2015: Hope Of Ending Health Sector Crises Dims Posted: 15/Jan/2015 Hope of ending major challenges that has afflicted the health sector for years especially the rivalry between medical and dental practitioners also known as medical doctors and health workers has dimmed. This came to the fore recently as leaders of the health work-ers under the umbrella of Joint Health Sector Unions (JOHESU) and Healthcare Professional Association (AHPA) have rejected the report of the Yayale Ahmed Presidential Committee of Experts on Professional Relationships in the Public Health Sector (YAPCEPRPH). This report which was submitted to the federal government on December 19, 2014 is widely expected to provide the template that will resolve the age-long problems that have pitted medical doctors against other health workers. With the exception of medical doctors, health workers constitute about 90 percent of the entire health workforce. JOHESU comprises five professional bodies namely Medical and Health Workers Union of Nigeria (MHWUN), National Association of Nigerian Nurses and Midwives (NANNM), Senior Staff Association of Uni-versities Teaching Hospitals Research Institutes and Associated Institutions (SSAUTHRIAI), Nigerian Union of Allied Health Professionals (NUAHP) and Non Academic Staff Union of Educational and Associated Institutes (NASU). Although, the submission of the report was commended given the delay the committee experienced due mainly to lack of sufficient funding of its operations, stakeholders in JOHESU and AHPA have raised an alarm, crying wolf. For them, if the report is implemented in its present form, it will not resolve problems in the health sector. Both JOHESU and AHPA rejected the Committee’s creation of the office of Chief of Medical Adviser to the President whom the Committee said would be “exercising essential responsibilities including issuing reports on such issues as “smoking and health” as well as issuing warning to the public on health hazards, advising the President in coordinating National Health emergency preparedness and advising the President on emergent public health issues”. Describing the appointment as unnecessary, they said it was a ploy to reintroduce the earlier rejected office of a Surgeon- General in Nigeria, to be occupied by medical doctors only. They said apart from being a duplication of function, creating the office of a Medical Adviser to the President would amount to a waste of public resources “since it adds no value.” Among those who signed the submission on behalf of JOHESU are Dr. Ayuba P. Wabba, president of MWHUW, Abdulrafiu Adeniji, president of NANNM, Felix Faniran, president of NUAHP, Dr. B Benjamin Akintola, president of SSAUTHRIAI and Mrs Ladi Iliya, president of NASU. Others who signed on behalf of AHPA are OlumideAkintayo, president of the Pharmaceutical Society of Nigeria (PSN), RaheemToyosi, president of the Association of Medical Laboratory Scientists of Nigeria (AMSLN), Dr. Mark Okeji, president of Association of Radiographers of Nigeria (ARN), Mr. Wole Ajayi, president of Health Information Managers Association of Nigeria, and Mr. Taiwo Oyewumi, president of Nigeria Society of Physiotherapy (NSP). Although, the report of YAPCEPRPH is expected to create harmony between medical doctors and health workers, JOHESU and AHPA lamented that the Committee’s proposal for the creation of a National Healthcare Commission to take over the functions of 15 different professional regulatory councils as well as regulate the activities of 55 federal health institutions as presently constituted, will create chaos. While describing the idea as capable of introducing confusion, they noted that a similar clause was in the proposed National Health Bill, but noted that health workers ensured that it was struck out before it was passed into law. “Why would this Yayale Committee reintroduce such a clause,” they asked. On the headship of teaching hospitals, one of the areas of contention in the health sector, JOHESU and AHPA similarly rejected the proposal of the Committee that only medical and dental practitioners should head these institutions on the basis that they only are medically qualified. Although, JOHESU noted that it is presently in court to determine the meaning of ‘medically qualified’, in the interim, both groups suggested that the responsibility of heading public hospitals should be handled by administrators. Furthermore, the Yayale Committee opposed the appointment of other professionals as directors in federal health institutions on the ground that they run different progression paths with different salary structure and nomenclature. “This is not only unjustifiable but discriminatory against citizens of the country,” stated JOHESU and AHPA. In addition, both groups stated that going by the above recommendations of the Yayale Committee, it has failed to enlist their confidence in major areas of its report including: *urging governments not to recognise the Pharm D programme of Pharmacists and O.D Programme of Optometrists because the National Universities Commission (NUC) has not approved them. They added, “For the records the PSN/Pharmacists Council of Nigeria (PCN) are still engaging the NUC to regularise grey areas identified as drawbacks in Pharm. D. So, nobody has a right to shut the door prematurely. This is same for stakeholders in optometry.” *The recommendation that the Central bank of Nigeria (CBN) immediately withdraws its circular authorising MLSCN to approve licenses for the importation of 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’s report makes the situation more inflammable.” Gasau’s report Sadly, the Yayale Committee is not the first time the federal government would set up a team to resolve problems of disharmony between the two major professional groups in the health sector. It would be recalled that the report of Retired Justice Abdullahi Bello Gusau Committee on Harmonius Relationship Among Health Professionals/ Workers in the Health Sector which was submitted