Conflict management among health workers in Nigeria

Introduction

Colonialism brought industrialization with a new pattern of work which involves wage employment. Wage employment is the situation whereby an individual, exchanges his God given labour power for money to sustain himself and his family. This is emergence of a new work relationship which is unequal. In the pre-colonial era, there were no paid jobs even though Africans were hardworking and believed in the dignity of labour (Eniola, 2002).

They were all self-employed, employing family members in their jobs. This industrialization with a new pattern of work which involved wages employment brought by the colonials revealed that the employer owns the means of production and dictate whom to employ and how much he pays them. This situation unfold to employ the need for him to combine with other workers in the struggle for improve conditions, hence, the need for industrial relationship industrial relationship is defined as the interrelationship that occurred in the work place between the employers and the employees. The relationship equalize the power in balance, the more numerous powerful employees have to constitute themselves into a trade union (Adeogun, 2001).

In addition, management is interested in more production to maximize profit, while workers are primarily working for economic reason. They prefer to less work for more wages. The fragile cooperation that exists in the work place is due to the fact that both parties cannot afford to see the death of the Organization, because they all depend on it for their sustenance and survival. For the survival of the organization, much harmony needs to sustain through the process of industrial relation.

Conceptual framework

So many authors and researchers have written on the subject matter, conflict management among health workers in Nigeria. Conflict according to a Student Standard Dictionary is disagreement between two or more people or a state of disorder and unpleasant relationship among people

By quality standard reason, effective health management demand reliance on team approached with involved health professionals and non-professionals both group contributing significantly to the goals for quality health for Nigeria patients. The Health professional team includes:

• Health record officers
• Medical doctors
• Medical laboratory
• Pharmacists
• Radiographers,
• Nurses
• Physiotherapists, etc.

Going by composition of the health team, it goes without saying that no single profession can claim the monopoly of knowledge, skill, expertise for health care system in Diaspora especially in a third world nation. A team is made up of a people brought together permanently or ad-hoc to achieve a goal.

The effective health team are:

• Definite goal setting
• Collective planning and execution of goal
• Leadership style
• Monitoring and result
• Feeling of employers and employees (Justice, 2005)

According to a paper presented at a discourse organized by the Nigeria union of pharmacists, medical technologies and professionals allies to medicine (NUPMTPAM) OAUTHC unit, Ile-Ife on Tuesday, 6th December by Comrade S. B. Olanisebe, National president NUPMTPAM in 1994 and 1996 respectively when the issue of circular I that elaborate on the differential salary structures and harmonies allowances and prerequisites respectively led to palpable demoralization among health workers. The situation actually resulted in intra and inter personal and professional ill-feeling bordering on malignant conflicts which led to the sporadic industrial action of April/May, 1996, involving the combined forces of all health workers in Nigeria except the medical doctor who appeared to have accepted the offer in circular 1, the employers of health professionals in Nigeria up to date with the supposed robust team which is sinequanon for total quality health care for all in the year 2000 and beyond (Yusufu, 2002).

A paper titled current industrial relations practice among health workers in health institutions what it is wrong with it? By M. O. Ogundipe, OAUTHC, Ile-Ife discussed the tinder listed subheadings:

 Wages and salaries administration

This is a very important aspect of industrial relations. The worker is in the employment basically to earn his living. The salary he earns is very important to him, since apart from determining his standard of living, also dictate his social status.

Also, to the employer, the quality and the quantity of work done by his employee (i.e. the workers productivity) is important and should be at the lowest possible, it is therefore very important for waged and salaries administration to employ their specialized knowledge to relate work done and other factor to salaries paid (Alpalla, 2004).

In Nigeria, the salary and wages commission is supposed to be saddled with this responsibility but it is obvious it is not doing this effectively.

Industrial relation practice

Industrial relation practice deals with the mode of achieving maximum welfare for members by unions and unhindered activities (production) of the industry or establishments. It is better done without friction or conflict. To achieve this, experience in business practice, administration and labour laws are brought into play. Union leaders and managers therefore need to be versed in negotiation act and trade union laws.

