In circular 069 dated June 4, 2012, the government added that it would enforce the policy of ‘No-Work, No-Pay’, and discipline unauthorised absence from work in accordance with labour laws and civil service rules.

The circular, which was signed by the Acting Head of Service, Mrs. Josephine Williams, explained that the government was disturbed by the adverse effects of recurrent disruption of health services on patients.

The circular read, “There are also growing concerns about the quality of service and dedication of staff in public hospitals, which has made it duty-bound on government to clarify that medical services are classified as essential under Nigerian law.

“Even in the event of any strike or lockout, professional code of ethics demands the continuation of essential services.”

The government explained that essential services consisted of attention to emergency cases; attending to elective and emergency surgeries, including caesarean section; continued treatment and care for surgical patients; and giving full attention to critically-ill patients and all patients on life support.

Willaims said the government would continue to implement its present wage policy and structure concerning its employees, including those in the health sector, until a wage review is carried out.

She said, “All employees in the state public service should note that agreements made with employers of labour other than the Lagos State Government are not binding on the state.

“Furthermore, the policy of ‘No-Work, No-Pay’ and disciplinary process for unauthorised absence from work shall be strictly enforced in accordance with relevant labour legislations and civil service rules.

“In case of any grievances, the channel of communication should be in line with civil service guidelines and where appropriate, the dispute resolution processes in the Trade Dispute Act.”

She added that a process of dispute resolution created by the government would initially be adopted to resolve issues.

The government and doctors in the state had been at loggerheads over the implementation of the Consolidated Medical Salary Scale.

Of these objectives, the EPI was the most concrete and probably made the greatest progress initially. The immunization program focused on four major childhood diseases: pertussis, diphtheria, measles, and polio, and tetanus and tuberculosis. Its aim was to increase dramatically the proportion of immunized children younger than two from about 20 percent to 50 percent initially, and to 90 percent by the end of 1990. Launched in March 1988, the program by August 1989 was said to have been established in more than 300 of 449 LGAs. Although the program was said to have made much progress, its goal of 90 percent coverage was probably excessively ambitious, especially in view of the economic strains of structural adjustment that permeated the Nigerian economy throughout the late 1980s.

The government’s population control program also came partially under the PHC. By the late 1980s, the official policy was strongly to encourage women to have no more than four children, which would represent a substantial reduction from the estimated fertility rate of almost seven children per woman in 1987. No official sanctions were attached to the government’s population policy, but birth control information and contraceptive supplies were available in many health facilities.

The federal government also sought to improve the availability of pharmaceutical drugs. Foreign exchange had to be released for essential drug imports, so the government attempted to encourage local drug manufacture; because raw materials for local drug manufacture had to be imported, however, costs were reduced only partially. For Nigeria both to limit its foreign exchange expenditures and simultaneously to implement massive expansion in primary health care, foreign assistance would probably be needed. Despite advances against many infectious diseases, Nigeria’s population continued through the 1980s to be subject to several major diseases, some of which occurred in acute outbreaks causing hundreds or thousands of deaths, while others recurred chronically, causing large-scale infection and debilitation. Among the former were cerebrospinal meningitis, yellow fever, Lassa fever and, most recently, AIDS; the latter included malaria, guinea worm, schistosomiasis (bilharzia), and onchocerciasis (river blindness). Malnutrition and its attendant diseases also continued to be a refractory problem among infants and children in many areas, despite the nation’s economic and agricultural advances.