The Sun News

Can reps reign-in resident doctors?

One more terrifying time. The National Association of Resident Doctors (NARD) embarked on a warning strike on Monday, September 4. The strike is supposed to last for seven days. Judging by the fact that healthcare services are basically about saving lives, industrial action by healthcare professionals, especially doctors who are perched on tip of the pyramid should be a rarity. But like many strange traditions evolving from Nigeria’s arrested development, doctors dropping their stethoscopes is an ugly drama that has been staged at different times.

Doctors resorting to strikes has degenerated to the level that, from the Late Professor Babatunde Osotimehin, to Professor Onyebuchi Chukwu, and the  current minister of Health, Professor Isaac Adewole, heads of the ministry, especially post 1999 have had to contend with striking doctors. As shameful as it is, how a minister manages doctors’ strikes has become one of the yardsticks used to adjudging his tenure. 

Folks sink into despair, when resident doctors resort to strikes, as  they like many of their friends and relatives use public hospitals because they can’t afford even some of the sub-standard private hospitals. In times past, when government owned facilities operate at half capacity, due to the absence of NARD’s heady members, who constitute the largest group of doctors in our poorly equipped and funded hospitals, tragic stories of preventable deaths have been told. NARD is a powerful group among doctors. This is not just because it has become pain in the neck of the parent body of doctors, the Nigerian Medical  Association (NMA), impetuously ignoring its stringent warning to always get clearance before commencing on strike. Resident doctors are the men and women who do a high percentage of the work in secondary and tertiary health facilities. 

Owing to the integral role played by resident doctors, it’s simply  commonsense to prioritise matters that concern them and regularly invest in providing them with the best of equipment and facilities to enjoy rendering service to the people. Regrettably, the issues that these doctors are agitating for aren’t new. Chairman of the Association of Resident Doctors (ARD), Federal Neuro Psychiatric Hospital, Yaba, Lagos, Dr Kenneth Uwajeh, in justifying the current strike told Daily Sun, that the government was insensitive to the plight of doctors and patients in the country. “The strike was embarked upon since government refused to come up with meaningful resolutions. We are demanding a revitalised residency training programme, implementation of the National Health Act (NHA) and payment of arrears, among other things. The National Health Act (NHA) is all encompassing as it would ensure universal health coverage in the country and all Nigerians will be well catered for. As a doctor, when I am well equipped with training and remuneration, I will deliver better,” Uwajeh said.

On Wednesday, resident doctors met with representatives of government, trying to trash out among other issues, how owed salary shortfalls  from January 2016 to May 2017 will be paid. Predictably at the meeting which lasted for hours, the doctors forgot about NHA and the lack of equipment back in the places they work and all the issues discussed centred on money and their welfare. 

Yet, it is the dilapidated  state of our hospitals that has led to the shame of our leaders, the most recent being President Muhammadu Buhari, hobbling overseas for treatment. Sadly, no president including Buhari who promised change has been embarrassed enough to invest in upgrading our hospitals or domesticating the Abuja declaration made by African heads of government to allocate 15 percent of countries annual budget to health or even simply implement the NHA.

The rash of meetings including the one held on Wednesday is an improvement on government’s response to NARD’s warning strike.  The initial reactions from the Federal Government were deplorable, with the Labour and Employment minister, Dr. Chris Ngige, already beleaguered by the Academic Staff Union of Universities (ASUU) strike, describing as rascally,  the action taken by his younger colleagues. His description is a first among labour ministers, who fret at NARD downing tools. Ngige’s explanation that Vice-President Yemi Osinbajo took over negotiations was debunked, leading to another disgraceful first in Federal Government’s handling of the trade dispute. Professor. Adewole’s reaction to strikes by resident doctors is hardly commendable.

The minister’s response to resident doctors’ strike in 2016, which was the unsustainable threat to sack and replace all of NARD members and his directive to Chief Medical Directors (CMDs) on Tuesday, that doctors be employed on temporary basis as replacements for the striking doctors are uninspiring and a case of grandstanding taken too far. It is disheartening that Adewole, despite being a former national president of NARD didn’t take the initiative of ensuring that age long problems, which doctors list as reasons for going on strikes  are fully resolved.