According to Eniola (2002), in order to avoid friction, the scientific approach to industrial harmony will involve consultation, discussion and concession. The general principle of industrial relation recognizes the right of both the employer and the worker to negotiate the terms of employment. This is currently done by collective bargaining.

Essential service

The Trade Dispute Act 1976 schedule 1 sub-section 2 includes workers in the hospitals as those partaking in essential services. Also, the trade dispute (essential service). Act 1976, section 1 sub-section 1a states that:

1. If the head of the federal government is satisfied that trade union or association, any of the members of which are employed in essential services.
   • Is or have been engage in acts calculated to disrupt the smooth running of any essential services or (b) he may by order publish in the gazette prescribed the union or association (hereafter referred •to as the prescribed organized) and prescribed organization shall be from the date of the order cease top exist section (1a) sub-section (2b) stipulated a fine of N2,000.00 or 6 months imprisonment or both the official or any other found guilt under this act (Justice, 2005).

The health care institutions

The health institution is divided into three tiers, which includes primary, secondary and tertiary health care instructions. The tertiary health care institution is basically for teaching research and services, and it consists of the teaching hospitals and specialist hospitals. The tertiary health care institution is one of the most important providers of essential service. Being the apex health care delivery system, it requires highly skilled professionals who should be well motivated and remunerated to render cost effective interrupted services to patients that must be constantly supported without obstruction (Adedibu, 2006).

They also provide prevention and rehabilitation services. The primary healthcare system treats minor ailments and refers services. While the secondary healthcare institution consist the central hospital and general hospital that render services like curative and rehabilitation.

Historical review of trade union in Nigeria

Early in the century, a number of trade unions grew up around the only establishment in existence then. Thus, as would be expected, the civil service union was one of the very early to come into existence in 1912.

At that time however, those who form these union did not appear to understand the purpose of trade unionism. Dr. T. M. Yusuf suggested that the main reason for the formation of the civil unions was merely to match the existence of such union elsewhere, for instance, in Sierra Leone it was not until after some time that the union’s aim was spelt out to promote the interest and welfare of native members of the civil service (Adams, 2002).

Other union came to existence following the civil services union. The laying of the railway line from Lagos to the north gave rise to a workers union which was named the Nigeria Railway Native Union 1919. Among the union which came into existence at that time, were the Nigeria Mechanic Union, the Railway Loco Drivers Union, and some employers union which includes the motor transport union. These were formed in 1931 by the Railway Workers Union and the Nigeria Union of Teachers. The aims of these unions were to obtain a better condition of employment for their members.

Conflict

The chief medical official was regarded as the head of the hospital’s administration set up, but the actual administrative cum executive power lies with the head of administration (warding) who seemed to be enjoying the exercise of executive control.

Furthermore the head of administration could not exercise executive directive, it became difficult and resulted in a situation where the medical officer gave counter directives, a kind of power conflict. In one of the occasions where there were industrial unrest by the doctors, there was an incident when a ,motorcycle operator who had an accident and was rushed to the hospital or treatment, the young man died because there was no doctor available who could give or provide immediate attention and treatment to the man. This situation infuriated the motorcycle riders who mobilized themselves in large numbers to the hospital premises beating and arising all the hospital workers and as a result a surgeon and other hospital workers were arrested and put behind bars for some days by the police. This situation further compounded the misunderstanding between the doctors and the hospital management.

Conflict among health workers in Nigeria

The number of strike action in health institutions from 1990 to date outnumber the total number of strike action from the inception the health institutions up to 1990, despite all the labour regulation quoted earlier. This is so because of the economic hardship brought by government policies. And in sincerity on the part of Government which multiplied during the Late Sani Abacha regime

Any Government that has no respect for the rule of law is calling for anarchy, and this is the situation in the health institution in particular and the Nigeria labour industry in general (Shonekon, 1999). The Babangida government set up the Justice Fatayi William’s panel on 26th July 1990 with the following terms.

