Why discard something as beautiful as this if not for personal gain ego centrism and lack of regard for the governed. Health is wealth,a popular saying, has been used over and over again and has now become a cliché, any society wherever it finds itself deserve good and affordable health care system for its members,however,the gladiators in the health sector has plummeted the sector to an all-time low ebb due to their egocentric tendencies at expense of the patient and the society whom they were meant to serve.
Thus, worried by the poor health indices in Nigeria Health Sector occasioned by the combined debilitating effect of various factors, particularly the deep-seated disharmony and infighting amongst health workers and various Professional groups on the one hand and incessant strikes in the sector on the other hand, the President and Commander-in-Chief of the Federal Republic of Nigeria, Dr. Goodluck Ebele Jonathan (GCFR), directed the Honourable Minister of Health,prof.onyebuchi chukwu to ensure industrial peace and harmony in the Sector
A Presidential Committee to harmonize working relationship among health workers and professional groups in the health sector was inaugurated in 2010
The forty two member committee, headed by Justice Bello Abdullahi was to identify the root causes of disharmony among health workers, and professional groups in the sector and to examine the negative impact of such problems on the healthcare delivery system.
It has become extremely necessary to re-visit that report, understand why such report was not implemented and has thus, generated more disharmony that it was set to address ab initio.
The Committee had the following members:
1. Hon. Justice Bello A. Gusau Box 233, Gusau -Chairman
2. L. N. Awute PS/Fed. Min of Health -Member
3. HRH Dr Haliru Yahaya NPHCDA – ,,
3. Amb. A. M. Bage NSIWC – ,,
4. Pharm. Azubike Okwor PSN – ,,
5. Ayuba Wabba MHWUN – ,,
6. Mr. F. O. Faniran NUPTPAM – ,,
7. Prince M. O. Ogundipe SSAUTHRIAI – ,,
8. Dr. Omede Idris NMA – ,,
9. Pharm. J. E. B. Adagadzu FMOH – ,,
10. Dr. Godswill C. Okara AMLSN -,,
11. Dr. Pullen Igbinosun UNIBEN – ,,
12. Dr. T. A. Abiola-Oshodi SOGON – ,,
13. Dr. Ugwu Ikechukwu Odo AGPMPN- ,,
14. Mohammed M. Ibrahim HIMAN – ,,
15. Dr. MacJohn Waobiala OHCSF – ,,
16. Dr. A.E. Ike FMOH – ,,
17. Dr. Alex Onoyona TA/HMH – ,,
18. W.G. Yusuf Badmus NANNM – ,,
19. Prince Peter A. Adeyemi NASU – ,,
20. Dr. Akuma Aja EBSUTH, Abakaliki – ,,
21. Dr. N.R.C. Azodo FMOH – ,,
22. Mrs. E. C. Azuike FMOH – ,,
23. Mrs V. E. Jemide FML&P – ,,
24. Mr. Adeoye Awofe ARN – ,,
25. Mrs. N.A. Nwoke FMOH – ,,
26. Dr. A. M. Akpama FCSC – ,,
27. Prof. I. Abdu-Aguye ABUTH, Zaria – ,,
28. Dr. A.A. Ibrahim MDCN – ,,
29. Mr. R.S.J. Babatunde RRBN – ,,
30. Dr. Ego Nnadozie NTHC/FMOH – ,,
31. Prof. Nene Obianyo College of Med.,Enugu – ,,
32. Prof. Abba Hassan UMTH, Maiduguri – ,,
33. Mrs. Bola Oduntan PCN – ,,
34. Mrs. O.A. Olanipekun NMCN – ,,
35. Prof. Anthony Emeribe MLSCN – ,,
36. Hajia Amina Bayi GRA, Kaduna- ,,
37 Ebere Okogwu FML&P – ,,
38. Dalhatu Sule, mni FMOH – Member/Secretary
The committee was given about three months to submit its report.When the committee submitted their report, their findings where as follows;
1. Attitude of Medical Practitioners
The Committee was informed that doctors’ attitude of seeing themselves as all-time leaders of the Health Team without due regard to other Professionals in the Team was a major cause of
disharmony in the health sector. As observed by members during deliberations, the problem of organizational/team leadership ranked as the most critical dividing factor among health professionals; whereas the doctors see themselves as most qualified for the leadership position which they have been occupying, other professionals are of the view that as players in the team, they are similarly qualified to play the leadership role.
