Maternal Health: Unpaid salaries, arrears dog expanded Midwives Service Scheme

Doctors, nurses, and Community Health Extension Workers (CHEWs) employed under the federal government’s Expanded Midwives Service Scheme (eMSS) across the country have lamented the non-payment of their salaries and arrears despite giving their best to ensure maternal and child health in the country.

Nigeria has one of the worst maternal mortality rates in the world. According to the global trends in maternal mortality report, Nigeria records 82,000 maternal deaths every year. This translates to 225 deaths from maternal mortality every day.

Also, the 2018 Nigeria Demographic and Health Survey (NDHS) estimates that Nigeria’s estimated maternal mortality ratio is 512 maternal deaths per 100,000 live births.

One of the factors fuelling the poor maternal health indices in the country is inadequate competent personnel to provide care especially at the rural areas.

The Expanded Midwives Service Scheme (eMSS) is implemented by the Federal Government of Nigeria through the National Primary Healthcare Development Agency (NPHCDA) to meet the quality health care worker need, and to tackle maternal, neonatal, and child mortality in Nigeria. The Sydani Group provides technical support to the NPHCDA for the scheme.

However, the untold hardships the health care workers are subjected to due to the non-payment of their salaries is affecting the targets of the scheme, and health care services for maternal and child health in the various primary health care centres (PHC) in the country.  Some of the health care workers said they could no longer afford transport fare to their workplaces.

Findings reveal that most of the healthcare workers under the scheme are owed several months salaries while some have never been paid since receiving their employment letters last year.

About 2,000 persons from three cadres of health professionals—doctors, nurses and midwives, CHEWs (Skilled birth attendants SBAs) work under the scheme.

They are employed as contract staff with salaries ranging from N45,000 to N70,000.

The health care workers lamented that despite the meagre salaries, they were still owed for as much as eight months, six months with the least being three months. They said this is happening in the face of the biting economic challenges in the country.

Experiences of doctors, nurses, CHEWS

Chuku Godfrey, a nurse deployed to Model Primary Health Care Centre (MPHC), Ubimini, Emohua Local Government Area of Rivers State, said it was an irony that health care workers under the scheme were combating the high maternal and child mortality rate in the country but nobody was really caring for them.

“Life is becoming so unbearable due to lack of payment from the agencies that engaged our services (NPHCDA and Sydani group) and every effort made to have our money paid has proved abortive,” he said.

He said they have made contacts with all the heads and coordinators of the organisations working on the scheme to know why they have not been paid but didn’t get any response from them.

He said, “The unfortunate part is that both Sydani group and NPHCDA always deny responsibility for our payment and they keep diverting our attention from the salary issue using monthly clearance that usually linger into months.

“Our major disappointment with their lack of responsibility over our payment is that all the doctors, nurses and midwives, CHEWs had jobs prior to the employment scheme, but decided to come and serve the vulnerable population in the local communities across the country.

“But we have lost out because our livelihood is gone and we can no longer care for our dependents or meet our basic needs. How can you employ people without provision for their salary in a project that is co-funded by the World Health Organisation (WHO) and Federal Government of Nigeria? From all indications, there is no plan in place to pay our backlogs of salary, even with the peanut they are paying us in the name of salary. At least, they should pay us fairly and in time for the sake of the vulnerable population we care for and for humanity.”

Chuku said “We want them to increase our salaries too. We have told them countless times that the salary does not reflect our commitment, expertise, qualifications and the job description. Each time we ask for the token to be increased; we are always met with threats. The agonizing part is that we are just contract staff (one year).”

Many of the affected staff depressed, living in poverty

Chuku further said that many of the affected health care workers have become depressed, with some kicked out of their rented apartments because they couldn’t pay rent.

“A colleague had to sell his blood for N4,000 just to feed,” he narrated. “Feeding our dependents and caring for our aging parents is now impossible and paying for transportation fare to and from work now is very hard. We have to borrow. Many of us who are on special diets and with medical conditions can no longer afford to get them.”

He called on the presidency, the federal ministry of health, WHO, and all stakeholders to come to their aid.

“The NPHCDA and Sydani group have failed us and we need help regarding our salary and the pathetic working conditions. We want our money paid in full and salary increased,” he added.

