This was even as the association said there has not been an official meeting with the government since its declaration for the protest.

NARD had on Saturday said it would embark on peaceful protests from Wednesday and picket the Federal Ministry of Health, the Office of the Head of Civil Service of the Federation, and the federal and state tertiary health institutions in the country.

NARD embarked on an indefinite strike on July 26, 2023, following the expiration of a two-week ultimatum it issued to the government to meet its demands.

The doctors are demanding the implementation of the one-for-one replacement policy for healthcare workers; the Medical and Dental Council of Nigeria to discontinue the downgrading of the membership certificate issued by the West African Postgraduate Medical and Surgical Colleges; the immediate payment of all salary arrears; the implementation of the Consolidated Medical Salary Structure; a new hazard allowance; and the domestication of the Medical Residency Training Act; among others.

Meanwhile, the FG had in a circular dated August 1, 2023, directed the Chief Medical Directors and Medical Directors in the Federal Tertiary Hospitals to implement the ‘no work, no pay’ policy on the striking members of NARD.

Speaking with our correspondent on Monday, the President of the association, Dr Emeka Orji said, “There is definitely going to be an escalation of the strike if the government does not accede to our demands by Wednesday, 10 am.

“We have mobilised our members for the nationwide protest. For those in Abuja, we will gather at the National Hospital, Abuja, and move to the secretariat of the Federal Ministry of Health. For our doctors in other states, the resident doctors will be protesting around their hospitals.”

Asked if the doctors have met with the government after the declaration of the protest, Orji said, “We have not been invited for a meeting officially. Though I am aware some government officials are making moves to call us for a meeting, but we have not received an official invitation for the meeting.”

Our correspondents, who monitored the strike in different states, however, observed that consultant medical and dental doctors, nurses, and other health workers were offering health services to cushion the effect of the strike.

But patients lament the delay in accessing care in the hospitals while some patients were discharged to seek health care in other health facilities.

NARD declared an indefinite strike on Tuesday night during its Extraordinary National Executive Council meeting in Lagos, following the failure of the Federal Government to meet its demands.

NARD had on July 5, 2023, issued a two-week ultimatum to the government to meet its demands.

The ultimatum expired on July 19, 2023.

The doctors are demanding the immediate release of the circular on one-for-one replacement of exited clinical staff in the various hospitals, immediate payment of the 2023 Medical Residency Training Fund, the commencement of payment of all salary arrears owed to our members including the 2014, and 2015, and 2016 salary arrears, hazard allowance arrears as well as arrears of the consequential adjustment of the minimum wage.

Our correspondent in Abuja reports that at the National Hospital, Abuja, patients decried delays in accessing health services.

A patient at the Surgical Out-Patient department, Nathan Isa, said he arrived at the hospital at 8 am but had not been attended to as of 10 am.

“I am not aware of the strike and I just came to the hospital this morning, only to find out that there is a strike but I hope I will be attended to before leaving,” he said.

The President of the Association of Resident Doctors at the hospital, Maruf Alao, also confirmed that his members were participating actively in the strike.

At the Federal Medical Centre, Jabi, the resident doctors complied with the national body’s directive on the total and indefinite strike.

As of 11 am, the doctors had handed over their patients to the consultants and other health workers.

At the University of Ilorin Teaching Hospital, our correspondent observed that none of the resident doctors was present in the wards of the hospital at about 11 am, leaving the patients who came for medical treatment unattended.

However, it was gathered that medical and dental consultants were attending to some critical cases.

President of the association at the hospital, Dr Mubarak Ijaiya, said, “We cannot but comply with the directive issued by the NEC that we should not perform our duties in the hospital until the government acceded to all the demands of the association.”

Similarly, resident doctors in Bayelsa State joined the indefinite strike.

the commencement of the industrial dispute forced the management of public hospitals in the state to discharge patients from their health facilities.

The chairman of NARD, Federal Medical Centre Yenagoa branch, Dr Romeo Mbooh, who confirmed the situation, said his members were participating actively in the action.

Mbooh said, “Yes, we are involved in the strike fully. They are discharging patients. Strike monitoring by our team is ongoing. We are doing what we can do while we await further directives.”

