CRISIS IN THE HEALTH SECTOR: HEALTH PROFESSIONALS IN WAR OF WORDS All is not well with the health sector in Nigeria. For months on end, the industry has been entwined in a web of dispute, discord, protests and wranglings culminating in or arising from strikes, or threats of strikes and other expressions of disharmony. Watchers of the industry have interceded at various times, but rather than wane, the spate of unrest is waxing stronger – strongly suggesting the extent to which there is no love lost among the professional groups. Even as accusations and counter-accusations continue to fly around as to who takes responsibility for the dwindling fortunes of the nation’s healthcare system, the agitations for “justice” have also become much more strident. Sadly, Industrial dispute now has the sector by the jugular – in a death-grip. Lately, series of wranglings has forced dividends of healthcare delivery to its knees. A fortnight ago, in acceding to the demands of the Nigeria Medical Association, NMA, President Goodluck Jonathan, among other assurances, promised to appoint a Surgeon General for the Federation. But last week, the Joint Health Sector Unions, JOHESU, in league with the Assembly of Health Sector Professionals called for unconditional halt to the appointment of a Surgeon General for the Federation and threatened fire and brimstone in default. Aggrieved parties have since expressed divergent views on this seemingly intractible issue as well as other matters of mutual interest. The question making the rounds now is whether such unhealthy rivalry is good for the country’s already battered health sector. Who will save the troubled sector from imminent collapse? In this first part of our special series on Crisis in the Health Sector, health professionals bare their minds on the proposed appointment of the Surgeon – General and their thoughts on attaining the elusive peace and harmony. Excerpts: Surgeon General will address critical gaps in healthcare delivery —Dr. Osahon Enabulele, President, Nigeria Medical Association IN line with the need to promote the growth, development and good health of Nigeria, there is a compelling need for the establishment of the Office of the Surgeon-General of the Federation to be occupied by a licensed medical/dental professional (called Surgeon-General of the Federation) who, as an officer of the nation, should be an independent officer and not a member of any political party. Independence He/She should independently articulate national and international health perspectives based on evidence-based best practices targeted at empowering Nigerians for healthy living. Importantly, the Surgeon-General of the Federation, amongst other functions, should be conferred with the technical, professional co-ordination and expert leadership of a commissioned Medical Emergency Corps to handle public health/medical emergencies during disasters, as well as the power to assess the medical fitness of political office holders. Health Ombudsman In different countries, there is a Health Ombudsman whose duty it is to technically guide the nation on matters of public health importance. Different countries have different names for their Health Ombudsman who is held responsible for the health of the nation and who is not subject to the vagaries of politics. What is important is therefore the accorded roles and responsibilities and overall objective. In Nigeria, there used to be a Chief Health Adviser, including Sir Manuwa, who made remarkable contributions to the growth of the health system. No conflict It should be noted that the functions of the Surgeon-General of the Federation are not in conflict with those of the Minister of Health, but rather are complementary. The Office, through its separate and statutorily defined functions, will support the work done by the Minister and Mr President on health with improved technical competence and stability brought to bear on the health of Nigerians. Similar positions It should also be noted that similar posts already exist in Nigeria’s public service and they perform useful services. These include Accountant-General of the Federation, as distinct from the Minister of Finance; Surveyor-General as distinct from the Minister of Lands and Housing; Attorney-Genera, Auditor-General as distinct from the Minister of Finance and Statistician-General. Conviction I wish to once more express my patriotic conviction that our country urgently needs to establish the Office of Surgeon-General of the Federation as a way of addressing critical gaps in our constitutional, political and medical history. I am clear on the fact that beyond the opposition being engineered on the basis of primitive prejudices, this creation of the Office of the Surgeon-General will help to significantly improve Nigeria’s essential health indicators, with the overall aim of driving growth, development and the future progress of Nigeria. Nigeria needs appointments that can ameliorate our burdens —Pharm Olumide Akintayo, President, Pharmaceutical Society of Nigeria, PSN THE justification for the position of a Surgeon – General, hinged on the need for such a public officer to be saddled with the responsibility of coordinating public health on face value is ridiculous and certainly most unconvincing. This is because the basic tenets of medical training positions any registered medical practitioner to undertake the responsibility of driving processes that border on public health. Duplication It is instructive to note that the office of the Assistant Secretary of health to which the Surgeon General reports in the United State of America is junior to the Minister of State for Health in Nigeria. The office in whatever nomenclature will mean an unnecessary duplication of offices and functions which are presently being articulated and undertaken by the office of the Minister of Health and the Minister of State for Health with an array of Directors, Deputy Directors and Assistant Directors. Some stakeholders in health probably see Nigeria as a Health outpost that deserves a Chief Medical Officer. Team concept The fact is that healthcare is increasingly a team concept and multidisciplinary where each stakeholder contributes to a pooled effort to achieve desired outcomes. The health sector has suffered from avoidable entropy because of ill – conceived policies and statutes over time. What is the enabling law to justify the appointment of Surgeon – General in Nigeria? Our nation needs appointments that can truly impact by ameliorating the burdens of our depressed citizenry and not those that intensify conflict potentials in a perennially tension – soaked sector at the detriment of overwhelming pubic interest. Surgeon-General is not a professional cadre. Consequences One is bound to ask if the President has powers to appoint a Surgeon General. The concept remains both unconstitutional and outrightly unlawful. It is an unnecessary procedure. On face value, it is valueless. Government is advised