Another nurse, Sani Sule Mashi, has not been paid since December. He said he had a stable job for several years before he came across the job advertisement for the eMSS.

He explained that he raised eyebrows from the start over the remuneration package. He said “As a nurse, the offered salary of N70,000 seemed unusually low for a contractual service. I pushed aside my doubts, hoping that this opportunity would lead to greater things.

“But my daily commute to the assigned healthcare facility was costly, amounting to N30,000 per month. I also had to spend N20,000 per month on breakfast and lunch at the facility. On top of that, I had to purchase data for weekly clearance data collection and submission, which drained another N5,000 from my finances.

“With a wife and five children to take care of, and my ageing parents solely reliant on me for their well-being, the financial strain was overwhelming. How could I make ends meet with a mere N15,000 take-home from the promised N70,000 monthly remuneration? These calculations were only feasible if the payments arrived on time, but since December, I have not received a single kobo from the NPHCDA.”

He added that the eMSS job seemed promising at the beginning but accepting the job had become a millstone around his neck, dragging him deeper into debt and despair.

“I regret accepting this contract and resigning from my previous stable job. From August 2023 till date, I have been haunted by the consequences of my ill decision, a constant reminder of the perils of chasing mirages in the desert of false promises,” he stated.

Dr Obari Sarah Omene, who is deployed to MPHC Elelenwo, in Obio Akpor LGA of Rivers State, said some of her colleagues haven’t received a dime since the start of the program in August last year.

She said, “It is quite unfortunate that my colleagues and I under this scheme have to experience this as the cost of living is unbearable and the peanut they agreed to pay by month end still isn’t paid.

“We are suffering the hardship of the present economic state of the country as we can’t even provide basic needs for our families yet we wake up each day to carry the job description. Each time we ask for the token to be increased; we are always met with threats. The agonizing part is that we are just contract staff (one year).”

Many of the affected staff depressed, living in poverty

Chuku further said that many of the affected health care workers have become depressed, with some kicked out of their rented apartments because they couldn’t pay rent.

“A colleague had to sell his blood for N4,000 just to feed,” he narrated. “Feeding our dependents and caring for our aging parents is now impossible and paying for transportation fare to and from work now is very hard. We have to borrow. Many of us who are on special diets and with medical conditions can no longer afford to get them.”

He called on the presidency, the federal ministry of health, WHO, and all stakeholders to come to their aid.

“The NPHCDA and Sydani group have failed us and we need help regarding our salary and the pathetic working conditions. We want our money paid in full and salary increased,” he added.

Another nurse, Sani Sule Mashi, has not been paid since December. He said he had a stable job for several years before he came across the job advertisement for the eMSS.

He explained that he raised eyebrows from the start over the remuneration package. He said “As a nurse, the offered salary of N70,000 seemed unusually low for a contractual service. I pushed aside my doubts, hoping that this opportunity would lead to greater things.

“But my daily commute to the assigned healthcare facility was costly, amounting to N30,000 per month. I also had to spend N20,000 per month on breakfast and lunch at the facility. On top of that, I had to purchase data for weekly clearance data collection and submission, which drained another N5,000 from my finances.

“With a wife and five children to take care of, and my ageing parents solely reliant on me for their well-being, the financial strain was overwhelming. How could I make ends meet with a mere N15,000 take-home from the promised N70,000 monthly remuneration? These calculations were only feasible if the payments arrived on time, but since December, I have not received a single kobo from the NPHCDA.”

He added that the eMSS job seemed promising at the beginning but accepting the job had become a millstone around his neck, dragging him deeper into debt and despair.

“I regret accepting this contract and resigning from my previous stable job. From August 2023 till date, I have been haunted by the consequences of my ill decision, a constant reminder of the perils of chasing mirages in the desert of false promises,” he stated.

Dr Obari Sarah Omene, who is deployed to MPHC Elelenwo, in Obio Akpor LGA of Rivers State, said some of her colleagues haven’t received a dime since the start of the program in August last year.

She said, “It is quite unfortunate that my colleagues and I under this scheme have to experience this as the cost of living is unbearable and the peanut they agreed to pay by month end still isn’t paid.

