UNHEALTHY AND SELF SEEKING CLAIM BY NIGERIA PHYSICIANS by OBISESAN, OLUWATUYI The action of the NMA in causing confusion in the Nigeria health sector can be likened to the insurgents and if not checked can go viral and hydra headed. It is sad that NMA who called itself elite Association could be little itself and result to name calling referring to other members of the health sector as amorphous, supportive staff and non- medically qualified. The same NMA who berated the action of Joint Health Sector Unions when they threatened to embark on strike is now declaring an indefinite strike which I refer to as senseless and egocentric as a close look into their demands revealed that none of those things demanded can add value to patient’s care rather enhancing their self earned ego. It is important that Nigerians are enlightened to the facts concerning some of the requests of the Nigeria Medical Association. 1. APPOINTMENTS OF DCMAC: There is no law in Nigeria that established the position Deputy Chairman Medical Advisory Committee in our health sector but NMA smuggled the position into the administration of our various hospitals through the Federal Ministry of health and exclusively for medical practitioners, a way to siphon public fund. The law that established teaching hospitals in Nigeria referred to as University Teaching Hospitals (Reconstitution of Boards, Etc.) Act otherwise known as Decree 10 of 1985 or Act U 15 LFN 2004 section 5 subsection (4) states that “There shall be for each hospital, a chairman of the Medical Advisory Committee who shall be appointed by the Board and responsible to the Chief Medical Director for all the clinical and training activities of the hospital.” 2. APPOINTMENTS OF DIRECTORS IN THE HOSPITALS: Contrary to the claims of NMA that this Position distorts the chain of command in the hospital, induces anarchy and exposes the patient to conflicting treatment and management directives with attendant negative consequences. They should be reminded that aside medical practitioners in the hospitals, there are several other professionals whose scheme of service allows them to reach the peak of their professions which further reiterates the recognition accorded to the practice of each profession and informed decision making. How can the NMA question the statutory positions of other health professionals that have been in place since 2001? It is clear that they are the ones breeding anarchy. 3. DEMAND FOR SKIPPING: When JOHESU challenged the FMOH circular that ordered reversal of skipping of grade level 10 in the health sector, NMA accused JOHESU of stealing from the Government coffers, a position that was challenged in court and won. At the verge of implementation for other health workers NMA came up asking for skipping. Who is now a thief? 4. THE TITLE OF CONSULTANT IN A HOSPITAL SETTING: The leadership of NMA should go and check the meaning of a consultant in a dictionary. This simply means professional adviser; an expert who charges fees for providing advice or service in a particular field. Whereas there are a lot of specialists setting in the health sector (Physiotherapy, Dietetics, Medical Laboratory Science, Pharmacy, Radiography, Optometry etc) what then give the NMA the temerity to think they are the only professionals/specialists in the hospital? 5. RELATIVITY IN HEALTH SECTOR: There used to be one salary structure in our hospitals until the regime of late Prof. Olikoye Ransome Kuti who initiated the gross disparity in the salary structures in Nigeria hospital in a bid to favour his constituency (NMA) with the advent of circular 1 of 1991which has thrown the bane of the troubles in the health sector till date. An attempt to amend this anomaly failed due to the parochial interest of medical practitioners who wants to go home with sacks of currency in the name of salary while what is earned by others is determined by them making it to look like master- maid relationship. This is sheer selfishness, as the well being of a patient does not rest on the shoulders of the NMA who is still living the old tale. 6. IMMEDIATE WITHDRAWAL OF THE CBN CIRCULAR AUTHORIZING THE MEDICAL LABORATORY SCIENCE COUNCIL OF NIGERIA (MLSCN) TO APPROVE LICENSES FOR THE IMPORTATION OF IN-VITRO DIAGNOSTICS (IVDs): The singular act of NMA on this matter clearly portrays them as ignorant and lawless. Section 4 subsection (e) of MLSCN Act states that the Council shall power to “regulate the production, importation, sales and stocking of diagnostic laboratory reagents and chemicals; When did NMA become sensor board? NMA is busy chasing shadows by not wanting to obey the law of the land. What a shame. 7. RESIDENCY TRAINING: NMA enjoys full residency training at the expense of all Nigeria scholars as they are the only set of people that Government trains at the post graduate level. I don’t even know if Nigerian youth enjoys this Father Christmas venture from the Federal Government at post graduate levels and yet they are asking for a review to travel abroad for training at whose expense? NMA keeps talking about international best practices. Is this what happens outside the shores of Nigeria where people pay for trainings? Another way of licking the honey. Alas the funding of this training is taking a chunk of resources from the sector, no wonder other health workers cannot be trained or sponsored to workshops 8. THE ORCHESTRATED INTIMIDATION, HARASSMENT AND PHYSICAL ASSAULT BY LABORATORY SCIENTISTS: Members of NMA in this department has chosen to continuously disregard government rules, regulations