RE: Health System Injustice in Nigeria: A Cry From a Broken Heart

Firstly we the University Graduates of Nursing Science Association, UGONSA, popularly known as the Graduate Nurses Association of Nigeria (GNAN) bring you and the entire senate a superlative nightingale’s greetings.

We wish to commend the senate under your leadership for the prompt and positive attention it has been giving to public petitions. We also commend the senate for its purposeful screening of the ministerial nominees, which in our understanding has signposted to the now sworn-in ministers that a new era, in which we are poised to get it right,  has come and Nigerians are going to hold them accountable and responsible for our success or failure through our legislators.

For now all we can assert about the 8th senate is that it has so far done its task well above average. We therefore commend you for diligently leading the senate to perform at a level that has reposed in us the confidence that the people we elected to represent us and our interest in the red chamber are doing the work we elected them to do despite that you have not had it rosy since your election as President of the Senate.

  • We, the Nigerian Nurses, cannot bear the brunt of the age-long injustice against our profession any longer! Our hearts are full and very heavy. We have cried out our eyes and the tears in our lacrimals are fast drying up. We cannot bear it anymore. Our predicament has so devastated us that we now lack the energy to carry on if the grip of our tight yoke is not timely loosened. This cry for help needs your urgent attention sir because a lot of things have gone wrong, and if your kind intervention is delayed more would still go awry and the consequence for the entire nation would be a preventable  precarious situation we shall all regret. To us sir, you and the entire 8th senate are a knight in shining armour.
  • Sir, it is very unfortunate and regrettable that Nurses are the most visible healthcare professionals in the hospital setting yet the most marginalized in Nigeria’s health system. Over the years the profession of nursing science has received less attention from the authorities and policy makers in our country and the result has been a complete stagnation of the profession and a resultant underperformance of our healthcare delivery system as evidenced by the geometric rise in medical tourism to hospitals abroad over the years.
  • As at date, sir, nursing science is the only profession among the core healthcare professions whose University Graduates are aberrantly under placed on CONHESS 07 grade level after the National youth service corps (NYSC) schemes whereas others are properly placed on at least CONHESS 09 post-NYSC.Despite the provision of the Industrial Arbitration Panel (IAP) Award, 1981 (herein attached as Annexure A) that the profession of Nursing is on parity with that of Pharmacy in Nigeria, as is obtainable in Great Britain, what we see in practice is an aberrant situation where the University Graduates of Nursing are appointed directly on CONHESS 07 post-NYSC while their counterparts in Pharmacy are appointed on CONHESS 09 despite both having identical entry requirements and course duration for the first degree in the University. Pharmacy interns for example, are even appointed on CONHESS 08 pre-NYSC, a grade higher than CONHESS 07, which University Graduates of Nursing are appointed to post-NYSC. Apart from Pharmacy, the University Graduates of other healthcare professions such as Medicine, dentistry, Optometry, Physiotherapy, Medical Laboratory Science, and so on, enjoy at least CONHESS 09 post-NYSC except their nursing counterparts, who are unjustifiably buried on CONHESS 07.
  • Sir, we have challenged the ‘powers-that-be’ in the health sector, including the office of the honourable minister of health to expound on the rationale for such aberration but none till date has adduced any scintilla of reason for such a leaching and monumental injustice yet they carry on as though nothing is at stake with no visible effort to rectify the anomaly.
  • Sir, our heart bleeds in pain as we wish to humbly inform you that the profession of nursing science is also the only core healthcare profession whose University Graduates do not participate in the mandatory one year internship training approved for University Graduates of core healthcare disciplines and designed to blend the more theoretically skewed University education with comprehensive clinical expertise for enhanced performance and qualitative client care. This persists even as mounting evidence underscores that nurses need the internship training more than other members of the health team since they stay longer and closer with patients, care for them and as well monitor them round-the-clock.
  • One dicey misconception we have always strived to correct is the unintelligible insinuation that one becomes a super nurse by just bagging a degree in nursing. There is no reason to consider a fresh Graduate Nurse a “super nurse” than to consider a young Medical Doctor (House Officer) a “super doctor”. Therefore, the internship training is paramount to baccalaureate programme of nursing as it is to those of other healthcare disciplines since we are all products of the same theoretically skewed Nigerian Universities and most importantly because nurses are universally entrusted with people’s lives. Those that are entrusted with people’s lives must be adequately trained and competent to discharge their responsibilities efficiently and effectively.
  • That the Federal Government has implemented the NUC approved mandatory internship training for the University Graduates of other health professions such as   Pharmacy, Medicine and Surgery, Dentistry, Optometry, Medical Laboratory Science, Physiotherapy and so on while that of Nurses has been treated as trivial and non-mandatory despite the formidable niche we occupy in care delivery, as well as our selfless sacrifice and commitment to improved client care, is a pointer that our contributions in the Nigerian health system are either under rated or not in any way appreciated, or both. If not, it may simply imply that some people are deliberately manipulating our health system to run at a level of underperformance ostensibly to promote medical tourism, one of the avenues through which our collective patrimony is siphoned, by denying the caregivers the opportunity of being properly and adequately trained to discharge their responsibilities effectively as is the case with the paradoxical exclusion of nurses from internship training.
