Medical Centre, Ondo | Mid 2016 |
9 | Ladoke Akintola University | June 2016 |
10 | Federal University of Agriculture Abeokuta | August 2016 |
11 | Ebonyi State University | October 2016 |
12 | Ambrose Ali University | October 2016 |
13 | Nigeria Union of Petroleum and Natural Gas and PENGASSAN | January 2017 |
14 | National Orthopaedic Hospital, Igbobi, Lagos (NOHIL) | March 2017 |
15 | Nigerian Union of Allied Health Professionals (dental therapists, medical physicists, health information officers, clinical psychologists and medical social workers) | March 2017 |
16 | Federal Medical Centre, Yenogoa | May 2017 |
17 | Benue State University Teaching Hospital Joint Health Sector Union (JOHESU) chapter | May 2017 |
1- Obafemi Awolowo University | 9- Ebonyi State University |
2- University of Lagos | 10- Ambrose Ali University |
3- Ladoke Akintola University | 15- Imo State |
4- Federal University of Agriculture, Abeokuta | 16- Benue State University Teaching Hospital |
5- Kogi State University | 17- National Orthopaedic Hospital, Igbobi, Lagos |
6- Adekunle Ajasin University, Akungba-Akoko | |
7- University of Ibadan | |
8- Imo State University |
Methods
Results
Demographic characteristics of respondents
Frequency | Percent | |
---|---|---|
Age of respondents (years) | ||
< 30 | 6 | 10.7 |
30–39 | 38 | 67.9 |
40–49 | 11 | 19.6 |
50–59 | 1 | 1.8 |
Total | 56 | 100 |
Missing system | 2 | 3.4 |
Year of graduation of respondents | ||
< 2000 | 2 | 3.6 |
2000–2004 | 7 | 12.5 |
2005–2009 | 35 | 62.5 |
2010–2014 | 10 | 17.9 |
2015 + | 2 | 3.6 |
Total | 56 | 100 |
Missing system | 2 | 3.4 |
Academic qualification of respondents | ||
MBBS/BDS | 57 | 100 |
MPH or MSc | 7 | 12.3 |
MWACP | 16 | 28.1 |
FWACP | 3 | 5.3 |
Total | 57 | 98.3 |
Missing system | 1 | 1.7 |
Total | 58 | 100 |
Geopolitical zones of participants | ||
North Central | 8 | 14.3 |
North East | 1 | 1.8 |
North West | 4 | 7.1 |
South East | 9 | 16.1 |
South South | 14 | 25.0 |
South West | 18 | 32.1 |
Non-Nigerian | 2 | 3.6 |
Total | 56 | 100 |
Missing system | 2 | 3.4 |
Department/faculty of respondents | ||
Internal Medicine | 15 | 27.3 |
Community Health | 16 | 29.1 |
Family Medicine | 7 | 12.7 |
General Practitioner | 12 | 21.8 |
Paediatrics | 3 | 5.5 |
Others | 2 | 3.6 |
Total | 55 | 100.0 |
Missing system | 3 | 5.2 |
Position/level in training | ||
Medical Officer of Health/Registrar | 14 | 24.6 |
Senior Registrar | 39 | 68.4 |
Consultant/Fellow | 3 | 5.3 |
Others | 1 | 1.7 |
Total | 57 | 100 |
Missing system | 1 | 24.6 |
Frequency, nature and consequences of industrial action in healthcare establishments
Frequency | Percent | V. Percent | |
---|---|---|---|
Physicians mediated healthcare worker strikes in Nigeria | |||
0 | 2 | 3.4 | 4.3 |
1 | 14 | 24.1 | 29.8 |
2 | 22 | 37.9 | 46.8 |
3 | 5 | 8.6 | 10.6 |
4 | 2 | 3.4 | 4.3 |
5 | 2 | 3.4 | 4.3 |
Total | 47 | 81 | 100 |
Missing system | 11 | 19 | |
Other healthcare workers mediated strike actions in 2016 | |||
0 | 2 | 4.45 | 4.45 |
1 | 20 | 44.45 | 44.45 |
2 | 17 | 37.8 | 37.8 |
3 | 5 | 11.1 | 11.1 |
4 | 1 | 2.2 | 2.2 |
Total | 45 | 100 | 100 |
Missing system | 13 | 22.4 |
Description | Frequency | % | Type of comments made |
---|---|---|---|
Government | 5 | 13.9 | Failure of hospital management to uphold Federal Government (FG) agreements about salaries and allowances; Breach of trust by the government and government insincerity; Unfulfilled agreements reached with the Government on wages, training, equipping the hospital; Insincerity of FG and Chief Medical Directors (CMDs) in keeping to agreements and manipulation of union heads by politicians; Change of Government |
Infrastructures | 4 | 11.1 | Poor hospital utility facilities (No water in wards, Poor/No doctors’ call room, etc.); Poor working environment; Security of staff; and Poor infrastructure in the hospitals |
