RE: SUBMISSION OF THE REPORT OF THE PRESIDENTIAL COMMITTEE OF EXPERTS ON INTER-PROFESSIONAL RELATIONSHIPS IN THE PUBLIC HEALTH SECTOR. We bring Your Excellency good tidings of the season. It is our prayers that the many blessings of this special period will fill the home of your Excellency. The Joint Health Sector union (JOHESU) and Assembly of Healthcare Professional Association (AHPA) have jointly reviewed the report of Yayale Ahmed Presidential Committee of Experts on Professional Relationships in the Public sector (YAPCEPTPH) submitted to Your Excellency on December 20, 2014 at Aso Rock, Villa, Abuja. Our findings confirm our fears that as usual the secretariat of the Committee was infiltrated by the Nigerian Medical Association (NMA) through the instrument of the its privileged members in high places in government.Nothing gives insight to this better than the pharseologies which perennially referred to doctors as leaders of the health team while other health professional were favcritely dubbed allied health profesionl. Your Excellency, after a very critical evaluation of the Yayale Ahmed Presidential Committee of Experts on Professional Relationships in the Public Health Sector (YAPCEPRPH) report we wish to draw your attention to our intendment to dissociate our respective organisations from the less than credible posturing of the committee on fundamental practice including the reflected:- 1. Etablishment of the office of Chief Medical Adviser to the President 2. Creation of a National Healthcare Commission 3. Matters Arising from Teaching Hospital Act a. Headship of Teaching Hospitals b. Appointment of CMAC c. Appointment of Deputy CMAC d. Consultancy Cadre for Eligible Health Professional. 4. Opposition of Appointment of Other health Professionals As Directors in Federal Health Institutions 5. Establishment of Post-Graduate Colleges for Allied Health Professionals. 6. Obvious Bias Against Health Professionals other than Doctors Especially in the Reflected Areas. a. Position of the panel on Pharm D and 0. Programmes b. Withdrawal of Central Bank of Nigeria circular authorizing MLSCN to approve licence for importation of IVDS c. Poor hazard, call-duty and related allowances to heath professionals. 1. ESTABLISHMENT OF THE OFFICE OF CHIEF MEDICAL ADVISER TO THE PRESIDENT In one of the most nauseating recommendations of the Yayale Ahmed Presidential Committee of Experts on Professional Relationships in the Public Health Sector (YAPCEPRPH), it recommended the establishment of an unnecessary office of Chief Medical Adviser to Mr. President. A perusal of the functions of this office including exercising essential responsibilities for issues as smoking and health as well as issuing warning to the public on health hazards, advising the president on emergent public health issues confirms that this recommendation is only a short-cut to bringing back to life the concept of Surgeon-General as demanded by the Nigerian Medical Association (NMA). The Yayale Ahmed Presidential Committee of experts on Professional Relationships in the Public Health Sector (YAPCEPRPH) found it necessary to cite experiences in climes where doctors have monopoly of some public health initiatives. It conveniently and cleverly avoided the United States America experience of the Surgeon-General which is open to all health professionals. Your Excellency, it is fundamental to draw you memory lane by posting that the 6th National Assembly, the 2014 National Conference which are all legislative templates have all rejected the concept of Surgeon-General or any of its epitome. All the health professional associations apart from NMA and the trade unions in the health sector which collectively make up 95% of the health workforce have repeatedly the need for a Surgeon-General in Nigeria. For the Umpteenth time we restate with necessary emphasis that for a country whose public sector wage profile has increase by a whopping 100% from N890 billion to N1.83 trillion in a 5 years period should not be contemplating setting up fresh bureaucracies especially when it is unnecessary to satisfy ego trips. If the structure at the Federal Directors out of which one is in charge of public health and another hospital services, why on earth do we need another dramatis personae whose job is to advice the President on emergent Public Health issues or issue or issue reports on smoking and health?. Mr. President Sir, we respectfully submit again that the establishment of any new bureaucracy in health amount to an unnecessary duplication waste of public funds, since it adds no value. 