  •  If the healthcare team is likened to a football team, we would say that the nurse is the goal keeper of the team. A team where the goal keeper is underprepared or not adequately trained remains a bad team because despite the efforts of other team mates in scoring goals and securing their post against the opponent, the team would always concede goals which an adequately trained goal keeper would ordinarily stop. And the fact remains that the success or failure of any team is rightly attributed to the team and not any individual player. This is why equal treatment and motivation in training and remuneration is availed the entirety of players in the team.  Exclusion of Nurses from internship training that accommodates other members of the healthcare team is the major factor responsible for the underperformance of our healthcare team with the ugly result of escalation of medical tourism to foreign hospitals as a result of gross loss of Nigerians’ confidence in our own health system. When the healthcare team fails, it can therefore be simply put that the Physicians, the surgeons, the Nurses, the Pharmacists, the Medical Laboratory Scientists, the Physiotherapists, the Optometrists, and so on, have all failed the system. This precarious situation will remain unabated until we do the needful by ensuring that nurses who are  entrusted with people’s lives are adequately trained to be able to carry out their responsibilities efficiently and effectively.
  • Chief Medical Directors (CMDs) and Medical Directors (MDs) of Federal health institutions, the demigods of our healthcare delivery system, alas, have equally compounded our problems by their flagrant impunity and disregard for the schemes of service, civil service rule and other extant circulars governing the civil service of the federation. For example, when teaching allowance was wrongly and irrationally withdrawn from nurses and midwives below the grade of CONHESS 09 in January 2014, we frowned at and condemned the development on the ground that Nurses and Midwives, irrespective of grade and cadre, are involved in client teaching and advocacy and that student Nurses and Midwives, and others including interns, also get a lot of tutelage from nurses in the clinical setting. And more so we saw no reason why nurses that work in the clinical setting should be exempted from such allowance that is exclusive to clinical staff whereas non-clinical staff that work in offices are remunerated for such, notwithstanding that they have no business with patients and medico-nursing students. We directed our complaints to the National Salaries, Income and Wages Commission (NSIWC) and the commission saw reason with us and ordered the restoration of the withdrawn teaching allowance in a circular Ref no. SWC/S/04/S.176/T/73 dated 4th July, 2014.Since the restoration of the teaching allowance no CMD/MD had effected its payment to the affected nurses and midwives despite glaring evidence that they have received funds for such as exposed by a circular from office of the permanent secretary, Ministry of Health Ref no.C2262/T/110 dated 29th July, 2015 (herein attached as Annexure B).
  1.  Some of the CMDs/MDs possibly have their own separate schemes of service different from that of the civil service of the federation. If not, how can some CMDs, for example those of Federal Medical Centre (FMC) Umuahia, Abia State, and University of Port Harcourt Teaching Hospital (UPTH),Rivers State, brazenly go against and desecrate the provision of section 3.7, page 105, of the Schemes of Service for use in the Civil Service of the Federation, 2003 (herein attached as Annexure C) which makes it strict, compulsory and unambiguous that a Nurse must have at least a first degree in Nursing to be qualified for promotion to the directorate cadre of the Nursing profession, to appoint their unqualified cronies not only into the directorate cadre but also promoting them above their qualified seniors to head the departments of Nursing services in their respective hospitals and yet they were not investigated let alone queried till date despite our complaint to the office of the head of the civil service of the federation?
  2. As we are still groaning under the rubble of the already wrecked havoc, more came our way by the surreptitious disappearance of Uniform allowance from the payroll of Nurses in the wake of migration to the integrated personnel and payroll information system (IPPIS).The exclusivity of Nurses’ uniform allowance is well detailed, unequivocal and unambiguous in Chapter 13 paragraph 130127 of the Public Service Rules 2008 edition (herein attached as Annexure D), yet was omitted by IPPIS with the excuse that the ‘above the law’ CMDs/MDs shall pay it from the internally generated revenues (IGR) of their respective hospitals. Since migration to IPPIS, the question that begs an answer is; how many CMDs/MDs have complied with payment of the uniform allowance to Nurses from the IGR? Is leaving the uniform allowance to the mercy of the CMDs/MDs not tantamount to technically and indirectly telling Nurses to forego their uniform allowance? Since wearing uniforms is a compulsory obligation for Nurses as stipulated by law, isn’t the stripping of uniform allowance that gives them the capacity to carry out the obligation sheer hypocrisy on the part of the authorities that serve as custodians of our law? Why remove the only thing that is exclusive to nurses from their payroll when those which are exclusive to other professions are retained? This demeanor of the authorities, in our understanding sir, is not different from the local adage-“telling a child to carry salt and at the same time tell the rain maker to make rain”- used to describe sheer hypocrisy and deception.
  3.  Mr. President these wanton injustices are an important nexus to the gross animosity, disaffection and disharmony that has characterized our contemporary health system. How can we be talking about achieving industrial harmony in the health system when we are deliberately encouraging and perpetrating injustice? Can there be peace and harmony where inequity, marginalization and isolated deprivation of due rights thrive? Equity they say breeds lasting peace. Therefore until equity triumphs over professional chauvinism and deliberate injustices in our health system no lasting peace or harmony can be achieved. For we, the nurses, we have no sense of belonging in our healthcare system and never shall we have confidence in the system unless the guile, deliberate injustice and unfair treatment meted out to us are addressed.
  4. Despite the provocative short-changing and unwarranted deprivation  orchestrated against  nurses, we have never derailed from showing Nightingale’s patriotism, decorum, calmness and unequalled commitment towards qualitative healthcare by putting our clients first and above other things and shunning the temptation of industrial action to press for the rectification of these injustices being meted out against us. It is unfortunate and a grisly precedence that our patriotism, restraint and maturity in the face of gross injustice have been misconstrued as fragility or foolishness. Notwithstanding, we have an unalloyed belief that the 8th senate under your able leadership does not yield to unwarranted injustices, cheats and marginalization of any sort hence this humble petition from our broken hearts.


