Health workers strike action; matters arising

Workers in Federal Health Institutions across the length and breadth of Nigeria commenced an indefinite strike action at midnight this morning. This is as the ASUU strike in the education sector inches towards its fiftieth day. And very much like the university teachers strike, the current working class action in the health sector stems from the crass insensitivity and utter dishonesty of the Nigerian state and the ruling class which it serves.

The Joint Health Sector Unions (JOHESU) which is a coalition of: Medical and Health Workers’ Union of Nigeria (MHWUN); National Association of Nigeria Nurses and Midwives (NANNM); Nigerian Union of Pharmacists, Medical Technologists and Professions Allied to Medicine (NUPMTPAM); Senior Staff Association of Universities, Teaching Hospitals. Research Institutes and Associated Institutions (SSAUTHRIAI) and; Non-Academic Staff Union of Education Institutions, Research and Allied Institutes (NASU), called this strike action to demand the implementation of the National Industrial Court of Nigeria’s ruling of July 23, 2013, after the expiration of a 21-day ultimatum.

Background to the strike

Health workers on the Consolidated Health Salary Structure (CONHESS) won a victory on July 23, when the National Industrial Court ruled that it was unjust and illegal for the Federal Ministry of Health to insist that members of the unions constituting JOHESU must pass through the null CONHESS 10 grade level, in their career progression. With this victory, the workers won a battle, but the 2-year war for skipping CONHESS 10 did not abate as the ministry of health remained adamant, despite the court ruling.

The ministry, working with the office of the Head of Service had issued a circular almost three years ago to Federal Health Institutions, insisting that workers on CONHESS 9 that should normally be promoted to CONHESS 11 must rather be placed on CONHESS 10.

This is against the practice in the civil service where Grade Level 11 (roughly equivalent to CONHESS 10) is traditionally skipped. The aims of the bosses, and government was to get workers to work for a longer period of their lives (by spending at least three years more on an actually null grade level) before getting to the peak of their careers, and earn less (i.e. the difference between CONHESS 11 and “CONHESS 10” wages).

This is actually what employers in general want, so that they, who are rich get richer and we the working people get poorer. The secret of their wealth lies in our poverty. Through exploitation, they maintain inequality, extracting surplus value from the toil of our labour.

It takes struggle to turn this situation around. Every single concession we benefit had to be fought for by workers, yesterday and today. It is basically through struggle that salary increases, improved working conditions and the expansion of our democratic rights in the larger polity, is won.

Negotiations, collective bargaining and the law courts alone do not win anything. These are mechanisms with which we can formally secure what the bosses grudgingly concede, only because of the might of our combined power which they fear.

For example, there had been a series of mass actions, including rallies and strikes since 2011. It was these that sent home a clear warning to the industrial court even before it began sitting that we know our rights on the matter and are ready to fight for it.

Apart from winning its demand that CONHESS 10 has to be skipped (which is the major binding element in this united struggle), health workers also secured victory regarding the payment of specialist allowances, and placement as consultants for other health professionals apart from doctors (who alone have been benefiting these in recent times). JOHESU and the health professionals’ assembly are demanding the full implementation of these won demands.

The National Industrial Court, the state and the bosses

The dispute over non-skipping of CONHESS 10 and other issues between the health workers and the ministry had been referred to the National Industrial Court by the minister of labour some four months back. This was to stave off an imminent strike action of JOHESU, then. There was a tacit understanding by “the two parties” (i.e. the ministry as employer and the unions representing the workers) that the decision of the NICN, which is the appellate court on industrial relations matters in the country would be binding.

Had the court ruling been in favour of the ministry, it would have taken action IMMEDIATELY...and the trade unions, obviously, would have complied. But despite all its empty “commitments” to that effigy of a rule of law, the Federal Government chose to disregard the ruling of ITS OWN court. Yes, the FGN as a whole and not just the ministry of health, which of course is a part of it. JOHESU wrote to President Goodluck Jonathan, asking him to call the ministry to order, wanting to avert a strike as its last alternative. But, it was not just tough luck that the presidency would not be bothered. It acted true to type in its disregard for the lives of working people who rely on public healthcare delivery.

And what has been the role of the NICN after its landmark judgment? It has revealed itself as being part and parcel of the state which is meant to safeguard the bosses’ rule in our economic as well as political lives as “citizens”. It chose not to hold the ministry responsible for its condemnable irresponsibility. On the converse, it accepted the not-exactly-honourable minister’s petition against the strike which it has called upon poor Nigerians. For days now, its bailiffs have been parading MHWUN House, the National Secretariat of Medical and Health Workers’ Union of Nigeria, whose National President, Dr. Ayuba P. Wabba is the the JOHESU National Chair.  

But shame on them! Not a single soul could be found as all members of staff have been deployed to the field to ensure full compliance with the strike action and pave the ground for what could be phase two of the action, if the bosses remain obdurate; a complete shutdown of public health services delivery at all tiers of governance.

Medical doctors: “professionism” or being scabs?

A rather unfortunate dimension of this strike, at least in its discourse, as it unfolds is the shamelessly sectionalist position of the Nigeria Medical Association. In a statement signed today by its President, Dr Osahon Enabulele, a good friend with a socialist background, he expressed the view that support staffers in the health sector are set to prevent doctors from delivering health services, describing the strike action as an “obstruction” of the genteel doctors’ selfless service in the cause of humanity.