This irreconcilable stance of the major players in the health sector, the Committee further learnt, stemmed from the understanding or the lack of it, of the provisions of Cap 463 which some argued has vested the headship of Teaching Hospitals on Medical Doctors2. Preferential Treatment Given to Medical Practitioners in
2.Training Institutions to the Detriment of other Health Professionals
The genesis of disharmony in the health sector, the Committee was informed, could be traced to the habit of medical practitioners in trying to determine the growth and development of other professions in the health sector irrespective of existing regulatory laws of various professions in the sector. This tendency to prevent the growth of other health professions by doctors was said to have resulted in an attempt, sometime in 1991, to stop degree programmes from being offered in some professions. The Ministry had then requested the National Universities Commission to close down degree programmes in Medical Laboratory Science and other healthcare professions when it wrote, inter alia, to the Commission: “The Ministrystill supports the sub-degree programme as is taught in the Federal Schools of Radiography, Medical Laboratory Technology and Physiotherapy. A degree programme in these disciplines is irrelevant to our health delivery system…..” The Committee was similarly told that higher certificates obtained from post graduate schools in some courses were not accorded recognition. The Committee was further informed of the regrettable use of denial of accreditation of Medical and Dental Council of Nigeria as a tool to seek for change in the headship of medical laboratory departments from medical laboratory scientists to medical doctors contrary to the provisions of schemes of service.
3. Discrimination in the Remuneration of Medical/Dental Practitioners on the one Hand and other Health Professionals on the other
The Committee noted the above cause of disharmony but reasoned that issues of remuneration would be better addressed by the National Salaries, Incomes and Wages Commission, (possibly) through the process of collective bargaining.
4. Composition of Boards of Management of Health Institutions
The composition of Management Boards of Health Institutions which, many argued, is unduly skewed in favour of doctors was identified as a cause of disharmony in the health sector. The Committee was informed that the number of doctors on Boards of Management of Health Institutions far exceed that of other health professionals. Thus, the desire of these health professionals for adequate and equitable representation on Management Boards which has remained unfulfilled was said to be causing disenchantment amongst them and invariably disharmony among the contending health professional groups
5. Structure of the Federal Ministry of Health
Some members canvassed the view that the existing structure of the Federal Ministry of Health favour Medical Practitioners more than other Health Professionals in terms of appointment as Directors. The Committee however noted that it is the duty of the Office of Head of the Civil Service of the Federation, subject to approval of the Federal Executive Council, to alter the structure of any Ministry. By its approved structure, the Federal Ministry of Health has eight Departments, namely: Department of Human Resources; Department of Finance & Accounts; Department of Planning, Research & Statistics; Department of Procurement; Department of Hospital Services; Department of Public Health; Department of Family Health and the Department of Food & Drugs Services. Of the four Professional Departments, three are headed by medical practitioners while one is headed by a health professional who is not a medical practitioner. This seeming imbalance, it was argued, has a negative impact on industrial harmony.
6. Non-implementation and Selective implementation of Scheme of Service in the Health Sector.
While some cadres in the health profession do not have any approved scheme of service, there are others who cannot progress to the peak of their career even though such progression is guaranteed by their scheme of service. There are yet others whose progression to the peak of their career is unhindered. This inequity in career progression which is a source of disillusionment for professionals who cannot rise to the peak of their career also breeds disharmony in the health sector
7. Disparity in Remuneration between Federal and State Medical and Health Personnel.
The passion for having a salary structure that will apply to all medical and health personnel across the different tiers of government – Federal, State and Local Governments –was noted by the Committee as a major cause of disharmony. However, members were also quick to point out that the Nigerian Constitution places health on the concurrent list, by reason of which the Federal Government cannot legislate for the States on health matters.