In Rivers State, our correspondent who visited the University of Port Harcourt Teaching Hospital reports that there was increased waiting time for patients.

The NARD President, UPTH chapter, Noah Ibe, said promises by the House of Representatives to look into the issues affecting resident doctors failed to resolve the impasse.

The National President of NARD, Dr Emeka Orji said, “There is no official positive response from the government regarding the doctors’ demands yet, but the strike is ongoing.”

NARD gave the ultimatum after its Extraordinary National Executive Council meeting held via Zoom on Wednesday.

President of NARD, Dr Emeka Orji, said “We are issuing a two-week ultimatum to the Federal Government to meet our demands with effect from today, Wednesday, July 5 to Friday, July 19, 2023.

“Unfortunately, none of the demands that made us embark on the five-day warning strike have been met. The government has not attended to any of them even after signing the Memorandum of Understanding. All the timelines on the demands have passed.

“The circular for one-on-one replacement was signed in the MoU that it will be released on or before June 5, 2023, and this is over a month, nothing has been done and it has not been released. The government said the payment of the 2023 Medical Residency Training Fund will be paid when the 2023 fiscal year starts, we learnt the fiscal year started last month and up till now, it has not been paid.

“If the government does not meet our demands at the end of the ultimatum on July 19, industrial harmony cannot be guaranteed and from the feelers we have, it will no longer be a warning strike, it will definitely be an indefinite strike.”

resident doctors in the country embarked on a five-day warning strike on May 17 to 21, 2023, to press home their demands.

The association had signed a Memorandum of Understanding with the government to address the issues raised by the resident doctors.

The doctors are demanding an immediate increment in the Consolidated Medical Salary Structure to the tune of 200 per cent of the current gross salary of doctors, immediate massive recruitment of clinical staff in the hospitals; immediate withdrawal of the bill seeking to compel medical and dental graduates to render five-year compulsory services in Nigeria before being granted full licences to practise; immediate infrastructural development in the hospitals with a subsequent allocation of at least 15 per cent of the budgetary provisions to health in line with the 2001 Abuja declaration.

They are also demanding the immediate massive recruitment of clinical staff in the hospitals and the abolishment of the bureaucratic limitations to the immediate replacement of doctors and Nurses who leave the system.

Other demands are the immediate payment of the 2023 MRTF in line with the agreements reached at the stakeholders’ meeting convened by the Federal Ministry of Health on February 15, 2023; among others.

The doctors are demanding an immediate increase in the Consolidated Medical Salary Structure to the tune of 200 per cent of the current gross salaries of doctors.

The doctors also want the immediate withdrawal of the bill seeking to compel medical and dental graduates to render five-year compulsory services in Nigeria before being granted full licence to practise.

They also want the immediate implementation of CONMESS, domestication of the Medical Residency Training Act, and review of hazard allowance by all the state governments, as well as private tertiary health institutions where any form of residency training is done; among other demands.

Speaking with our correspondent on Wednesday, the President of NARD, Dr Emeka Orji, said there had been no counter-offer made by the government to the doctors’ demands.

Orji said, “The ultimatum is running, and as of today, there is no counter-offer, and we are hoping that the government will step in before the end of this week.

“This fight is for Nigerians, and that is why we are not looking back. We have talked a lot since last year, but unfortunately, it is making us believe that the Nigerian government will not listen until you get to the level of escalations that will end up in disharmony, and that is where we are now.

All we hear are threats on national television, and each time they issue these threats on TV, it angers our members the more because if you are meant to be negotiating on how to resolve the issues and you are going on TV to issue threats, it means the government is not willing to find a solution to this. The threats may lead this country to another round of nationwide industrial crisis in the health sector.”

The NARD President noted that a notice of an extraordinary executive meeting of the association would be issued to its members at least three days before the end of the ultimatum.

“The meeting will focus on updating the members of our demands, if the government has responded and if their response is inadequate, then we cannot guarantee industrial harmony, but all options are on the table. If during that briefing, our members feel that nothing has been achieved, anything can happen,” he added.

According to them, the UK can only define its terms as freedom of movement is a fundamental right.