This is an attempt to whip up public opinion against the striking workers. Its roots lie in the medical doctors’ professional chauvinism which Prof. Festus Iyayi rightly described as “professionism” (I would say professional cretinism!), at the 2^nd Annual MHWUN Guest Lecture in April, which Dr. Enabulele was also present at. One of the demands which JOHESU and its components have consistently made in recent time is for the implementation of the report of the Presidential Committee on Harmony in the Health Sector. Another has been for using the sectoral Job Evaluation Report for determining the relativity of remuneration for all workers, including the broad array of professionals in the health sector, of which medical doctors are just one, even as leaders of the health team.

Before this strike NMA had gone to the extent of describing the membership of JOHESU as comprising mere “nonentities”, despite the fact that these unions and their allied professional associations include virtually every other cadre in health facilities except medical practitioners and dentists!

NMA has called for security to be provided around the hospitals so that doctors (and dentists) can work even if all other workers choose not to. Of course this is nothing but a pipe dream. A foreman is not four men. Even Lionel Messi cannot play alone as a football team. But, behind this seeming illusion lurks a grave danger; workers-baiting, on the picket line. We do hope and I am very sure the JOHESU unions are taking steps to avert any possibility of physical violence against the striking workers. But if NMA does not withdraw this provocative statement, it should be held responsible for any bloodshed at teaching hospitals gates.

In looking at this rather pitiable play of medical practitioners at being scabs, it is necessary to point out two important points.

First, the attempt by the NMA to portray itself as the poster boy for “professionalism, patient-centred care and development initiatives with positive impact on the health of Nigerians", devoid of such mundane things as strikes, "despite the fact that NMA’s several demands for best practices, strengthened public-private partnership policy and professionalism in Nigerian hospitals, as well as better working conditions for her members are yet to be attended to”, is at best a wanton display at hypocrisy. No association, union or group in the health sector has gone on strike as much as those of medical practitioners.

Second, despite the costs of these strikes by NMA as whole or resident doctors on the NARD platform, other unions and associations have given tacit support, standing along with the public in defence of the rights of doctors to struggle. It bothers on the morally criminal to now try to whip up public sentiments against the striking workers. It is the bosses who oppress all that benefit from divisions within our ranks.

Lessons and the way forward

It might be a bit early in the day to draw conclusive lessons from the strike. Trade unions as organisations that mediate the exploitation of their worker-members have a two-faced essence. They are the basic schools of workers’ in their struggle for self-emancipation, through the platform for solidarity that they are and the mobilisation for class action like this strike that carry out. But they could be limited by the ideology of collective bargaining, trying most times, as much as possible to avoid frontal confrontation with the bosses.

In the specific case of this strike that has just commenced there is great enthusiasm, both on the part of JOHESU leaders and rank and file workers to fight until victory. There is a moral sense of outrage, with the Federal Government’s disregard for the NICN’s judgment, along with a sense of vindication by the judgment itself. We might thus be in for a long drawn strike.

The unions have also resolved that their members in the state-owned general hospitals and LGAs-run primary health care members will join in a pan-sectoral sympathy strike, as an injury to one, is an injury to all. Support is also being sought from health workers’ and other trade unions across the world to put pressure on the deaf and heartless Federal Government of Nigeria, and save public healthcare delivery from collapse.

A few interim lessons can be drawn from where we are now. First is the truism that if we dare to struggle, we dare to win! The battle has been long and hard and sacrifices made in solidarity by health workers who might not be directly affected by the non-skipping of CONHESS 10, for the past two years. Workers who were already beyond CONHESS 9 or had not yet gotten to that grade level and would thus not have been immediately affected chose not to take promotion examinations until the matter was resolved.

Second is the need for us to fight with all possible means, including where necessary, the law courts. The ruling of the NICN has become a just plank for deepening the workers agitation for this strike. Third and very much related to this though, is that we should not rely strictly on the laws and courts of the bosses to win our rights and even beyond that, and through that to emancipate ourselves from the wage-slavery the bosses reduce us to, in their capitalist system.

As we argued a fortnight back in the Abuja Workers’ Socialist Bulletin:

“As workers, we must however realize that when we win one victory from the bosses, they always find new ways to further our exploitation. While we must continue to fight to win concessions, we have to realize that the final answer to end this oppressive exploitation is for us to change the system. Capitalism rests on our bent backs. To win our emancipation, we have to mobilize from below, stand straight and replace this evil system with socialism, based on the most democratic form of government i.e. a government of workers and the poor.”

Finally, this brings us to a very critical issue. There is a strong connection between the recent and still ongoing spate of strikes in the education sector and that which is now unfolding in the health sector. This goes beyond the government’s patent flouting of agreements reached and in this telling case, a court order to boot.

On one hand it is part of the general flood of workers resistance to the general crisis of capitalism which we are witnessing. On the other hand, when we spend a minute to recall that these two sectors provide the primary social services in society, we cannot but see the unmasked attack of the bosses on those public services that could in anyway hold some iota of hope for the hopeless poor. Underfunding of social services and short changing the public servants that render them are characteristic elements of capitalism’s neoliberal order, which we must fight and break.

It is “morning yet on creation day”, once again. The need for uniting the resistance of working people in strikes spreading across, virtually all sectors of working life, cannot be overemphasized. The workers united cannot be defeated. The Nigeria Labour Congress, Trade Union Congress, and radical civil society organisations need to go beyond episodic battles, waging an all out class war, to change the system. There will be turns and twists in the way forward, but there can be no hope for a better society under the watch of the bosses ruining the lives of the working poor, whose toil creates the wealth they lavish. Enough is enough!

A luta continua!! Victoria ascerta!!!