2. CREATION OF A NATIONAL HEALTHCARE COMMISSION TO REPLACE PROFESSIONAL REGULATORY AGENCIES AND REGULATE TERTIARY HEALTH FACILITIES. In discourses that evudently betrayed the mandate of the Yayale Ahmed Presidential Committee of Experts on Professional Relationships in the Public Health Sector (YAPCEPRPH) to facilitate harmony in the health sector, the Presidential Committee proposed a template for the age-long desire of the Nigeria Medical Association (NMA) and its appendages to have a short-cut to regulate and control all the cadres of health professional in Nigeria. One of the major recurrent contentions in the National Health Bill which Your Excellency refused to sign into law when passed by the 7th National Assembly was because a potentially explosive section 1(1) created a caveat that a supposed National Health system would regualte and control all health services in Nigeria. Your Excellency, the recently approved National Health Act was acceptable to JOHESU and Assembly of Healthcare Professional Associations (AHPA) only when necessary safeguards to protect the autonomy of all health professions was inculcated into section 1(1) of the National Health Bill. That safeguard is the clause that declares that regulation of health services in section 1(1) of the new Health Act is without prejudice to existing health laws. Even when the Yayale Ahmed Presidential Committee of Experts on Professional Relationships in the Public Health Sector (YAPCEPRPH) was designed to create harmony, we find it expedient to lament very loudly that this particular recommendation is clearly out of line and a design to institutionalise confusion. In terms of logistics how can one commission as proposed take over the functions of 15 different prefessional regulatory councils as well as regulate the activities of 55 Federal Health Institutions as presently constituted? It should be a matter of common-sense that this is a recipe for unprecedented entropy. For some of the old professional councils like Pharmacists Council of Nigeria (PCN) established through its precursor the Pharmacists Board of Nigeria (PBN) in 1958 the peculiarities of the output re diversified. It not just registers the relevant professionals like other professional Councils, but registers pharmaceutical premises. Most other health facilities including private clinics are registered at state levels through agencies which now have established structures.Why then create avoidable confusion, because people must be whipped into adopting defective policies at the whimsical and capricious propensities of Nigerian Medical Association (NMA)? If there is particular area the Yayale Ahmed Presidential Committee of Experts on Professional Relationships inthe Public Health Sector (YAPCEPRPH) went too far in the realm of irrational logic, then it was this ill-conceived concept of a Healthcare Commission to replace 15 regulatory agencies which are products of valid Acts of parliament as section 315 of the constitution conveys validity on those laws that were creations of the military. MATTERS ARISING FROM TEACHING HOSPITAL ACT In yet another departure from its well-known terms of reference including a review of the Gusau Presidential Committee on Harmony in the Health Sector Recommendations, the Public Health Sector (YAPCEPRPH) did not reckon with holistic appraisals of the contentious matters under this ACT. This includes:- a. Headship of Teaching Hospitals Existing legislations provide that medically qualified persons can be appointed as Heads of Federal Health Institutions in Nigeria. Over time the Federal Government in conjunction with Nigerian Medical Association (NMA) has interpreted this to imply that only Doctors meet this eligibility clause. Rather craftily the Yayale Ahmed Presidential Committee of Experts on Professional Relationships in the Public Health Sector (YAPCEPRPH) relied on the ancient perception known to only our clime that doctors are the sole cadre of staff who are medically qualified and so should continue to head Federal Health Institutions. The job description of the head of a Federal Health Institions is purely administrative. It needs no knowledge of surgical procedures or stethoscope for effective output. In the golden era of healthcare in Nigeria when a hospital like the UCH, Ibadan was rated as part of the top 5 in the commonwealth, administrators designated as Hospital Governors were in charge. Your Excellency, there are a numbers of suits where stakeholders are currently seeking interpretation of who is medically