COVID-19: Safety and welfare of Nigerian health workers, By Isaac N. Obasi

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In the last few months (May to July precisely), Nigeria has witnessed a harvest of warning strikes, threat to embark on strikes, and actual strikes, by different health workers’ unions in the health sector at both the federal and state levels of government. Regrettably, part of the reasons for the strikes or threat of it had to do with the safety and welfare of health workers in relation to the coronavirus (COVID-19) pandemic. One of the earliest threats of strike during this pandemic period, which happened in May came from the Joint Health Sector Unions (JOHESU) in the Federal Capital Territory (FCT), Abuja. 

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The particular unions under JOHESU that gave the threat to go on strike then were the Medical and Health Workers Union of Nigeria, National Union of Allied Health Professionals (a combination of pharmacists, Medical Laboratory Scientists, Physiotherapists etc), and the National Association of Nigerian Nurses and Midwives.

In as much as Nigerians were shocked that a strike could be contemplated by JOHESU under the COVID-19 situation, the reality of their safety and welfare conditions made their threat to embark on a strike understandable. Come to think of it, these people too are human beings who have families to cater for in these trying times of theirs requiring enough sacrifice.

 Since then, many strike threats, warning and actual strikes have occurred in the months of June and July in the midst of the ravaging COVID-19. But more worrisome were the happenings over the last few days and weeks. Over the weekend (Saturday, 25 July 2020) for example, there was news that the Nigerian Association of Resident Doctors (NARD) threatened to go on strike by 17 August 2020 if the Federal Government fails to meet its demands. Over the same weekend, the TVC news (25 July) carried another news report that medical doctors in Delta State were to go on a three-day warning strike. 

Just about two weeks ago (13 July 2020), medical doctors in Lagos State under the umbrella of the Medical Guild announced their intention to also embark on a three-week warning strike. Again, the Nigerian Medical Association (NMA), Ekiti State chapter, over the last weekend vowed that its members would not call off their indefinite strike until its demands are met by the government. The doctors complained about the poor welfare conditions in midst of COVID-9 challenges. And as if each state must experience a strike under COVID-19, JOHESU (Akwa Ibom State chapter) which had also been on a two-week strike, suspended it on Wednesday, 29 July 2020).

The concept of health worker is a complex one. People often think of medical doctors and nurses most of the time when safety and welfare issues are raised in the health sector, but there are many other categories of health workers. According to the World Health Organisation (WHO), health workers are classified into five categories namely health professionals, health associate professionals, personal care workers in health services, health management and support personnel, and lastly other health service providers (See https://www.who.int/hrh/statistics/Health_workers_classification.pdf?ua=1). Many of those we know are in the category of health professionals comprising medical doctors (specialist and generalist practitioners, nursing and midwifery professionals, dentists, pharmacists, physiotherapists, dieticians and nutritionists, optometrists and ophthalmic opticians, etc. 

In the category of health associate professionals are such important professionals that ‘perform technical and practical tasks to support diagnosis of illness, disease, injuries and impairments’ etc (WHO, Ibid). The list is endless and these ones mentioned suffice for our purpose. 

But what is the common denominator of risks or hazards faced by most health workers (if not all) in their daily provision of services? Again, the WHO in another document provides us the needed guidance.

According to the WHO, health workers across the world face a ‘complex variety of health and safety hazards everyday including’:

  • biological hazards, such as TB, Hepatitis, HIV/AIDS, SARS;
  • chemical hazards, such as, glutaraldehyde, ethylene oxide;
  • physical hazards, such as noise, radiation, slips trips and falls;
  • ergonomic hazards, such as heavy lifting;
  • psychosocial hazards, such as shiftwork, violence and stress;
  • fire and explosion hazards, such as using oxygen, alcohol sanitizing gels; and

electrical hazards, such as frayed electrical cords See https://www.who.int/occupational_health/topics/hcworkers/en/

Then continuing, the WHO in its advocacy aptly said:

Health-care workers (HCWs) need protection from these workplace hazards just as much as do mining or construction workers. Yet, because their job is to care for the sick and injured, HCWs are often viewed as “immune” to injury or illness. Their patients come first. They are often expected to sacrifice their own well-being for the sake of their patients. Indeed health protecting health-care workers has the added benefit to contributing to quality patient care and health system strengthening. Some of the same measures to protect patients from infections, such as adequate staffing, protect health-care workers from injury…

Unsafe working conditions contribute to health worker attrition in many countries due to work-related illness and injury and the resulting fear of health workers of occupational infection, including from HIV and Tuberculosis. The 2006 World Health Report Working Together for Health reported on a severe health workforce crisis in fifty-seven countries, most of them in Africa and Asia. Protecting the occupational health of health workers is critical to having an adequate workforce of trained and healthy health personnel.

Given all the hazards facing health workers in Nigeria, can we in all honesty say that the different levels of government are treating them well? These are people who are not just essential workers but essential workers with a difference namely people exposed to great hazards to their health while rendering services to the public. Again, some of them belong to the category of workers with scarce skills too. What this means is that issues concerning such workers need to be prioritised by the government. This explains why there is high level of brain in this sector. 

In one of our earlier articles in this column in April, we argued that under this COVID-19 pandemic, no occupational category should be given high priority more than the ones in the health sector. We argued further then that the ‘almighty’ Very Important Persons (VIPs) in our society had suddenly become Very Unimportant Persons (VUPs), as none of them could be called to confront and save us from the ravaging COVID-19 pandemic. The fear of COVID-19 in the months of March and April provided enough lessons on how to treat our health workers. But we appear to be missing this lesson.

The provision and payment of special hazard allowances to those of them in the front line of confronting the deadly virus should not be played with, and a delay in the payment of the allowances should not even be contemplated. But we do see today? All over the states, there are arrears of unpaid allowances to these people making enormous sacrifices to save lives. Again, the non-provision, or delay in the provision of all safety materials such as Personal Protective Equipment (PPE) should not be contemplated. But what we see all over the place are complaints of non-provision or delayed provision of these safety materials. This should not be so, as we need, through good planning, to prioritise the needs of the health sector.

Let it be said loud and clear that we cannot be talking about rebuilding the health system of this country, without prioritising the safety and welfare of all health workers. It is as easy and complex as that depending on how the government sees the problem of rebuilding the health sector.

Prof. Isaac N. Obasi, a public policy expert (& former columnist in the Daily Trust, Abuja, March 2003 to October 2006, & Daily Champion, Lagos, April 2005 to December 2008), is of the Department of Public Administration, University of Abuja. Email: nnamdizik@gmail.com      


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