Culled from Austin Isuekpe’s facebook wall. X-RAYING THE 24 POINT DEMAND OF THE NMA: THE FACTS, TRUTH AND MYTHS (PART ONE): It is the duty&civic responsibility of every citizen to contribute his/her quota to issues bordering on national progress as the inbroglio in the Nigerian health sector has thrown up. Thus, i seek to initiate an intellectual discourse by this write up, with a view to addressing the points raised by the NMA, proferring possible solutions, while welcoming intellectual contributions from all. So as not to bore my readers, il have this discussion in parts for easy understanding and targetted solution proferring. APPOINTMENT OF CONSULTANTS IN HOSPITAL SETTINGS: A word has meaning only in the context used. For example, cell means different things the scientist, the police man, the terrorist, the doctor. Likewise, the title consultant in the hospital setting defines the relationship between a medical or dental specialist and his patient with the Specialist doctor taking ULTIMATE RESPONSIBILITY for the patient care. Thus, the bucks stops at his table. This does not stop other health professionals from undergoing specialist or advanced training in their chosen field of expertise as this will undoubtedly impact positively on both the health team & patient care. However, it should not also undermine the ultimate responsibility of health care vested on the Medical or Dental Specialists. It is worthy of note that in some climes, non doctor specialists are required to add their roles while introducing themselves to patients eg Im Dr Austin, your attending physiotherapist. This is to avoid ambiguity in the minds of the patient as pertaining to your role, responsibility and limitations in decision making in healthcare management. Presently, NON DOCTORS in hospital settings in the USA are proposing the abolition of the use of the title Dr by non medical doctors IN HOSPITAL SETTING to prevent any ambiguity and protect their patients. This is a society that focuses on patient care, rather than being bogged down with titles. If a highly literate society like USA has these identity problems, what would happen in our society with her low level of literacy, high level of quackery and poor regulatory agencies? A society where the male nurse or porter is seen as a doctor and every female doctor is called a nurse? This is what the NMA demand seeks to protect. WAY FORWARD: Let other designations be given to other deserving specialist health professional eg Nursing Practitioner (NP). X-RAYING THE 24 POINT DEMAND OF NMA; THE FACTS, TRUTH AND MYTHS (PART TWO) HEADSHIP OF HOSPITALS BY DOCTORS: It is a fact that over 2,000 public hospitals in the USA are headed by non doctors eg MBA, MPH holders. It is instructive, however, that these hospitals are PROFIT ORIENTED, thus the high cost of healthcare and the need for a universal health insurance coverage for the citizens in order to access health facilities. In spite of this, in 2011, scientific studies independently conducted in USA and NHS hospitals in the UK, hospitals run by medical doctors scored 25 points higher in patient care and satisfaction when compared with those run by these professionals. As a result, present trends encourage the appointment of doctors to head public hospitals while encouraging them to obtain further administrative degrees to enhance their skills. Why would we therefore ask doctors to cede headship of hospitals in Nigeria? Truth be told; the decay in the health sector is due to dwindling government funding and commitment to health care at all levels, and the attendant reducing morale among health workers as they can not attain to their full potentials due to delays in promotion, stagnation of careers, poor infrastructure and an overworked health force. The health sector, a microcosym of the larger society, isnt immune from the debilitating effect of the high level of corruption with her attendant ills on the effective administration of healthcare at all levels of clinical and non clinical governance. It is also instructive that all WHO heads and Surgeon Generals in the USA HAVE BEEN DOCTORS. WAY FORWARD: I advocate putting doctors with the prerequisite additional qualifications and proven expertise to run hospitals. I also propose adequate budgetary funding of the health sector and, possibly, the setting up of a Special Intervention Fund to close the years of deficit in infrastructure & manpower development in the health sector. This can be funded from phone costs, Public Private Partnerships etc. Other suggestions are most welcome. X-RAYING THE 24 POINT DEMAND OF THE NMA; THE FACTS, TRUTHS AND MYTH (PART 3) APPOINTMENT OF DIRECTORS IN HOSPITAL SETTING: In every endeavour of human life, there are core professionals and support/allied professionals. From my research on the web, there are three core health professionals; doctors, nurses and pharmacists. As well, there are OVER 50 ALLIED HEALTH PROFESSIONALS, ranging from lab scientists&technicians, pharmacy technicians, physiotherapists, social works, counsellors etc. Can we therefore imagine the financial and administrative burden on the health sector if every health parastatal has over 50 directors? Could this cost not be channeled to improve on our health infrastructure. What is the role of directors in parastatals? Would they not better serve in the Ministry where policies are formed and handed down for implementation, rather than bog down patient care with administrative bureaucracies? What is the real aim and possible cost:benefit ratio of the proliferation of directorates in all hospitals? The war front, which hospitals represent, isnt for drawing up war plans (policy making) but FOR EXECUTION OF ALREADY DRAWN OUT PLANS (policy implementation). The act setting up hospitals recognises three directorates (clinical, administrative) to work in conjunction with the hospital board in policy interpretation and implementation. WAY FORWARD: Maintenance of status quo as in the act setting up hospitals. X-RAYING THE 24 POINT DEMAND OF NMA: THE FACTS, TRUTH AND MYTHS (PART 4) RESIDENCY TRAINING: It is the basic responsibility of government to secure the health of her citizenry. This is the principal reason for funding of residency training of doctors by nations. In the private sector outside health, core professionals are sponsored for courses both within and outside the country to enhance expertise, performance and capacity building. Why not health with her gross deficit in medical personnel? With her dearth of specialists as evidenced by about only 3000 medical specialists attending to the health needs of about 170million Nigerians, the urgency to train specialists who will effectively provide specialised health services comparable to any in the world can not be overemphasised. Not only will it stem medical tourism put recently at a whopping 1 TRILLION NAIRA, but our health sector could be a potential source of revenue generation for the country, as well as securing the health needs of our future generation. Economic sense states that resources are scarce and wants unlimited. Government obviously CAN NOT fund the specialist training of all health professionals. Thus, opportunity cost must prevail, with core professionals maintaining core priority. WAY FORWARD: Government should continue to fund residency training while exploring earlier discussed avenues to train other professionals as resources are available X-RAYING THE 24 POINT DEMAND OF THE NMA: THE FACTS, TRUTH AND MYTHS (PART 5) THE RELATIVITY AMONG HEALTH PROFESSIONALS: Worldwide, indices for remuneration are based on duration of study of course, relevance of expertise in said sector, level of expertise, rarity of skill, level of responsibility bestowed and level of risks involved. The above is self explanatory. It is also a fact that remuneration directly impacts job satisfaction and performance. A comparative look of the remuneration of the various health professionals in various climes is available online for your perusal. Permit me to note that in 2013, following a similar crisis in her health sector, the Ghanaian government invited Pricewater Cooper, an international audit firm of repute, to perform a scientific job evaluation and place all health professionals on a Single Spine Salary Scale. Following this evaluation, it is instructive to note that where the most senior nurse exits the system IS LOWER than where the doctor enters. This is a reflection of the practice in most climes. Even the much celebrated National Industrial Court judgement by JOHESU denied JOHESU their prayers for the erosion of relativity between doctors and other health workers. Nigeria is noted to have one of the lowest relativity ratios between doctors and other health professionals. WAY FORWARD: An independent, objective and scientific job evaluation and remuneration by an international audit firm of repute be carried out on all health professionals and adopted by the Federal government.
Posted on: Sun, 17 Aug 2014 22:54:29 +0000
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