8. Operation of the National Health Insurance Scheme (NHIS)
The committee was informed that all was not well with the operation of the National Health Insurance Scheme despite the lofty ideals which the Scheme stands for. The Committee further gathered that a major lacuna in the operational guidelines of NHIS is that the payment mechanism gives room for abuse. Health Management Organisations, HMOs, are the major beneficiaries of the system. Other players thus feel shortchanged by the system
9. Non-adherence to Job Definition and Description in the Health Sector.
Non-adherence to established job definition and description in the health sector is said to have resulted in a situation where everyone in the health profession wants to do the job of a medical doctor, overtly and covertly. This phenomenon, according to the Nigerian Medical Association is a cause of disharmony
10. Absence of Office of Surgeon General.
The Nigerian Medical Association stated that for health sector to be under good professional surveillance, it was necessary to create the Office of Surgeon General. Drawing from the experiences of
United States of America and Great Britain, the Nigerian Medical Association, the Office of the Surgeon General will give professional direction to the health sector and bring about the desired harmony. The Association also made allusion to the Office of Solicitor General to reinforce its argument on the need for creating Surgeon General’s Office. However, the Association did actors in the Ministry of Justice, among whom the Solicitor General may be considered as first among equals, are all lawyers. Besides, Office of Solicitor General is a creation of statute. Thus other Health Professionals and Unions were opposed to the creation of Office of Surgeon General, saying th
11. Recruitment of untrained / unlicensed personnel to practice in medical records and other fields.
The unethical recruitment of untrained / unlicensed personnel to practice in medical records and other fields undermines the reputation of the qualified personnel in the affected professions.
This is another cause of disharmony in the system. The committee resolved that government should ensure that only trained and licensed medical personnel are recruited to man medical records and other fields.
12. Poor working conditions and Healthcare environment
The Committee was informed that the unsatisfactory working conditions and environment in most public hospitals and health institutions has been a source of distress and disharmony amongst health care workers in Nigeria. The absence and, in some cases, poor state of healthcare facilities and operating instruments in the public hospitals, the Committee was further told, breeds conflict
amongst health care workers in Nigeria. This has grave implications for service delivery.at such would further aggravate the existing disharmony among health workers / professionals.
13. Indiscipline in the Health Sector.
On the problem of indiscipline as a cause of disharmony in the health sector, the Committee noted that the lack of respect for hierarchy and professional colleagues is a common feature in
health institutions. However, for efficient service delivery to be guaranteed, every member of the health team must be alive to his/her responsibilities, especially in terms of carrying out their professional duties, obeying constituted authority and according due respect to one another
14. Perennial Staff Shortage.
The Perennial staff shortage in most public hospitals and health institutions in Nigeria puts undue pressure and stress on the available staff. This shortage which, the committee gathered, is more pronounced at the primary and secondary levels of healthcare often creates avoidable crisis, disruptive behavior, uncooperative attitude and disharmony amongst health care workers, especially as the increased pressure of work makes it almost impossible for socialization amongst health workers to take place
15. Reward system.
Although some professional Associations allude to inadequacy and inequity in the reward system in health institutions as a major cause of disharmony, it is the opinion of the Committee that the Public Service Rules made adequate provision for thecompensation of outstanding performance. The Chief Executives of the various health institutions are thus to ensure faithful adherence to the provision of the rules. The Chief Executives may also take the initiative of instituting appropriatereward systems, in line with the Public Service Rules, in order to promote healthy competition with an overall objective of achieving better service delivery.
16. Appointment of Health Minister.
The question of who is best suited to be appointed Health Minister at any material time is a major cause of disagreement between the medical/dental practitioners on the one hand and
other health professionals on the other hand. While the doctors believe that they are best qualified and best endowed to lead the health team, the other health professionals argue that
they are also well qualified for the position of leadership and as much eligible as the doctors for appointment as Health Minister. This disagreement was also identified as a cause of disharmony in the health sector.
