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When Health Minister Osagie Ehanire was, on Thursday, asked if Nigerian health workers are being paid “hazard allowance for the job that they are doing,” in tackling the coronavirus pandemic, PREMIUM TIMES reported how he responded that he was “not aware.

Mr Ehanire had quickly added that “whether during a pandemic or not, handling emergencies is a standard job they (health workers) do every day.”

An apparently bemused House Speaker, Femi Gbajabiamila, replied: “I thought you said coronavirus is novel? How is it a standard job they are doing?” to which the minister replied: “they are screening for temperature.”

An unimpressed Speaker pressed on.

“They don’t screen for coronavirus everyday. They’ve never done it before. It’s the most infectious disease in the world. The answer to my question is that they are not being paid a hazard allowance.”

“I’m not aware” was again the minister’s curt response.

“You should be aware. You dropped the ball there,” Mr Gbajabiamila chided as lawmakers met with the leaders of Nigeria’s team tackling the coronavirus.

Frontline warriors

Across the globe, health workers have become frontline warriors battling to rein in the deadly COVID-19 that has so far infected and killed thousands across the globe and is wrecking world economies.

As doctors, nurses and other health practitioners race against time to curb the rampaging virus that has so far defied science, many of them have been killed in the line of duty by the infectious ailment.

The welfare of these health workers, not only in Nigeria, but globally, is gradually taking the front burner in the debate on how to save humanity from the ravages of the novel viral disease.

Central to the debate is whether the welfare and personal safety of these practitioners are taken as paramount by the authorities in relation to the provision of personal protective equipment (PPEs) and hazard allowance.

Hazard pay is a form of compensation, apart from regular entitlements, granted to officials who have been requested to remain and report for work in duty stations under very hazardous conditions, such as war or pandemics.

Health minister, Osagie Ehanire at the National Health Dialogue organised by Premium Times. Health minister, Osagie Ehanire at the National Health Dialogue organised by Premium Times.

In Nigeria, hazard allowance is ₦60,000 ($167) per annum for medical workers at all grades, Olanrewaju Amusat, registrar of the department of surgery, University Teaching Hospital, Ibadan recently said. That means a health worker receives N5000 monthly for putting his or her life at risk.

Also, some health workers, who spoke with our reporter under condition of anonymity, said most Nigerian health facilities do not have adequate stocks of PPEs and the current battle to curb the coronavirus May turn ugly if these are not provided.

A doctor at one of the General Hospitals in Abuja, who did not want her name in print told PREMIUM TIMES, “please pray for us. They are expecting us (health workers) to do our best in fighting this disease (COVID-19) and they are not providing us with adequate PPEs. They have also been cutting our salaries for the past few months due to this IPPIS (Integrated Payroll and Personnel Information System) controversy. Yet we are the ones in the frontlines. It is well.”

Global challenge

On April 9, a hospital consultant in East London, UK died from the coronavirus weeks after pleading with the prime minister for more personal protective equipment for frontline staff.

Abdul Mabud Chowdhury, a consultant urologist at Homerton hospital in Hackney, East London, died after spending 15 days in Queens hospital, Romford.

The UK Guardian reported that Mr Chowdhury last month wrote a Facebook message to Boris Johnson outlining the urgent need for PPE for frontline staff and calling for testing for healthcare workers to be fast-tracked.

Mr Chowdhury is one of many healthcare workers who have lost their lives in the fight against the COVID-19 outbreak globally, many of them infected in the process of carrying out their duties.

The World Health Organisation (WHO) on April 7 said over 3,000 health workers have been infected with coronavirus globally while many died in the process of offering care to affected people.

The Director-General of WHO, Tedros Ghebreyesus, said many health workers had paid the ultimate price in the fight against the virus.

“When health workers are exposed or become sick, they have to go home and stay there for at least two weeks. Hospitals scramble to find replacements,” he said. “That’s why we must ensure that health workers have the medical masks and other personal protective equipment they need.”

Health workers used to illustrate the story.Health workers used to illustrate the story. Health workers used to illustrate the story.

While deaths of health workers, in the line of duty, are yet to be recorded in Nigeria, health workers in the country have been making incessant calls for governments to provide essential materials, including PPEs.

The health workers urge the government to provide protective gear such as gloves, face mask, head shields among others to enable combat the increasing cases in the country.

Repressed emotion

A medical doctor, Mario Adelaja, said the conditions of service, allowances and the environment for Nigerian doctors are “very hostile” and could negatively impact the fight against the pandemic if not addressed now.

“The sad reality is that the government (state and federal) never considered it (welfare, PPEs) as important. The clamouring from the medical associations and its affiliates always end up being wrongly perceived by the political class as mere complaints on salary issues,” Mr Adelaja told PREMIUM TIMES.

He addsedthat there had never been a critical financial and economic evaluation of the impact medical doctors have on the healthcare system “because health is seen more as a social service rather than a commodity which people pay for (be it patient, HMOs or government).”