The Nigerian Medical Association and the Nigerian Association of Resident Doctors were reacting to the UK code of practice, which listed Nigeria among 54 other countries where health workers should not be actively recruited.

The UK explained that the 54 countries were those the World Health Organisation recognised as having most pressing health and care workforce-related challenges.

The UK code read in part, “Countries on the list should not be actively targeted for recruitment by health and social care employers, recruitment organisations, agencies, collaborations, or contracting bodies unless there is a government-to-government agreement in place to allow managed recruitment undertaken strictly in compliance with the terms of that agreement.

“Countries on the WHO Health Workforce Support and Safeguards list are graded red in the code. If a government-to-government agreement is put in place between a partner country, which restricts recruiting organisations to the terms of the agreement, the country is added to the amber list.”

Reacting to the restriction, the NMA President, Dr Uche Ojinmah, in an interview with The PUNCH said Nigerian doctors migrate to other countries because they are poorly treated by the government.

“I don’t actually begrudge the UK for recruiting Nigerian doctors because it’s the poor treatment they are getting from Nigeria that’s pushing them away. If the Nigerian government and people place a premium on Nigerians, they obviously won’t migrate.

“It is okay that the UK is placing us on the lower rungs for recruitment but what about the United States of America, Canada, Grenada, Kingdom of Saudi Arabia, Oman, Qatar, Kuwait, South Africa, Germany, etc?

“Nobody can take away the freedom of movement; it’s a fundamental right. They can only define the terms,” Ojinmah said.

Also, the President of the Nigerian Association of Resident Doctors, Dr Emeka Orji, said doctors can go to other countries to practise the profession.

Orji said, “The truth is that it is not only the UK that Nigerian health workers go to and even with this list, it only means that they will not only be headhunting our health workers. So, that doesn’t mean people can’t apply to work in the UK.”

The NMA president also said the restriction might not be unconnected with the Federal Government’s move to curb the brain drain in the country.

“I know that last year, the MDCN Registrar went to the GMC and the report we got that time was that they discussed how to mitigate the effect of brain drain in Nigeria.

This is purely speculative but we believe this was part of what was discussed. We can’t confirm that but it is possible,” Ojinmah added.

Some officials of the Medical and Dental Council of Nigeria had, in October 2022, visited the General Medical Council Office in Manchester, UK.

The officials of the MDCN on the visit were its Chairman, Prof Abba Waziri; Registrar, Dr Tajudeen Sanusi, and the Head of Department, Registration, Dr Henry Okwukenye.

The General Medical Council is a public body that maintains the official register of medical practitioners within the United Kingdom.

Parts of the tweet on MDCN’s Twitter handle @MDCNOfficial on the GMC’s visit read, “We had a lot of useful discussions amongst which is the possibility of the UK government to repatriate some funds in line with global health initiatives from Nigerian doctors who were trained with tax payers’ funds.

“Discussion around stemming the tide of brain drain also took place.”

The restriction by the UK comes amid a bill in the House of Representatives seeking to impose a five-year compulsory service on doctors as a condition to grant them full practice licence upon graduation.

The NARD’s President added that, “It’s possible the Nigerian government pushed for this (the restriction) but we have not seen any official release to that effect.”

He called on the Federal Government to improve the working condition of health workers and fund the health sector in order to discourage migration.

He explained, “The government is now complaining that there is a brain drain but we have always known this and we have been talking about it. What is now expected is that government should increase the production capacity so that even when these foreign countries come for the doctors, nurses, and other health workers, you will turn it to an advantage, improve on training, infrastructure, improve your personnel and fund health, so that you will not be complaining to foreign countries to stop encroaching on your medical workforce. What you should be doing is encouraging it as long as you have enough. That is what India did.”

The PUNCH reports that there are currently 11,055 Nigerian-trained doctors in the UK, based on statistics obtained from the GMC.

Nigeria has the third highest number of foreign doctors working in the UK after India, and Pakistan.