in the Federal Medical Centers, Specialist and Teaching Hospitals. The statutory scheme of service for medical laboratory scientists clearly provides for the functions of the Director, Medical laboratory services; namely: “Taking charge of General Administration of medical laboratory services; Budgeting and ordering for laboratory equipment and reagents; Advising on the formulation, execution and review of medical laboratory policies” among others. This dates back to 1972. Organograms are being designed with complete disregard to structure of professional services as designed by schemes of service; harassment of hardworking professionals; threats of “sack” by Medical Directors, Chief Medical Directors and even Boards of Management. Why won’t there be anarchy when this set of people (NMA) perpetrates organized quackery in the laboratories. 9. THE POSITION OF CHIEF MEDICAL DIRECTOR/MEDICAL DIRECTOR: It is laughable to hear NMA say that the position is sacrosanct. One wonders if medical practitioners think they are the only one that is medically qualified in the health sector. They have deceived Nigerians to believe that the position of the Chief executive in our hospitals, Commissioners and Health Minister positions respectively is their exclusive rights. Section 5 subsection 2 of the law that established teaching hospitals in Nigeria states that “The Chief Medical Director shall - (a) be a person who is medically qualified and registered as such for a period of not less than twelve years, and has had considerable administrative experience in matters of health and holds a post - graduate medical qualification obtained not less than five years prior to the appointment as Chief Medical Director; and (b) be charged with the responsibility for the execution of the policies and matters affecting the day - to - day management of the affairs of the Hospital.” Where then in this act was the position reserved for these sets of power mongers? Having let the cat out of the bag, is it not clear that the requests of the so called NMA is self driven? What manner of ego is it that a group of employed workers by the government will tell the government how to relate with other employed medical workers? It is the same Obembe led NMA that demanded Nigeria should give all physicians’ special cars with special plate number for whatever reasons. Soon they will be telling all Nigerians to leave the roads for them when they pass in a supposed hurry to attend to emergency. Soon they will tell us to create a special road for them to drive on with siren. Has NMA no shame that it will attempt to practice world standard but wants to turn the rule upside down when it does not favor them? Also in one of their request, NMA members must be paid a minimum sum of N100, 000 as hazard allowance a month. What then makes them feel that they are exposed more than Nurses who stays with the patients 24hrs or Medical Laboratory Scientists who does the dirty job or even an ambulance driver? Over pampering of these elements for long has made them look directly at us in the face to call Nigerians fools. Physicians in Nigeria throw in stethoscope and abandon their duty post at the slightest opportunity to jeopardize the health of Nigerian citizens. They should be told that they don’t have this opportunity to do so as they are never a registered Trade Union that is regulated by law. No wonder why they are lawless. Resident doctors are group of students who are training to specialize. How then is the system so bad that a group of student will be allowed to hold a nation to ransom without caution? This is how insurgency started in the North eastern part of Nigeria, can we manage another insurgency in the health sector in the name of NMA or are we trying to create another sambisa forest in the guise of coerced request? Of course NO. I was greeted by news of an industrial action of NMA on 1st july 2014 after an injunction of the National Industrial Court which they dragged the Federal Government and its agencies warning them not to go on strike as the matters are before the court. Is this not the height of lawlessness in an attempt to pervert justice? Prof. Shettima Gyoh, a renowned Surgeon and an esteemed member of NMA in a write up published by African Health Magazine, September 2013 Vol.35 No 6 pg 2 titled Disharmony in the Nigerian Health Sector advised “the doctors and dentists to soften their insistence that only they can head health administration institutions which arose from the arbitrary selection that started during the era of Military rule. Military Government had only doctors in mind when it came to appointing Heads of Health administration without considering the ability to manage. This practice has continued as Civilian Governments have tended to imitate their Military predecessors. Doctors often claim that only they have the comprehensive picture of the health needs of society because of their education and training. They should realize that after many years of experience other health worker can and also do have that same picture equally comprehensively. They should realize that neither stethoscope nor dental drill is required in administering health”. It is obvious that the clamour for health administration by NMA is not based on the wish to serve people better but to corner public funds and the dictate for pecking order. He also asserted that we like quoting developed countries and we know that the British even appointed non-health professionals as hospital administrators. In the 1960s and ‘70s when professional health