VZCZCXRO4999
PP RUEHMA RUEHPA
DE RUEHUJA #0489/01 0731220
ZNR UUUUU ZZH
P 141220Z MAR 07
FM AMEMBASSY ABUJA
TO RUEHC/SECSTATE WASHDC PRIORITY 8854
INFO RUEHZK/ECOWAS COLLECTIVE
RUEHWR/AMEMBASSY WARSAW 0165
RUEHCD/AMCONSUL CIUDAD JUAREZ 0163
RUEHOS/AMCONSUL LAGOS 6324
RHEBAAA/DEPT OF ENERGY WASHINGTON DC
RUEHC/DEPT OF LABOR WASHDC
RHEHNSC/NSC WASHINGTON DC
RUEAIIA/CIA WASHINGTON DC
RUEKDIA/DIA WASHDC
RHMFISS/HQ USEUCOM VAIHINGEN GE
RUFOADA/JAC MOLESWORTH RAF MOLESWORTH UK

UNCLAS SECTION 01 OF 02 ABUJA 000489 
 
SIPDIS 
 
SIPDIS 
 
DEPT FOR DRL, AF/W 
DOL FOR SUDHA DALEY 
DOE FOR CAROLYN GAY 
 
E.O. 12958: N/A 
TAGS: PGOV ELAB SOCI TBIO NI
SUBJECT: NIGERIA: DOCTORS' STRIKE HIGHLIGHTS HEALTH SECTOR 
DISCONTENT 
 
 
ABUJA 00000489  001.2 OF 002 
 
 
¶1. (SBU) SUMMARY.  Doctors at Nigeria's public hospitals 
initiated a two-day warning strike on March 5 to protest 
eroding pay and benefits under a newly enacted salary 
structure.  The new structure fixes rates for previously 
percentage-based allowances and calculates taxes on the gross 
rather than pre-allowance salary.  The doctors have acted 
alone, through the Nigerian Medical Association, rather than 
through the Medical and Health Workers' Union of Nigeria 
(MHWUN) both to bypass legal requirements for a strike and 
because the union, which represents all health workers, lacks 
consensus on the doctors' concerns.  As a result, the 
doctors' negotiating position appears weak.  The strike, 
however, shines light on a deeper discontent in the 
profession.  With morale extremely low, inadequate pay and 
deteriorating facilities, Nigeria is experiencing a shortage 
of doctors as large numbers leave in search of better jobs. 
END SUMMARY. 
 
THE STRIKE OVER ERODING BENEFITS 
-------------------------------- 
 
¶2. (SBU) On March 5, doctors at Nigeria's public hospitals 
initiated a two-day "warning" strike over eroding pay and 
benefits under the newly enacted Consolidated Tertiary 
Institutions Salary Structure (CONTISS).  The two-day strike 
followed a February 27 work-to-rule strike, in which 
employees follow rules to the letter, thereby slowing down 
operations.  Under CONTISS, on-call and hazard allowances are 
a fixed amount, as opposed to a percentage of base pay under 
the old system.  In addition, the pool of specialists 
eligible for supplemental pay as honorary consultants was 
narrowed considerably.  The new structure also changes how 
taxes are calculated, with allowances and pension fund 
payments calculated before taxes rather than after, as used 
to be the case.  CONTISS was meant to monetize in-kind 
benefits, but Nigerian doctors argue that the cookie-cutter 
approach which lumps their pay and benefits with those of 
university staff and other non-medical personnel is 
unacceptable. 
 
¶3. (SBU) CONTISS was instituted by the National Salary 
Structure Commission (NSSC), apparently without input from 
the Ministry of Labor or the Ministry of Health.  Deputy 
Secretary General E.H.(Dayo) Tinuosho of the Medical and 
 
SIPDIS 
Health Workers' Union of Nigeria (MHWUN) told Poloff the NSSC 
did not seek advice from other ministries, nor from the 
union.  The Ministry of Health has set up a Technical 
Committee to look into the issue.  Tinuosho told Poloff that 
the strikes were initiated by the Nigerian Medical 
Association (NMA) and not by the NHWUN because the Nigerian 
Labor Law requires unions to pursue arbitration through the 
Ministry of Labor before initiating a strike.  As an 
association, the NMA was able to work around this legal 
requirement.  Tinuosho said the MHWUN, while it agreed with 
some of the doctors' complaints, represented a wider group of 
health professionals, many of whom resented the allowances 
and higher wages paid to doctors.  The union as a whole has 
raised concerns with the GON regarding the salary structure, 
including double payments into the pension fund (withheld by 
the GON and by the employing hospital), taxation of pension 
fund payments, and the absence of a formal gratuity policy. 
(NOTE: Tinuosho later told Poloff that NMA members had failed 
to show at a March 13 union meeting called to discuss pay 
structure concerns.  END NOTE.) 
 
¶4. (SBU) COMMENT.  While the initiation of the strike by the 
NMA succeeded in working around the Labor Law restriction, it 
has also created a weak negotiating position for the doctors. 
 The NMA is not equipped with a permanent staff nor with 
labor lawyers proficient in collective bargaining.  While 
sympathetic to the doctors' complaints, Nigerian press has 
highlighted the negative impact on patients, with some turned 
away from local hospitals and the overall quality of care 
clearly impacted.  The choice to go it alone without waiting 
for a consensus among their union compatriots and the growing 
public concern over the impact of the strikes may further 
undermine the doctors' position.  END COMMENT. 
 
ABUJA 00000489  002.2 OF 002 
 
 
 
DEEPER DISCONTENT IN MEDICAL SECTOR 
----------------------------------- 
 
¶5. (SBU) The strike over the CONTISS system shines a light on 
deeper problems in the medical profession.  Nearly all 
hospitals in Nigeria are state run and the maximum attainable 
salary level (for the highest ranking and most senior 
doctors) is just over 3.5 million Naira (28,000 USD) per 
year.  According to Tinuosho, Nigeria has more than enough 
medical students (owing largely to the prominent status given 
to doctors), but the country has a shortage of skilled 
doctors because large numbers immigrate upon graduation. 
Tinuosho said the problem is particularly acute in the North, 
because fewer students attend medical schools and southern 
doctors are unwilling to relocate because of ethnic and 
religious prejudices.  Rural areas are hit particularly hard. 
 Nearly all rural medical care is provided by community 
health practitioners -- primary care practitioners who are 
meant to act only as a referral point to doctors or more 
specialized care. 
 
¶6. (SBU) Tinuosho and MHWUN Secretary General Dr. Marcus 
Omokhuale shared with Poloff that morale in the Nigerian 
medical sector is extremely low.  Aside from poor pay and 
deteriorating facilities, both pointed to recent medevacs of 
prominent political figures as contributing to the poor 
public perception of Nigerian health care and the declining 
morale in the sector.  They insisted that public health 
facilities in Nigeria, and especially in Abuja and Lagos, 
were perfectly capable of dealing with the relatively minor 
issues for which prominent Nigerians often sought treatment 
overseas.  The issue, they maintained, had become one of 
prominence and prestige -- if an individual is important, he 
feels he should travel abroad for health care.  The union and 
the NMA have both called publicly for an end to the use of 
government funds to pay for medevac expenses. 
FUREY