With a broken heart and bloodshot eyes full of tears, this association passionately prays that you kindly use your altruistic personality, the power of your good office and goodwill of the 8th senate to

  1. Compel the concerned authorities especially the Minister of Health and the Head of Civil Service of the Federation to see to the immediate release of circulars implementing the NUC approved mandatory internship training and proper placement of the graduates of the Bachelor of Nursing Science (B.N.Sc) degree on at least CONHESS 09 post-NYSC as has been done for the University Graduates of other core healthcare professions.
  2. Strictly enforce the rule of law in the Health Sector by extending the oversight of legislators to CMDs and compelling them to pay in arrears, the Nurses teaching and uniform allowances, which they have withheld without any justification and above all  compel their respect for the sanctity of the schemes of service, the public service rules and other extant circulars.

Sir, your prompt response and that of the entire senate to our appeal would be phenomenal because it would inadvertently dispel the cloud of doubts and the already walling belief, that the Nigerian government does not promptly  respond to genuine issues when due process is followed unless and until coloured with violence and anarchy.

Please find attached copies of the referenced documents.

Submitted with deepest sense of respect and responsibility.


Chief (Hon) S.E.O. EGWUENU                                                                           Nurse G.I. Nshi

     National President                                                                                           National Secretary

TO: Dr Abubakar Bukola Saraki (CON)

The President of the Senate

Federal Republic of Nigeria.

The National Assembly Complex,

3 Arms Zones,

P.M.B 141 Abuja FCT, Nigeria.


Senator Samuel Anyanwu, Chairman Senate Committee on Ethics, Privileges and Public Petition.

Senator Enyinnaya Abaribe, Chairman Senate Committee on information and National Orientation.

Dr. Lanre Tejuoso, Chairman Senate Committee on Health

Mrs. Winifred Oyo-Ita, the Ag Head of Civil Service of the Federation.

Hon. Yakubu Dogara, Speaker House of Representatives.

Chairman House Committee on Public Petition.

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