Leadership and management | 5 | 13.9 | At the core of it is welfare issues like low staff motivation; Poor communication between hospital leadership/administration and healthcare workers; Hospital leadership quick to respond to circulars from the Federal Ministry of Health (FMOH) that are anti-workers, but slow to respond to circulars that favour workers; Hospital leadership disconnected from the true situation of things in the hospital and unmindful of the experiences of patients; Leadership tussle |
Welfare | 6 | 16.7 | For improvement in workers’ welfare; Delayed promotion; Joint Health Sector Union’s (JOHESU) demand to be appointed consultants; Failure of the management to sponsor residents’ exams and updates; Denial of basic entitlement such as salary and training sponsorship |
Compensation and salary | 5 | 13.9 | Poor workers’ compensation; Inconsistent salaries; Delayed salary payment; Pay check is delayed and very small to meet up with present day reality; Remuneration skipping/relativity |
Inter-professional disputes | 2 | 5.6 | Inter-professional disputes, unnecessary disharmony amongst healthcare workers |
Poor guidelines and services | 4 | 11.1 | Poor guidelines for progression for different cadre of healthcare workers; Agitation for improved service delivery; Upgrading the standard of health care delivery and assault on a health worker; Lack of residency training policy |
Others | 5 | 13.9 | Lack of facilities, residency templates for residents; In solidarity with unjustly dismissed colleagues in order that they be reinstated; For regularization of entry and other grade levels; Greed; Protest against sack of residents who have overstayed |
Description | Comments on strike consequences |
---|---|
Service delivery impacts | Skeletal services; Patients are unable to access healthcare services; Poor patient care; Patients suffer as patients that need attention are denied specialist attention; Beneficial departmental activities are stalled/cancelled; Disruption in service rendition |
Morbidity and mortality impacts | Loss of lives; Increased morbidity and its complications, increase in maternal and child mortality, overall mortality and morbidity: Patients who cannot afford private facility bills may end up dying |
Institutional impacts | Reduced revenue generation by the hospitals; Loss of confidence in the system; Industrial actions weaken the health system and constantly dragging the system backwards; negatively affects the productivity of a particular institution; Increased distrust of the public health system by the general public, dissatisfaction of clients/patients; Conflicts between employees and management: Reduced internally generated revenues; Disruption in key health services including immunization and Prevention of Mother-to-child Transmission of HIV (PMTCT) services; Low productivity |
Professional impacts | Loss of dignity and respect for the profession; Poor public perception of medical personnel; Unhappy doctor; Reduced efficiency of human and material resources; Unhealthy inter- and intra-health workers relationships |
Healthcare outcomes impacts | Distortions of patient care outcome parameters (both clinical and patient satisfaction) |
Governmental impacts | Government agencies responsible for reason for strike actions suddenly wake up to respond to the agitated needs; Medical tourism and capital flight |
Training impacts | Residents, especially in clinical departments, do not get to do enough procedures to meet the requirement of the various colleges in good time; Poor performances in postgraduate examinations with huge financial losses; Delayed clinical posting of medical students leading to overstay in the university; Disruption of research activities |
Description | Frequency | Percent |
---|---|---|
Groups and individuals that benefits from healthcare worker strikes | ||
No one | 26 | 47.3 |
Healthcare workers | 12 | 21.8 |
Private hospitals/practitioners | 12 | 21.8 |
Union leaders | 3 | 5.5 |
Not sure | 2 | 3.6 |
Government | 3 | 5.5 |
Patient | 1 | 1.8 |
Consultants | 1 | 1.8 |
Groups and individuals negatively impacted by healthcare worker strikes | ||
Patients | 47 | 83.9 |
Patients and their relatives | 3 | 5.4 |