Apart from Nigeria, some other countries placed by the UK on the red list of ‘No active recruitment’ are Afghanistan, Angola, Bangladesh, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Comoros, Congo, Democratic Republic of Congo, Côte d’Ivoire, Djibouti, Equatorial Guinea, Eritrea, Ethiopia, Gabon, The Gambia, Ghana, Guinea, Guinea-Bissau, Haiti, Kiribati, Lao People’s Democratic Republic, Lesotho, Liberia.

In a communique signed by NARD’s president, Dr Emeka Innocent Orji, and released after its national executive council (NEC) meeting in Uyo, Akwa-Ibom State, on Sunday, January 29, the Federal Ministry of Health was enjoined to expedite action on the ‘one-for-one policy’ to address the brain drain in the country.

the meeting, among other things, will address issues revolving around a decision on industrial action regarding the doctors’ demands and the welfare of the association.

The Association of Resident Doctors will host the five-day meeting, which will take place at the University of Uyo Teaching Hospital, Uyo, Akwa-Ibom State, and will end on Saturday.

A copy of the notice of meeting dated January 3, 2023, signed by its Secretary General, Dr Kelechi Chikezie, obtained by our correspondent, showed that the meeting is in accordance with Article 8(4)(b)(i) of the reviewed 2019 NARD constitution.

The association’s President, Dr Emeka Orji, in an interview on Monday, said, “We have a lot of issues we will be discussing, but topping them are welfare issues and how to improve the health sector in Nigeria.

“Of course, the decision to embark on a strike will be discussed.”

The National Officers Committee, which comprises the national executives, will meet on Friday and decide whether to embark on an industrial action or not.

“The decision to go on strike will be made on Friday, and we will be holding a press briefing on Saturday regarding our decision from the meeting we had,” Orji added.

the association had earlier petitioned the Minister of Health, Dr Osagie Ehanire, about unresolved issues affecting its members.

The NARD said if the issues were not resolved before its January NEC meeting, the doctors may embark on a nationwide strike.

The resident doctors stated in a letter dated January 5, 2023, that the association had issued an ultimatum to the Federal Government six months earlier due to lingering unresolved issues affecting its members.

The doctors noted that the lingering unresolved issues include the irregularities in the new circular on the upward review of the Medical Residency Training Fund, the outstanding payment of the arrears of the new hazard allowance, and the non-payment of the skipping arrears for 2014, 2015, and 2016.

Other issues are the non-payment of the consequential adjustment of the minimum wage to some of our members and the delay in the upward review of the Consolidated Medical Salary Structure, among others.

The revelation comes as the association expressed worries over government’s ‘nonchalant attitudes to members’ salaries, welfare and other deserved packages,” Vanguard reports.

NARD revealed that Nigeria had already lost 2,000 doctors to the other countries in the last two years and that Nigeria was well short of WHO’s recommended ratio of one doctor to 600 patients.

Although he admitted that mobility of labour was recognized anywhere in the world, he, however, said there were several reasons people can decide to leave their countries or migrate to other places, tasking government to find out the reasons and address them.

“Mobility of labour is recognized anywhere in the world.” NARD president, Dr Emeka Orji, told the publication on Sunday, November 27.There are several reasons why people can decide to leave their counties or migrate to other places even to move from one state to the other in the same country to work ranging from welfare services, remuneration,working condition, security and other social issues.And what government should do is to try to find out why and then address it.

That is what a serious government does, because the truth is that it is really a very serious problem in the health sector as we speak and we believe it is an emergency and that if nothing is done urgently to arrest the drift, we would come to a stage where we won’t have doctors in our hospitals.Over the past two years or so,we have lost over 2,000 doctors to an outside world and on average,we have lost between 100 to 160 doctors every month. We are not just talking about the low-level staff here,we are talking about the highly specialized doctors leaving the country.

And when you undertake studies to know why they are leaving, 80 percent of them responded that it is because of poor remuneration

“The salary structure we are using now came into being in 2009. That is over 13 years ago and part of the agreement we had with government then was that it should be reviewed after five years.

“And that five years was in 2014. Till now, we have been writing for it to be reviewed but we have not made any significant headway on that.

“You know the living conditions in 2009 compared to now with regards to inflation, dollar exchange rate and all that.