to remember the consequences of the unlawful Medical Salary Scale, MSS, of the 90′s which is the precursor of the industrial disharmony in the public service where different cadres of workers agitate for discriminatory and exclusive wages. The move to appoint a Surgeon General will lead to demands for such by all cadres of workers and therefore makes government more vulnerable to strikes and shut-downs in the months ahead. We all believe that access to good health is the right of the Nigerian citizen, but what we are saying as long as we continue to embrace and encourage these half measures and methodologies grounded in nepotism, so long shall we continue to contend with negative indices in healthcare. Team spirit is destroyed —Comrade Faniran Felix Olukayode, President, Nigeria Union of Allied Health Professionals, NUAHP TEAM spirit is destroyed. the patient cannot get the best care, collaborative research would be minimal or impossible, incessant strikes will be the order of the day, revenue generation would drop, health indices would be poor and medical tourism would be pronounced and the overall economy of the nation would be adversely affected. The Surgeon-General is the head of military medical services in the USA, Canada and UK and a few other nations. The head may be a nurse, pharmacist, medical practitioner or any other medical professional in the armed forces. In Nigeria, the head of medical corps is designated ‘Director’ At the Federal Ministry of Health, we have Director of Public Health, Director of Hospital services etc. All these directors are equivalent to Surgeon- General. Therefore, Nigeria does not need a Surgeon General since we already have its equivalent performing same duties. The Nigerian medical practitioners propose to have Surgeon General who shall be exclusively appointed from her members only so that they can use the position to oppress other health professionals. The sixth Senate once threw out the bill on Surgeon General due to its lack of support. In 2007, the matter was discussed again by the inter-Agency committee on the grievances of NMA. The Surgeon General was overwhelmingly condemned. Again, NMA presented it to a-38-member Presidential Committee headed by justice Abdullahi Bello Gusau between August 2010 and November 2011. It was flatly defeated. One is however surprised that Mr. President could give approval without seeking the opinion of other stakeholders other than medics. We appeal to Mr. President to withdraw his approval in the interest of industrial peace. The Presidency should remove the current Minister of Health and appoint two new persons – one from the NMA and the other from JOHESU/Assembly of Health Professionals. Restructure the the Federal Ministry of Health and Allied Health professional groups to be represented at the Directorate level. Allow equitable representation of major professional groups on the Boards of Management of each Hospital. Make the post of CEO of Hospital open to any competent and qualified health professionals without skewing it toward a particular profession. Promote all unduly stagnated health professionals to Directors cadre. Govt has failed to enthrone peace and harmony—Pharm Azubike Okwor, Past President, Pharmaceutical Society of Nigeria, PSN I THINK the Nigerian Medical Association was playing politics when it used the threat of strike to force Mr. President to make promises of appointment of a Surgeon General which we all know cannot be done by Presidential fiat. In the 6th Senate, Dr. Mamora, a distinguished Senator from Lagos State, sponsored a Nigerian Medical Association bill seeking the appointment of a Surgeon General. That effort was defeated at the Senate, but it gave other stakeholders is an opportunity to give their perspective on the issue. Our take then which still represents the view of many stakeholders is that the appointment of a Surgeon General was an ego trip by medical doctors who are losing sleep, because there are nomenclatures and appointments like Attorney General, Accountant General, Surveyor General and others in our polity. The Surgeon General in the USA where it is popular is the head of an interventionist commissioned corps of officers much like the Federal Road Safety Corps. In the USA, the list of Professionals that make up the officer corps continues to increase and now includes engineers, any of the 15 professions can aspire to lead the corps as Surgeon General. In the USA, the Deputy Surgeon General is a pharmacist and Rear Admiral Lushiniak a physician serves as Surgeon General. If Nigeria is desirous of a commissioned corps of public health professionals, we must propose and support an Act of Parliament that is not discriminatory and is designed to serve the best interest of Nigeria and Nigerians. In the meantime we should strive to make the best use of Primary Healthcare Development Agency, the Department of Hospital Services and Public Health in the Federal Ministry of Health. Leaders and elders in the health sector, in the spirit of new year must come together and save this important sector. It appears that government has failed to enthrone peace and harmony in the restive sector. The stakeholders meeting I am advocating will draw selfless practitioners who believe that the Sector must be operated as a team and that respect must replace hatred in so much as a team number contributes to the care of patient. Leadership of the team must be earned through demonstration of skills, competence, and humility that is the hallmark of international best practice and not the type the current act for the establishment of Teaching Hospitals that Decree 10 imposes on the sector. Surgeon – General will create a veritable platform — Dr. Anthony Omolola, National President, Association of General Private Medical Practitioners of Nigeria, AGPMPN IT is so unfortunate we are witnessing the current crisis in the health sector because they are avoidable or can be minimised. The wealth of a nation is measured by how healthy the citizens are. The implications of strike in the health sector have major consequences on the economy of the nation. Loss of lives is the most important consequence and increased morbidity. Strike should be the last weapon of negotiation in the 21st century when lobbying, constructive dialogue have failed. Even at the face of strike, emergencies should be attended to as to reduce mortality. Also government should take the issue of health very seriously because it’s her responsibility to provide good health for her citizen. The issue of Surgeon General will create a veritable platform for many health issues intra and inter professional disputes can easily be sorted out. The health team has to work together in a synchronized manner as to achieve proper health delivery system. Everybody has a role to the patient. Vanguard Online, January 14, 2014 By SOLA OGUNDIPE & CHIOMA OBINNA
Posted on: Sun, 26 Jan 2014 13:21:48 +0000
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