Matters of training and owed arrears can be resolved. But truth must be told that these issues cannot be dealt with only by lengthy negotiations and pleading with doctors to resume work. This much the Speaker of House of Representatives,  Yakubu Dogara may have learnt. Dogara in 2016 waded into the crisis, setting up a reconciliatory meeting that had in attendance, the Ministry of Health, NMA , NARD and the Ministry of Labour and Employment. During the meeting, the Speaker implored doctors not to allow their decisions to be defined by the issues that brought them to the negotiation table, but rather, to find solutions and a year later, the same association  is on strike.

The good news is that Dogara can lead the House to rein-in resident doctors, this time around by seeing to the passage of the Bill for an Act to Regulate Medical Training Programme in Nigeria and Other Related Matters, sponsored by the chairperson of the House Committee on Health Institutions, Betty Apiafi. The bill was passed for second reading during  plenary on Thursday March 30. Speaker Dogara presided over plenary on the day. The bill takes care of knotty issues, providing a legal framework for the entry requirements, the tenure of Part I and Part 2 of the residency training programme, sponsorship of the programme through budgetary allocations as well as internal funding from training institutions and an exit process for doctors who have completed or failed to complete the programme.

In her lead debate on the bill, Apiafi who was part of the Speaker’s team to last year’s meeting with doctors, said a law regulating the residency programme was long overdue. She traced re-occurring strikes by NARD and its local chapters to the frustration of doctors, arising from the many challenges they are confronted with during the residency programme. Before the National Assembly went on annual vacation, Apaifi presented the report on the bill, having conducted a public hearing, which saw key stakeholders backing the bill.

It wouldn’t amount to asking for too much, if the Speaker and his Health Institutions Committee  counterpart ensure the bill is listed on the Order Paper on the day of resumption, Tuesday September 19 and a motion is raised  for it to be read a third time on the same day. All these can be done, so that the bill is debated and passed in one day. Seeing how devastating doctors’ strike have been, Dogara also can push for quick concurrence in the Senate and still go a step further by exploiting his closeness to President Buhari to get the bill signed into law.

Again, I say this is not too much of an ask for a Dogara who sells himself as a selfless statesman and the House of Representatives as the the people’s House.


Enhancing financial system stability

At the 2017 Nigerian Bar Association (NBA) conference, the Governor, Central Bank of Nigeria (CBN), Godwin  Emefiele  notably remarked that the Financial Services Regulation Committee, led by the CBN was structuring a robust financial framework that would adequately promote stability in Nigeria’s financial system.

Considering the key importance of the financial system in driving economic growth vis-a-vis the fast complex systemic interactions in a globalized economy, the development is a laudable demonstration of strategic sensitivity.

Strategic sensitivity, according to  Yves Doz, Professor of Strategy at INSEAD, ‘‘is the sharpness of perception and attention. It is the capabilities for continuous changes and seeing and framing opportunities in insightful ways.’’ It is one of the components or enabling capabilities of the modern concept of fast strategy.

Financial system instability is detrimental to the economy and is caused by multiple factors with complex dynamics such as, global imbalances, market liberalization, under regulation/supervision, poor macroeconomic policies, poor corporate governance, insufficient transparency, moral hazards and irrational exuberance.

Other factors include, liquidity mismatch, non-performing loans, fall in asset prices, equity markets, detrimental exchange rate regimes , complex risks, such as credit risk, interest rate risk, exchange rate risk and contagion, and information asymmetries. The power of information in driving growth in the financial system is immense. Reports show that banking crisis occur on average once every 20 to 25 years and that the annual probability of a crisis is 4-5 per cent, and that higher capital base and liquidity requirements reduce rate of failure. 