“As a matter of fact, somebody like me; I’m a senior registrar, but what I was paid in 2009 as a house officer, if you will get the dollar equivalent, you would realize that it was even more than what I’m being paid now.o there is nobody that will see that kind of thing and stay back, especially seeing a place where your work is better appreciated, that won’t be tempted to go there.As I’m talking to you now, we have found out that over 4,000 of our members have decided to migrate within the shortest possible time.And if that happens, I can assure you that it would be a disaster. It will lead to poor patient management and difficulty in assessing health care.Patients will have long clinic hours such that a patient that should ordinarily see a doctor within one hour can spend the whole day, because if you have one doctor attending to more patients than he should, of course, he won’t give in his best and even the patient would have to wait much longer to be attended to.The approved doctor-to-patient ratio by the World Health Organisation, WHO, is one to 600. That is one doctor to 600 patients.But currently in Nigeria, we are doing one doctor to 10,000. You can see the huge gap and it would continue to worsen if government doesn’t don’t do the right thing.”

The Publicity Secretary of NARD, Dr. Yusuf Alfa, disclosed this in an interview with our correspondent.

The resident doctors had on July 30, 2022, issued a two-week ultimatum to the Federal Government to implement all the agreements it had with the association or it will embark on an indefinite strike.

The doctors are asking the Federal Government to expedite action on the payment of the newly reviewed Medical Residency Training Fund to enable its members to meet up with the closing date of examination registration as advertised by the National Postgraduate Medical College of Nigeria.

They are also demanding the immediate implementation and payment of the new hazard allowance and arrears as contained in the circular from the National Salaries, Income and Wages Commission.

NARD is seeking the payment of the skipping arrears for 2014, 2015, and 2016 to deserving members; the immediate payment of consequential adjustment of the minimum wage to members who have been deprived since it was implemented several years ago.

Other demands include an immediate review of the Consolidated Medical Salary Structure and other related allowances given the current economic situation in the country; payment of salary arrears for doctors in Abia (26 months), Imo (10 months), Ondo (five months), Ekiti (three months), and Gombe (two months) states; among others.

Meanwhile, Dr. Alfa told The PUNCH that the association is meeting with government officials regarding its demands.

He said, “We are meeting with government officials but not directly a round-table discussion that involves everybody. We are meeting government officials as regards how to solve the issues before the expiration of the ultimatum.

“So far, so good, we are getting some positive responses from those we are meeting but it has not transmitted to what we want. On the state governors owing our members months of salaries, some of them promised to pay part of it but nothing has been done.

“As regards the hazard allowance, and Medical Residency Training Fund, there is some progress being made even though it’s slow but we will hope that all of these are resolved before the expiration of our ultimatum.

“We have gotten some circulars regarding the MRTF but the monetary aspect of it is yet to come. For the hazard allowance, the process is ongoing but we have not seen anything regarding the payment yet.”

Our correspondent contacted the Minister of Health, Dr. Osagie Ehanire, for comments, but he did not respond to calls or the text message sent to him as of the time of filing this report.

Recall that the doctors, in August, embarked on strike following a disagreement with the Federal Government over the non-availability of medical equipment at public tertiary hospitals.

In a communique signed by the Nigerian Medical Association, Secretary-General Ekpe Philips Uche, after the meeting held among delegates of NMA and NARD on Sunday, October 3, in Abuja, the NMA advised NARD to stop the ongoing industrial action.

At the meeting, NMA mandated the National Officers Committee, NOC, to ensure the implementation of the memorandum of understanding signed with the federal government on August 21.

The association asked NOC to report back to the National Executive Council of NMA periodically on the progress being made on implementing the memorandum of understanding.

NMA also mandated the NOC to continue to interface with the chairmen of the state branches, including the FCT, on the progress being made.

According to Godiya Ishaya, NARD president, the association has officially called off the strike.

He said that the decision was taken after a meeting with the delegates of NMA and NARD.

He said: “We’ve officially suspended the strike to resume at 8:00 am on Wednesday. We made the decision in the wee hours of today (October 4). We held an emergency meeting from 5:30 pm on Sunday to the morning hours of today, and the NEC decided that having reviewed the progress made so far, the strike should be suspended.”