Friday, June 27, 2008

Revisiting the medical salary scale

IN February, the National Association of Resident Doctors (NARD), one of the affiliate groups under the Nigerian Medical Association (NMA), published an article detailing the history of the agitation for a Medical Salary Scale for Nigerian doctors. This came in the wake of a one-day solidarity strike with the NMA which the Association embarked upon. What appears to have been positive strides gained since that time have been overtaken by various events - notably the unfortunate scandal that rocked the Health Ministry and led to the exit of principal officers. In the NMA also, there has since been a change of leadership with inevitable loss of momentum as the new leadership tries to settle into office.

As the NARD holds its Ordinary General Meeting from the 26th to 29th June, 2008, at the Lagos University Teaching Hospital, it is imperative that we bring to the fore of public discussion again the urgent need for a Medical Salary Scale. The prime reason why the country needs a special salary scale for doctors is evident: it is a way of stemming the brain drain. It is easy to see why Nigerian doctors flock overseas. According to the Lancet, a foremost medical journal, pay and income could be described as hygiene factors which affect motivation, performance, morale and the ability of employers to attract and retain staff. Low pay results in moonlighting, engaging in other income-earning activities, extraction of informal fees from patients, seeking per diem payments, dissatisfaction, low morale and of course migration.

In the National Health Service (UK), the annual pay package ranges from 32,000 pounds (junior hospital doctor), 40,000 to 70,000 pounds (doctors in specialist training), 80,000 to 120,000 pounds (general practitioner ) to 70,000 to 170,000 pounds (consultants) per annum. The family physician earns more than ten times his Nigerian equivalent, not factoring in the difference in purchasing power and standard of living. In the US, a resident doctor earns between 45,000 and 60,000 dollars per annum, while an attending earns between 135,000 and 300,000 dollars per year. Indeed, in some specialties, a doctor could earn up to 1 to 2 million dollars per annum.

In Canada, the doctor earns averagely over 100,000 Canadian dollars per annum. The Australian dentist earns 40,000 to 100,000 Australian dollars per annum, while for most other specialties the figure is between 90,000 to 110,000 Australian dollars per annum. In Ghana, a house officer earns between 800 to 900 US Dollars monthly; medical officers 900 to 1,100 US Dollars monthly ; senior medical officers 1,200 to 1,300 US Dollars and specialists between 1,700 to 1,900 US Dollars. The average Zambian doctor earns over 17,000 US Dollars per annum. Compare with Nigeria, where the medical officer earns averagely less than 100 US Dollars.

The struggle for a Medical Salary Scale spans over two decades. In 1988, the NMA submitted two memoranda to the Presidential Committee on Brain Drain headed by Justice Atanda Fatai Williams. These memoranda were on remuneration and training of doctors. These were re-echoed in 1990 by the then Minister for Health, Professor Olikoye Ransome-Kuti, in a memorandum to the National Council of Ministers on the introduction of new salary scales for health services personnel.

The Medical System Scale was thereafter briefly introduced in 1991 but was soon overtaken by different wage reviews. The Consolidated Tertiary Institutions Salary Scale (CONTISS) was greeted with a lot of optimism but proved to be a major disappointment. In consequence, NMA and NARD have at different times had to embark on industrial action. Whatever progress had been made was stalled in the wake of the crisis in the Health Ministry. The facts, though, bear only one interpretation: there remains no alternative to the MSS.