It is the duty of central banks worldwide to ensure financial system stability but regulatory agencies around the world became more strategically sensitive in the aftermath of the 2008-2009 global financial crisis. They have become more concerned about the architecture of international financial system and more  alert to recognize changes in the global terrain and act fast as appropriate.  The domino effect of the crisis around the world brought to the fore the pitfall of globalization which has  broken down geographical barriers and presents a common platform for the operation of unequal partners(advanced and developing economies).

Globalization heightened competition among markets and economies, and with the changing perspectives, it harbours potential threats capable of triggering systemic crisis, thus the need for regulatory agencies to be agile and innovative.

As Harvard economist, Dani Rodrik, noted, ‘‘the expansion of globalization and free movement of capital flows are the reasons why economic crisis have become more frequent in both developing and advanced economies alike.’’

CBN places financial system stability  on the front burner, and as Emefiele remarked,  ‘‘the 2008-2009 global financial crisis necessitated the development of adequate framework and appropriate tools for managing financial stability, particularly macro-prudential and micro-prudential policies and crisis management conundrum.’’  In his maiden press briefing, the apex bank governor noted that the core of his vision was to effectively manage potential threats to financial stability and create a strong governance regime that would be conducive for financial intermediation, innovative finance and inclusiveness.

He said, ‘’in this regard we hope to anchor on two main pillars: managing factors that create liquidity shocks and zero tolerance on practices that undermine the health of financial institutions.’’  Also, his predecessor, Sanusi Lamido Sanusi(now Emir of Kano), anchored his blue print on four cardinal objectives, namely, establishing financial stability, enhancing the quality of banks, ensuring banking sector contributes to the real economy and enabling solution evolution.

Earlier, prior to the 2008-2009 global financial crisis, the apex bank under Professor Chukwuma Soludo  evolved the Nigerian Financial System Strategy FSS2020 to enhance stability of the financial system. FSS2020 was strategic, futuristic and pre-emptive as it were. It fortified the banking system ahead of the 2008-2009 fiasco and largely cushioned the devastating blow  the global crisis would have dealt on the Nigerian banking system.   The policy resulted in the emergence of  25 strong banks with larger capital base from the previously existing 89 banks and 16 of the  25 new banks joined the league of the top world 100. Nigerian banks were rated by international rating agencies such as Standard and Poor’s (S&P) and Fitch for the first time, even as non-performing loans dropped from 23 per cent to 7 per cent.

But, the capital market was not as lucky.  The crisis largely contributed to the destabilization of the market because of its(the capital market) intrinsic nature and operating dynamics. Having built a bubble over time, the market got triggered which led to herding and a massive outflow of speculative funds from the market by both foreign portfolio investors and local investors which resulted in drastic fall in share prices.

In the US, the 2008-2009 global financial crisis resulted in the loss of 8.7million jobs, foreclosure of 15 million homes, collapse of some giant financial institutions hitherto considered too big to fail, and wiped out $2.8trillion savings. It led  to the evolution of the Dodd-Frank Wall Street Reform and Consumer Protection Act 2010 (Dodd-Frank Act), which aimed to prevent another financial crisis, protect consumers, rein in Wall Street and big bonuses, end bailouts and too big to fail, create sound economic foundation to grow jobs.  A robust financial system has three basic characteristics, namely flexibility, resilience and internal stability. Among other benefits, it facilitates the smooth flow of funds from surplus to deficit ends, engenders macroeconomic stability which enable businesses to plan conveniently and attracts foreign capital for the greater benefit of the economy.

Recent CBN policies on the foreign exchange market have enhanced public confidence  inflow of more foreign capital into the economy. Data from the National Bureau of Statistics show that the total investment inflows into Nigeria peaked at US$1.7923billion in Q2 2017, US$884.1million higher than  Q1 2017, representing 95 per cent increase. And the year-on-year inflow rose to 43.6 per cent from US$1,042million same period in 2016. Foreign portfolio investments was noted as the main driver of the inflows.

Arize Nwobu is a Business Journalist and Chartered Stockbroker. He wrote via [email protected] Tel 08033021230


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