service Administrators were in charge of the management and administration of hospitals, the Nigerian health sector ranked 4th in the Commonwealth. In 2006 the Nigerian health sector was ranked 196th out of 201 countries by the WHO. In 2011, the Nigerian health sector was ranked 51 out of 53 countries in Africa by the Mo Ibrahim African Governance Index Rating. Since 1985 medical practitioners through decree 10 took over the management and administration of the sector, it has been a sad story of continuous decline and persistent crisis in the health sector. It is a fact that the NMA and its affiliate bodies are known more for strike and clamour for salaries and allowances in Nigeria. Suddenly, it now knows the prescription for reducing tension and crises in the health sector. Alas! What we see in Nigeria today is an orchestrated campaign to mislead the government again by the Nigerian Medical Association: “The NMA believes that the tension and crises in the health sector will be greatly reduced if certain services are privatized through the Public-Private Partnership (PPP) arrangement. Such services that can be easily privatized include: Laboratory Services, Pharmacy, Radiography, Physiotherapy, Catering and Laundry” (Vanguard 28/9/2012); Similarly, the Association of Chief Executives of Federal Tertiary Hospitals: “Meanwhile, all Federal Tertiary Hospitals are to submit accurate estimates of their financial requirements for outsourced services to the Hon. Minister of Health through the Director, Hospital Services, within two weeks to facilitate the meeting with the Hon. Minister of Finance and Director-General, Budget Office of the Federation on the provision of funding for outsourced services” (The Guardian 16/7/2012). Through newspaper advertorials and concerted effort in hospitals, they are working to jettison the National Medical Laboratory Services Policy through the privatization of core services in the hospitals. Dr. Michael Adekunle Charles, a public health specialist and medical Director of St. Paul’s Hospital & Maternity Centre, Ebute Meta, Lagos had said: “There will be more significant improvements in health care delivery in Nigeria, if trained and experienced administrators are allowed to head the country’s health institutions, rather than the present system which allows only doctors to head these institutions as a right. According to him, most of the people who studied medicine and who are heading national hospitals do not have any experience in health management and hospital management. We need people that studied management to head our health system. I think there will be more significant improvements, if we do this. In Germany where I studied, a board of directors usually heads a hospital. The board has as members a doctor, a lawyer, an accountant etc. The overall head of that team is usually not a medical doctor, unless such a doctor has extra qualification in administration”. – Pharmanews, Nov. 2004, vol. 26 No. 11 pg. 55. The NMA leadership in an attempt to cajole the Government of their good intention if any said that NMA as a responsible professional body and the custodian of the peoples health, would continue to support the Government as it strives to improve the health of our citizens through committed zeal in the discharge of our duties in a press release after their meeting of Friday 23rd May, 2014. If NMA admits that health sector is made up of team players then it should discard the idea of self projection as leader of the team as anyone with administrative competence and resource management irrespective of his/her professional background in the health sector can lead for a good result. I therefore submit that the tide of bickering in the health sector can be stemmed to its low ebb if these submissions are taken and acted upon. 1. That the Federal Government must not succumb to the cheap blackmail of NMA and her allies by granting requests that undermine the interest of the Nigerians. 2. That Government should without further delay institute appropriate disciplinary measures according to the provisions of the Public Service Rules, to curb this unfortunate phenomenon of unregulated display by NMA turned into political activism and gangsterism to the extent of total lack of respect to laws and regulations. The earlier this scenario is arrested the better for the nation. 3. With their recent actions, what is the place of these statements? Rather it is a blab of semantics from a set of lunatics who do not respect the sanctity of lives of Nigerians rather they chose to abandon Government hospitals for their privately owned ones at the expense of the Government they pledge allegiance. Who is fooling whom? 4. Resident doctors should be tamed to observe the rules while on training and various Teaching Hospital and Federal Medical centre should employ Hospital paid and graded Consultants not relying on the touting set of Consultants from the University on secondment to the adjoining Teaching Hospitals who are more concerned with the place of their primary assignments rather than rendering service they are paid for which accounts for patients not seeing Consultants on their clinic days hence leave these patients’ care in the hands of students. 5. Stakeholders’ round table meeting should be arranged devoid of sentiments and ego to discuss the way forward in the health sector with respect to statutory laws and regulations. By OBISESAN, OLUWATUYI obisco64@yahoo 08022640555
Posted on: Sat, 05 Jul 2014 09:42:55 +0000
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