17. Appointment of Chief Medical Director/Chairman, Medical Advisory Committee Chairman and Medical Director/Head of Clinical Services
The Committee noted the divergent views of the Nigerian Medical Association on the one hand and other Health Professionals on the other hand on appointment of CMD/CMAC and MD/HOCS as an indication of disharmony. The NMA’s position is that the CMAC could come from either the associated university or from within the Teaching Hospital, stressing that the provisions on appointment of CMAC in the Act should be followed to the letter. On the contrary, other health professionals demand that the CMAC must be a full time staff of the Teaching Hospital. The consensus agreement reached was that the process of appointing the CMD/CMAC and MD/HOCS should be open, competitive and transparent.
18. Discriminatory Definition and Application of certain Terminologies in the Health Sector
The Committee was informed by some members that terminologies such as “consultant”, “medically qualified” and “non-medically qualified” have been discriminatorily defined to favour doctors. It is the view of these members that the terms “consultant” and “medically qualified” apply to all health professionals as much as they apply to doctors. Thus, they contend that the discriminatory application of the terms deprive them of gains that they would otherwise have been entitled to, adding that such discrimination is a cause of disharmony. On the other hand, the doctors contend that there is no ambiguity about who a medically qualified person is, stressing that all over the world, the term medically qualified refers only to medical/dental practitioners. It was further argued in the course of deliberations that providing consultancy services is different from being a ‘Consultant’ as in the Scheme of Service. Mindful of the contending views regarding the terminologies, the Committee recommends that the review of the Act, CAP 463, should address
the seeming ambiguities by properly defining the terms and who they apply to.
19. Definition of status of Resident Doctors in theHospitals
The Committee gathered from written and oral submissions made to it that the status accorded resident doctors is a cause of disharmony. It was argued that whereas medical and dental practitioners enjoy sponsorship for residency programme, the same opportunity is not extended to other health professionals who engage in post–graduate studies on their own. Besides, the period of their post–graduate training is never recognized for remuneration as done for resident medical and dental practitioners. They believe that all health professionals should be
given equal opportunities. The Committee was further told that the ad-hoc or temporary nature of the appointment of resident doctors contributes significantly to instability in the teaching hospitals as the bulk of the job in general medicine and surgery is being carried out by residents, so that whenever they withdraw their services, as they often do, services are seriously disrupted.
This underscores the need for the appointment of permanent medical and dental officers while only a fraction should be allowed to undergo post-graduate training at a point in time. And since
the association of resident doctors is neither a professional association nor a registered union, residents should be barred from undertaking industrial actions. The NMA, which represents
the labour interest of all doctors, should be formally registered as a labour union in line with the Trade Union Act as a precondition for engaging in union activities, including embarking on industrial actions.
20. Absence of A Postgraduate College for other Health Professionals
From some of the memoranda submitted to it, the Committee identified the establishment of a National Postgraduate College for Medical and Dental practitioners and the failure to establish a
College of cognate status for other Health Professionals as a cause of disharmony in the health sector. In the main, the other health professionals are of the view that the existing Postgraduate
Medical College should be expanded to take care of others in the health profession instead of limiting access to only Medical & Dental practitioners
21. Industrial Unions and Professional Associations
Currently, some confusion exists in the membership of unions in the health sector. It is required that the Federal Ministry of Labour should re-define the jurisdiction of each union to remove overlaps which make a member to belong to two or three unions at a time or where two or three unions are struggling to mobilize the same people into their fold. This is presently causing confusion which needs to be addressed.
22. Non-compliance with Laws of Regulatory Agenciesunder the Federal Ministry of Health.
The Committee was informed of government’s meddlesomeness and non-compliance with the provisions of enabling Acts in the composition of Regulatory Councils/Boards of Parastatals of the Federal Ministry of Health. Appointments were said to be made to the Regulatory Councils without due adherence to provisions of the law governing such appointments.
Comments that trailed the dumping of the report and the committee’s recommendation would be published in subsequent publication
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