qualified. Which awaiting the outcome of these suits, we can safely inform the Federal Government that it is less than fashionable to legislate that a doctor heads a hospital in the global arena. The modern designation is to have a CEO of health facilities because healthcare has become a business endeavour which must be designed to be sustainable. The condition precedent to be CEO therefore must revolve around intereted person being seasoned administrators or managers of cognate experience. b. Appointment of CMAC: A need arises ot open borders of restriction associated with this responsibility to any of the staff (HOD level) in the clinical service department. c. Appointment D-CMAC: The Yayale Ahmed Presidential COmmittee of Experts of Professional Relationships in the Public Health Sector (YAPCEPRPH) in its wisdom rationlized the totl no of D-CMACs to two. It further recommended that one of the D-CMACs will be for Clinical services reserved for doctors and the other for medical training and research (which could be open to all other for health Professionals). This is fundamentally flawed as the Teaching Hospital Act does not legally create the office of D-CMAC as a line structure. The Yayale Ahmed Predential Committee of Experts on Professional Relationships in the Public Health Sector (YAPCEPRPH) unfortunately sees no reason why doctors cannot continut to unilaterally grab all privileges in healthcare contrary to evolving norms in the globak arena. d. Consultancy cadre for eligible health professional The only reference to this in the Yayale Ahmed Presidental COmmittee of Experts on Professional Relationships in the Public Health Sector (YAPCEPRPH) report were admonitions to invoke the spirit of the NICN judgment which gave the Federal Ministry of Health powers to approve this cadre. Your Excellency may wish to find out why the Federal Ministry of Health has not come up with a necessary circular prescribing conditionalities to appoint new eligible health professional since the judgment re-instated existing consultant in the various professional cadres. e. Composition of Boards of Management for Federal Health Institutions The cosmetic recommendation of increasing the number of health professionals on the Board of Management of Federal Health Institutions does not fundamentally redress the lopidedness in board composition as the adjustment just improve the ration of doctors to other professionals on the board from ratio 1:8 to 1:3 which is still inequitable.Your Excellency, the way forward is to allow for an amendment of the Teaching Hospital Act to redress permanently the items 3 (a) - (e) in public interest 4. OPPOSITION TO APPOINTMENT OF OTHER HEALTH PROFESSIONALS AS DIRECTORS IN FEDERAL HEALTH INSTITUTIONS The JOHESU and APHA are shocked that the Yayale Ahmed Presidential Committee of Experts on Professional Relationship in the Public Health Sector (YAPCEPRPH) registered its opposition to the appointment of other health professional as directors in the Federal Health Institutions contrary to existing sechemes of service for such professionals. Your Excellency, We urge the Federal Government to borrow a leaf from what is obtainable at state level where there exists a multiplicity of directors in some of the units but only the most senior is appointable as HOD. Opposition to appointment of other professionals as directors in Federal Health Institutions ground that they run different progression paths with different salary structure and nomenclature is not only unjustifiable but discriminatory against citizens of the country. 5. Establishment post-graduate colleges for allied health professionals Your Excellency, even despite the one-sided nature of the Yayale Ahmed Presidential Committee of Experts on Professional Relationships in the Public Health Sector (YAPCEPRPH) report in favour of the Nigeria Medical Association (NMA) it tied its approval of post-graduate colleges for allied health profressionals to the clinical needs of the intitutions in the approved areas of professional practice. The report could not disguise its bias as it still found it necessary to put in black and white that Post-graduate Colleges should not just be for acquisition of additional qualifications unrelated to professional speciality It is very strange that even in instances that government has rationalsed and approved capacity building in some professions via the National Council on establishment in tandem with due process, government has also truncated the process by refusing to give life to the consultancy cadre which is the whole essence of the post graduate college training/specialiasation. The Yayale Ahmed Presidential Committee of Experts on Professional Relationships in the Public Health Sector (YAPCEPRPH) report which gives a conditional approval to postgraduate traning ironically was non-comrnital to the enabe circular for other health professionals in its report which our analysis can now confirm amounts to a bundle of contadiction. 