General public | 6 | 10.9 |
Residents doctors | 6 | 10.9 |
Poor socio-economic class | 3 | 5.4 |
Government | 2 | 3.6 |
Proposed solutions to healthcare worker strikes in Nigeria
Theme | Samples of comments on solutions to healthcare worker strikes |
---|---|
Government respect for agreements and health acts | Government should implement the signed agreements, not just put them to paper; Fulfilment of agreement by Government to all health workers; Improvement in health service delivery including implementation of 2014 National Health Act. More sincerity on the part of Government |
Better leadership and management systems | Hospital management should communicate better with residents (not by issuing threats); The hospitals should operate at an internationally acceptable standard for the kind/level of facility it is; The hospital administration/leadership should involve the healthcare workers in decision making, leadership should be inclusive; To work on the leadership and administration of the health system; Sincerity on the part of hospital management |
Improved inter-professional relationships | Mutual respect among all healthcare cadres |
Timely and better salaries and compensations | Consistent and regular payment of salaries; Regularization of salaries to remove inconsistency; The remuneration of the health worker should be given topmost priority by the government and if they are unwilling, they can privatize hospitals for better management |
Infrastructural upgrade | Improved infrastructure in hospitals; Improved working conditions—renovations of the call rooms, Make working environment conducive |
Improve staff welfare | Increase welfare of health workers |
Better training management systems | There should be a clear template for the residency training programme which is universally applicable in all facilities in the country, and this should be followed strictly, including staff strength, work duration(s), remunerations, and taxation |
Theme | Comments on training deficiencies |
---|---|
Faculty and lecturers | Poor quality and mindset of the teachers (a lot of the teachers were seen as being not ethical in their leadership conduct and this has had a negative effect on the students, i.e. bullying behaviour during teaching sessions from consultants and registrars.); Lack of/Poor mentorship; Negligence of meritocracy; Poor staffing; Lack of commitment of consultants to residency training; Consultants were seen as being too busy to impact sound training for residents; Poor mentorship and commitment to residency training; Poor supervision by the trainers |
Funding | There is also the challenge of poor funding, obsolete teaching methods and facilities; Inadequate funding; Poor health system funding. |
Infrastructure | Overcrowded classrooms, poor amenities, too many distractions for medical students; Lack of essential equipment for skill acquisition; Lack of/Poor medical infrastructure; Lack of adequate facilities even in accredited institutions; Lack of equipment |
Research and development | Lack of sponsorship for research in tertiary institutions; The major deficiencies are lack of investigative materials. |
Curriculum | Lack of leadership and administrative training in the medical training; Deficiencies in curriculum, deficiencies in training guidelines, deficiencies in training institutions, on-appraisal of what is existing already and creating a benchmark for operation; Lack of harmonization of training curriculum; Non-inclusion of leadership/management training, policy-making and research with hands-on experience even at the postgraduate level especially as doctors are expected to lead the health team |
Career path | Lack of job security during and after the programme; Spaces for new fellows seem to be shrinking; The exams were considered to be biased; More emphasis on passing exams than on skill acquisition |
Strikes | Frequency of strikes; Incessant interruptions during the period of residency training; Interruption/ prolongation of residency training programme |