“We are suffering the hardship of the present economic state of the country as we can’t even provide basic needs for our families yet we wake up each day to carry out our duties and at the end nothing to show for it. Life itself is already difficult so why do we have to add more stress to the employees?”

She said the NPHCDA and Sydani group keep demanding clearance and telling them to fill forms for monthly data collation without any good explanation as to why they haven’t been paid their salaries.

Eunice Mariyom, a nurse deployed to PHC Hwolshe, Plateau State, said the non-payment of salary has caused her immense challenges. She has not been paid for four months after resigning from her previous job.

She said her aged mum who was scheduled for a surgery could not go for it due to lack of funds.

“I had to use my little savings to buy her drugs, yet her condition deteriorated because I could not afford to pay for the surgery. I wake up every day and tell her I am going to work and at the end of the month, I cannot account for any thing. She had to ask me if I’m truly working. I have sent emails to Sydani Group and NPHCDA, and also called and sent messages but there have been no responses from them up till now. Instead, they kept sending emails for clearance, which we did but they haven’t paid us till now.”

A CHEW and skilled birth attendant (SBA) with eMSS in Oyo State who wishes to be simply known as Bello said SBAs have not been paid since the beginning of the contract.

“SBAs have been working for five to six months without salary. They keep telling us they are working on our salary but nothing good has come out of it till now. This is so sad. We health care workers are not slaves.

“We (the SBAs) were employed to improve child and maternal care. It is so sad and disheartening that the people in charge of the project are breaking their part of the contract,” she lamented.

She said there’s inflation in the country and the non-payment of salaries is worsening their plight.

She said, “I personally have been drinking garri for months now, asking for urgent 2k from colleagues because I’m stranded. Imagine working without getting paid. If the same thing happens to them and their family members, how will they feel about it? We should empathise with each other. The government already failed us and the community coming to seek for health intervention in each PHC because they can’t be starving their workers.”

Another employee of the eMSS at MPHC Churchill, in Port Harcourt LGA, Rivers State, Dr Jebose Precious, said “I am happy to be part of the team to reduce maternal and child mortality but since the onset of the program, it has been a nightmare as I am not able to make ends meet due to chronic delay of payment of our salaries,” she said.

She lamented that the salary is not even enough to cater for the health workers needs yet they were being owed for months.

“I wonder how our employers sleep at night. Their only interest is collation of data for statistics meanwhile the health workers who provide this information are suffering.

“How can we offer adequate care when we are not being cared for? We call they don’t respond to our calls; we send them emails they don’t reply. They only send us emails giving us deadline to submit the data they want. Most of us are parents, how do they want us to feed, pay our rents, pay our kids school fees and meet up other responsibilities?? This is really frustrating.

“We are doing our part by carry out our respective duties, NPHCDA should do its part by paying our outstanding salaries and pay subsequent ones on time. We are not slave. We are health workers.”

Impact on maternal care

Chuku, one of the affected health care workers, said “Our regret is that the vulnerable groups we chose to serve are at the receiving end; a hungry doctor can never care effectively. How do you expect a hungry midwife or nurse to start taking delivery or do you talk of the CHEWs? With the way things are going, it will definitely impact negatively on the fragile state of the primary health care system in the country.”

NPHCDA to settle salary backlog of eMSS health workers

The NPHCDA said it will complete payment of salaries backlog of the health care workers under the eMSS before the month of March ends.

The spokesman of the agency, Dr Abubakar Jimoh, said “In a decisive move to bring succour to the concerned health workers, the Executive Director of NPHCDA, Dr Muyi Aina, upon assumption of office in October last year, directed the finance and accounts department to take urgent steps to settle the outstanding salaries.

“In December 2023, the salary arrears of the affected health workers for the year were cleared except some noticeable cases whose online payment failed or were inadvertently omitted in the clearance conducted by the states. These are currently being resolved internally and with the assistance of the Office of the Accountant-General of the Federation.

“It is also gratifying to note that the January and February 2024 arrears will be paid before the end of this month just as concerted efforts are currently being made to ensure that salaries of health workers under the scheme are henceforth paid promptly.”

He said Dr Aina is putting in place new mechanisms to strengthen the eMSS while ensuring that health workers are well motivated and paid promptly.