1. To look into all matters relating to remuneration Doctors generally.
2. To make recommendation including the or otherwise of Medical Service Scale (MSS) for Doctors
3. To make recommendation likely to enhance the job satisfaction and the professional fulfilment of Doctors. Dr. (Mrs.) Y.A. Thope, a consultant in the hospital services and training department of the federal ministry of health was appointed secretary to the committee.

According to Onocode who happen to be a member of the committee has to say “we have recommended that the university teaching hospitals and other research institutes should be category ‘B’ of our classification of parastatals. Although,, the term of reference of our commission specifically exclude the universities, we have put them in the same category because we believe that the staff of university teaching hospitals and research institutes should enjoy essentially the same conditions of services as those applicable to university staff.

The problem of the institution became so worrisome that between 6th and 9th September 1995, the federal ministry of health under Dr. I. C. Madubkie convene a National Health Summit at Abuja where many professional bodies and interested parties convene to look at the problems of inter-professional conflict resolution in health sector.

So the secular 1/1991 was identified as one major cause of the inter-professional conflict and it was resolved that effort should be made to involve all the professional bodies to such negotiation in the future. Between December 1998 and May 1999 alone, the National Association of Resident Doctors went on strike three times for non-payment of equitable allowance and other issues following the implementation of the Abubakar package.

This is the current trend on conflict among health workers in Nigeria and both the patients and the general populace have lost confidence in this all importance humanitarian services.

Causes of conflict

In the Nigeria context, conflict occur in health management once the leadership and feelings of workers go sour, leading to disequilibrium in the intra and inter professional relationship:

Precipitating factors for conflict among health workers includes:

1. Nigeria factor “settlement syndrome” among the union leaders selfishness within the work force.
2. Ignorance of employers on trade union education, relevant and setting.
3. Poor working environment and setting.
4. Inadequate or lack of equipment or logistics.
5. Domineering leadership (autocratic, resisting change etc.)
6. Tribalism and clash of interest among workers.
7. Lack of common interest and purpose among the professionals.
8. Encroachment into others responsibilities
9. Differential and professional salaries and allowances to a group with total disregard for other members of the health team (Adeogun, 2001)

Effect of conflicts

The unpalatable side of industrial relations, and one which the public often associates union with is the industrial action. This indicates a breakdown of cordial relationship between labour and management. The significant effects of industrial action in the health institutions may be very worrisome because it often leads to a chain of events within the hospitals and other establishment around the hospitals.

One of the negative effects of action in the tertiary health institutions is that suppliers to the hospitals would have to curtail or suspend operation, while chemist/supermarkets, food sellers, health service vehicles, petty traders around the hospital whose business activities depend on the hospital have to curtail or suspend their operations (Yusufu, 2002).

On the side of management, the effect of strike is in terms of deprivation of hospital services to the community, risks and threat to security of lives and properties within the hospital throughout the strike action.

References

Adedibu, O. (2006). Disharmony among Health Workers: A paper presented at a discourse organized by the NUMPMTPAM, OAUTHC Unit, Ile-Ife.

Adeleke, D. R. (2004). The Role of Training and Development in Enhancing Corporate Growth and survival. Journal of the Institute of Personnel Management of Nigeria.

Adeogun, A. A. (2001). Legal Framework of Industrial Relations in Nigeria. Nigeria Law Journal Vol. 3

Alpalla, A. (2004). Managing Industrial Relations in Nigeria. Enugu: Department of Management, University of Nigeria

Eniola, A. (2002). Nigeria Labour Law. P. 222.

Justice, E. O. (2005). Court Judgment Delivered on the 9^th January 1995 by Hon. Justice of the Federation.

Nwachukwu, C. C. (2009). Management Theory and Practice. African FEP Publication Ltd.

Shonekon, E. (1999). Career Structures and Condition of Service for Medical Dental Practitioners and Health Professionals.

Yusufu, T. M. (2002). An Introduction to Industrial Relation in Nigeria. London: Oxford Press.