“The aforementioned issues coupled with the disdain for doctors is no rocket science why the younger generation are leaving our shores in droves,” he added.

“Example: my set graduated in 2006, we were 160 then, as at present count about 60 of us remain in Nigeria with 1/3rd of that number now sitting foreign entrance examinations.”

The President, Association of Resident Doctors (ARD), Abuja chapter, Roland Aigbovo, said as at the last count, “about eight doctors have been confirmed positive with COVID-19 and many other health workers are presently in isolation as a result of exposure to confirmed COVID-19 patients”.

He said most health workers are exposed to the virus “while treating patients.”

He also said the country does not have enough PPEs “because the quantities available are being rationed.”

“There is no enough PPEs and that is why we are appealing to the government to provide adequate quantities to enable us carry out our responsibilities,” he said.

“All health workers are to observe strict infection prevention and control but for those that are directly managing the patients, they are to observe strict procedures and protocols to avoid putting their families at risk. We are proposing that they should be accommodated during this period to reduce the risk of transmission to their families,” he said.

Looming crisis

Health workers interviewed for this report decried the deplorable conditions of the health facilities in the country, noting that the facilities may not be able to handle the pandemic if it gets worse in Nigeria.

As of April 11, the NCDC said it has tested over 5000 people for coronavirus and 318 people have tested positive in 20 states. About 70 have, however, been discharged with 10 deaths recorded.

Nigeria Centre for Disease Control (NCDC)Nigeria Centre for Disease Control (NCDC) Nigeria Centre for Disease Control (NCDC)

However, going by the global trajectory, more cases are expected in the country. Health experts are crucial in curbing the spread.

Health experts say this job will be made easier, when health workers are not afraid of being exposed and infected with the virus as a result of lack of PPEs.

Before the present pandemic, Nigerian health workers have often been part of fatalities recorded anytime there is a major epidemic.

In the fight against the Ebola outbreak in 2014, some health workers – Stella Adadevoh, Justina Ejelonu, among others, paid the ultimate price.

Every year, health workers are equally affected by the Lassa outbreak, sometimes leading to fatalities. So far, the total number affected health workers in the ongoing Lassa fever outbreak is now 37.

Health workers are often in the frontlines in the treatment of patients and this makes them susceptible to contracting such diseases.

The President, National Association of Nigerian Nurses and Midwives (NANNM), Abdulrafiu Adeniyi, warns of a looming challenge as he said the government is not sensitive to the plight of health workers “especially nurses, as frontline caregivers in the raging global pandemic”.

He said the government, at both federal and state levels, has been neglecting the welfare of health workers and most of the nurses have been working without adequate provision of PPEs.

He said about 70 nurses (from UCH, Lagos, UITH, UBTH) “have so far been exposed to the virus from patients and are currently in isolation”.

“As frontline health workers and personnel who stay with the patients 24 hours of the day, we demand the highest level of protection for nurses to provide care for the community they serve,” he said. “The health workers are instrumental in the fight and their families must not need to suffer in the aftermath. As such, there is a need for the government to provide the N95 mask, and appropriate PPEs.”

“Health workers are playing a very huge role in this fight. PPEs should be provided to health workers across all the health facilities even to primary healthcare levels. We have to point out that it is essential that we protect both their safety, their families and that of the patients they are caring for,” he said.

Mr Adeniyi also asked spirited Nigerians to donate such materials to the government to help fight against COVID-19.

Meanwhile, the President, Association of Medical Laboratory Scientists of Nigeria, Enya Bassey, disagrees, saying it is the responsibility of the government to provide protective gears.

Mr Bassey said, “It is irresponsible of any government to send health workers to fight against any infectious disease without providing necessary equipment.”

He also said the laboratories are the backbone of the health sector and as such the laboratory workers are meant to be well-equipped and protected.

“There is yet to be any record of laboratory personnel infected with the virus,” Mr Bassey said. “But hazard allowance is very necessary for the motivation of people working on the forefront of containing the pandemic.”

Silver lining

Meanwhile, the Minister of Finance, Budget and National Planning, Zainab Ahmed, had said ‘adequate insurance’, compensation, and support would be provided to frontline health workers during and in the aftermath of the COVID-19 pandemic.

She said it had become compelling to offer the needed support through an adequate insurance policy.

Mr Adeniyi, however, said the government should go beyond rhetoric.

He said most health workers in Nigeria have health insurance but the government must provide other incentives and welfare packages.

“The government must provide a flat rate hazard allowance, with special compensation for crucial services as implemented in other climes during the COVID-19 outbreak,” he said. “The nurses demand remuneration, hazard allowance, and insurance commensurate to the threat to life that COVID-poses.”

Mr Aigbovo expressed a similar view.

“We have demanded for a review of the hazard allowance, life insurance package and incentives for all frontline health workers,” he said. “Governments at all levels are yet to come out with any package as we speak for reasons best known to them and this is not right.”

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