Pay Parity, Equity and Equality among Healthcare Professionals: UK vs. Nigeria Example
Twines of conscience twines me like a meandering snake when I ruminate on the senseless debacle that has engulfed the Nigerian health sector for years now. Historically, the Nigerian medical doctors uses the Nigerian Medical association (NMA) or the National Association of Resident Doctors ( NARD) and other affiliates to persuade the government to either increase their wages or prevent the government from honouring agreement with other healthcare workers. Hardly has the NMA gone on strike to press for improved infrastructure or the alarming state of decay in the health sector.
Pay Parity can be defined as the state or condition of receiving equal income, allowances and/attaining equal socio-economic status. Equity is defined as the quality or state of being fair and impartial to all concerned. Equality is defined as the state of being equal, especially in status, rights, or opportunities without discriminating against others. Everyone has the right to chose the profession they deem best for themselves. . It is ones’ choice to be a medical doctor, and another to be a nurse, radiographer, laboratory scientist or physiotherapist, all working to deliver best of care to the patient. In the UK, the health sector is seen as a multi-disciplinary sector where team work is enshrined in healthcare delivery for the overall benefit of the patient
In Nigeria, the salary of most other health professional is less than 40% that of the doctors at entry point and most will need to work for about 15 years to get to the grade level of a newly qualified medical doctor. To earn the same as a newly qualified medical doctor, most healthcare workers will have to work for about 15 years, assuming they receive specialist training and promptly promoted.
Recently, other healthcare professionals in (the NHS) England got an increment based on negotiations with all their affiliate bodies without a query from the British Medical Association(BMA).When it favours the NMA, they refer to international best practices. A quick comparism of pay parity among doctors and radiographers in the UK visa-vis Nigeria will help, as follows:
In the UK (2018), basic salary for junior doctors/foundation year 1 (FY1) starts at about £26,614 rising to £76,761 (specialist medical consultant) .It takes about 19 years to progress from FY1 to specialist consultant in the UK.
Basic pay for a newly qualified radiographer / (band 5) is £23,023 rising to £62,001 (Band 8) specialist or consultant radiographer. As a radiographer, it takes about 15 years to progress from band 5 to band 8.
In the Nigeria (2018), basic salary for junior doctors (CONMESS1/GL12) starts at about N240,000 rising to about N850,000 (COMESS 9/GL 16 (specialist medical consultant) .It takes about 10 years to progress from house officer to specialist consultant in Nigeria if you pass your examinations..
Basic pay for newly qualified radiographer / (CONHESS 9/GL10) is N140,000 rising to about N500,000 (CONHESS 15) deputy director, radiography. As a radiographer, it takes about 23 years to progress from senior radiographer to deputy director if you achieve professional skills and duly promoted.
The above comparism, although confirms pay parity, but clearly contrast the huge pay gap between a newly qualified medical doctor and a newly qualified radiographer in Nigeria visa-vis their UK counterpart..
Yes, the NMA insists parity is “sarcrosant” but denies that parity has been implemented ab initio entry point for the doctors. In 2009, the federal government approved CONMESS for medical doctors and CONHESS for other professionals and workers in the sector. At the entry point, the pay disparity between the two salary structure fall short of all know international best practices for equity. This injustice was further entrenched in 2014, against the tenets of the 2009 agreement, the federal government approved an upward adjustment of CONMESS for the doctors without an equivalent upward adjustment of CONHESS for other healthcare workers.
In the UK, pay parity is implemented only at entry point and any further pay negotiation between the NHS and any trade union is implemented without the fury of BMA. Most healthcare professionals or groups can earn as much as they can clock in their hours based on service needs and skills/expertise. So you find a radiographer clock so many hours and may earn more than a specialist registrar whose services are not needed as that of the radiographer. Will Nigerian doctors allow this to happen here?.
NMA is opposed to other healthcare professionals becoming consultants working in the hospital. In the UK, a radiographer can rise to become a specialist /advanced practitioner radiographer (reporting plain x-ray, cathlab, cardiac CT, cardiac MRI, etc) or consultant radiographer ( mammographer, cathlab, ultrasound, etc). In the UK, a lot of Nigerian radiographers, nurses and midwives carry out ultrasound services but Nigerian doctors do not allow Nigerians radiographers/sonographers including those returning from the UK to practice especially in the teaching hospitals where the doctors hold court.
In the UK, all the managers/heads of departments/units of NHS radiology are radiographers, working side by side doctors/radiologists who are appointed as clinical leads. The same goes for biomedical, physiotherapy, etc including the private hospitals (BUPA, SPIRE, BMI) where even non-medical mangers hold sway.
The NMA is opposed to the appointment of other health care professional as minister of health, minister of state for health, chief medical directors, chairman medical advisory committee, heads of departments and units including department such as radiography, pathology, medical laboratory etc. In the UK ( as well as most parts of europe) , the secretary of health and chief executives of most NHS are non-doctors.
Jeremy Hunt is the current secretary of state for health and social care in the UK and holds a degree in philosophy.
I recall the uproar when prince Julius Adelusi ( a pharmacist) was appointed minister of health. The NMA fought him to a stand-still because he was “not medically” qualified to be appointed minister of health in Nigeria
The birth of JOHESU is the greatest hope of liberation of the health sector from the mundane perception that the ministry of health belongs to doctors and doctors alone. JOHESU stands for Justice (not Injustice), Order (not anarchy), Humility (not arrogance), Equity (not inequality), Service (not slavery) and Unity (not disharmony).
The NMA needs to imbibe these values in order to move the health sector forward.
The way forward is for Nigerian doctors to put their patients first, understand that the health sector is multi-disciplinary and team work is the only way forward for service delivery in the interest of the patient . At the moment, they pay lip service to team work.
The times have moved on from when every other health worker is seen as part of the doctor’s tool. The days are gone when the doctors built schools of nursing, medical laboratory and radiography awarding diplomas while doctors alone got MBBS degree from the universities. Knowledge and technological advances now demystify most skills including healthcare. Knowledge boundaries are getting thinner. Patients now demands more choices, knowledge and rights about their treatment never like before. Artificial Intelligence, telemedicine, virtual reality learning are tools knocking on everyone’s door and demands a more open approach to patient treatment.
JOHESU and other healthcare workers must demonstrate that patient is the king and the reason why everyone is in the business of healthcare. The place of the doctor as a clinical lead must be sacrosanct, as is the practice globally. Also, Doctors do not hold exclusive knowledge in human resource management and other professionals with pre-requisite knowledge and skills must be allowed to manage our health systems. Any agitation for improved condition of service of healthcare workers must have patient interest at the centre.
By Daniel Okpla Onaji