to former Minister of Health, Prof. Onyebuchi Chukwu in November 2011 and later to the Federal Executive Council (FEC) in April 2013, was rejected because Chukwu then raised objections against it. Based on that the FEC rejected that report which is now referred to as Gusau’s Report but JOHESU vehemently disagreed hence the federal government’s decision to raise the Yayale Ahmed committee with a decision that the Gusau’s report must form part of d terms of reference for the Yayale team. What are the problems? The issue of remuneration and welfare is one of the factors at the root of the crises. How much medical doctors earn in relation to how much health workers earn remain a contentious issue. There is disagreement on format of increasing salary in terms of promotion and cadre. Other issues at the centre of disputes and rivalry between two major professional groups in the sector are professional status, career progression, job descriptions, roles and responsibilities within health facilities and major health institutions including ministries and parastatals. The alleged dominance of medical doctors which has resulted to health workers being allegedly shortchanged is presently being challenged by the affected group. This has resulted in various protests and persistent industrial strikes by both medical doctors and health workers, which they use as a strategy to press for each other’s demands. In 2014 alone, strikes by both medical doctors and health workers over welfare, appointment of Surgeon General, expanding headship of teaching hospitals to include health workers, among others lasted for about four months. This had serious consequences for patients many of whom lost their lives during the unnecessary strikes. Sadly, as at the time of filing this report, there is no reprieve yet for numerous patients waiting for the strike of JOHESU which started since November 12, 2014 to end. Although, medical doctors are not involved in this ongoing strike, normal health care service provisions have since been disrupted, ditching the hope of many less privileged citizens to access care in public hospitals. Reactions Telephone calls put through to the National President of the Nigerian Medical Association (NMA), Dr. Kayode Obembe was not responded to. A text message seeking reaction of the NMA to the issue, sent to his telephone was not responded to. However, reacting to the development, Second Vice Chairman, NMA, Lagos State Branch, Dr. Olusegun Akinwotu said the recommendations of the Yayale Committee are appropriate. Justifying his position, he noted, “The agitation of the other allied health workers is for them to be at par or higher than doctors. I don’t think that obtains anywhere in the world.” Implementing their recommendations is how hospitals in the health sector can forge ahead, he added. So, Akinwotu reasoned that if public hospitals should forge ahead, certain statutory matters regarding who heads the hospitals should not be debatable. “The same way the judge heads the court and the vice chancellor of a university is a professor, the person with the highest qualification in a hospital setting who is a doctor should head the hospital. As far as the hospital environment is concerned, doctors are more qualified to head the hospitals.” Other recommendations in the Yayale’s report are what should obtain, Akinwotu added. However, he noted that agitations of health workers including appropriating consultancy status for academic qualifications obtained after four academic years, is very absurd. “What the Yayale Committee recommended is what should obtain,” he said. Also reacting, Secretary of the NMA in Lagos State Branch, Dr. Babatunde Saheed said the recommendations of the Yayale Committee is okay and fair but needs some little bit of finetuning. “Some aspects of it have to be corrected or adjusted,” before the federal government should issue a White Paper on it, he noted. Although, Saheed did not highlight areas of the report that require the adjustments, he stressed that no further panel would be required to put the report right. “From the perspective of doctors, it is going to resolve the problems of the crises in the health sector. “The report placed people (various professionals) where they should be placed. In terms of practices all over the world, the Committee really tried to get to that level of normal practice all over the world. With this report, each professional group should know its limitation, where its members are supposed to work and where they should not work.” Furthermore, Saheed said the report highlights that every professional group in the health sector is important. “The relevance of each group is however relative. It specifies specific work for specific professional group. Although, the various groups should work together, the team should have a leader because without a leader in an organisation, it could lead to anarchy.” According to the secretary of the NMA in Lagos, the Yayale Committee has tried to resolve some issues that presently generate a lot of problems in the health sector. On his part, Felix Faniran, president of NUAHP, noted that JOHESU and AHPA have not out rightly rejected the report of the Yayale Committee as published in some media recently. While describing the initial JOHESU/AHPA response as premature, Faniran said, “There would be a detailed response from both JOHESU and AHPA after a meeting of their presidents/secretaries of professional associations with NUAHP to be held in Abuja from today, January 15 to 16. He however, noted, “There are several good recommendations made by both Gusau’s report and the Yayale Committee which we agree with” but there are a few which we do not accept. We shall continue to encourage dialogue on such issues until they are finally resolved. The solution is to provide a common forum for all stakeholders to discuss the issues and resolve them. We shall get there soon.”
Posted on: Thu, 15 Jan 2015 18:38:46 +0000
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