healthWhy 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

For further enquiries, contact pharmacist chijioke on ugwulekecc@gmail.com or 07039510463

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