6. OBVIOUS BIAS AGAINST HEALTH PROFESSIONALS OTHER THAN DOCTORS ESPECIALLY IN THE REFLECTED AREAS. From the major highlights we have documented in this memo Your excellency, the Yayale Ahmed Presidential Committee of Experts on Professional Relationships in the Public Health Sector (YAPCEPRPH) has faild to en-list out confidence in major areas of its report. We draw the attention of Government to the tragic position and recommendations of te Yayale Ahmed Presidential Committee of Experts of Professional Relationships in the Public Health Sector (YAPCEPRPH) reportin the following areas: i. Its declaration that Government at all levels should refuse to recognize that Pharm D programme of Pharmacists and O.D Programme of Optometrists because the NUC has not approved them. How does a supposed arbiter take a position to truncate the future developmental agenda of a stakeholder and yet expect to enjoy the confidence of such stake holders? For the records the Pharmaceutical Society of Nigeria/Pharmacusts Council of Nigeria is still engaging the NUC to regularise grey areas identigied as drabacks in Pharm. D. so nobody has a right to shut the door prematurely. This is same for stakeholders in optometry. ii. The recommendation that the Centre bank of Nigeria immediately withdraws its circular authorizing MLSCN to approve licences for the importation to In-vitro diagnostics (IVDs) in deference to Nigerian Medical Association (NMA) demands is lamentable. This matter will be subject to further interventions in the weeks ahead as the Yayale Ahmed Presidential Committee of Experts on Professional Relationships in Public Health Sector (YAPCEPRPH) report makes the situation more inflammable. iii. The insistence that the status-quo of maintaining 100% differential in the call-duty, rural, hazard and other allowances between doctors and other health professionals until an acceptable job evaluation is the climax of the many absurdities of the Yayale Ahmed Presidential Committee of Experts on Professional Relationships in the Public Health Sector (YAPCEPRPH) report. Doctors who already enjoy a much more superior entry point are structured to earn over 100% of basic salary board in all allowances. What this transcends to is that the most junior doctor (house-officer) earns more in allowance than other health professionals at apogee level (Director/HOD). This is the unfortunate status-quo the Yayale Ahmed Presidential Committee of Experts on Professional Relationships in the Public Health Sector (YAPCEPRPH) has recommended we maintain. CONCLUSION Your Excellency, we the under listed stakeholders in health find it necessary to inform the Federal Government that we outrightly reject the very biased and one-sided Yayale Ahmed Presidential Committee of Experts on Professional Relationships in the public Health Sector (YAPCEPRPH) in both public and professional interests. From all intents the report only seeks to futher marginalise our members and compromises the future of generations of our members who will be permanently made sub-servient to their contemporaries in medicine, We strongly demand this report which is not in tune with national development and interest be immediately withdrawn for public good and the future of the Health Sector. We wish Your Excellency the very best as you continue endeavours related to nation building. Once again do accept our esteemed regards Your Excellency. Yours faithfully, For: Joint Health Sector Unions Assembly of Healthcare Professional Associations Signed Dr. Ayuba P. Wabba, Mni President Medical & Health Workers Union of Nigeria (MWHUW) Olumide Akintayo, FPSN, FNAPHARM, FNIM President Pharmaceutical Society of Nigeria (PSN) Adenija A.A President National Association of Nigeria Nurses and Midwives (NANNM) Raheem Toyosi President Association of Medical Laboratory Sciences of Nigeria (AMSLN) Faniran F. O President Nigeria Union of Allied Health Professionals (NUAHP) Dr. Mark Okeji President Association of Radiographers of Nigeria (ARN) Dr. B. Akintola President
Posted on: Thu, 08 Jan 2015 07:52:49 +0000
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