It was James Baldwin, a foremost social critic and human rights activist who said; “Not all that is faced can be changed, but nothing can be changed unless it is faced”. Given the gravitas of recent agitations for change and complete overhaul of the healthcare system (both structurally and functionally) in Nigeria; it is now more than ever obvious that such revolutionary change as the type propagated by Baldwin and his likes to fight the racial evils of greed, tyranny and oppression, is permeating through our beloved country and in focus: its healthcare system!
It is no news that the Nigerian health sector has been in crisis, most evidential of which has been the on-going nationwide strike by the ‘Joint Health Sector Unions’ (JOHESU). These aggrieved healthcare professionals viz. Medical Laboratory scientists, Nurses, Pharmacists, Radiographers, Physiotherapists and the like, seek to redress some injustices ingrained in the sector by decades of undue oppression and misuse of authority. Worthy of mention in this expose` is the Nigerian Medical Association, the national body of Medical doctors in the county. JOHESU and NMA form the associations of key stakeholders in the sector, together with the Federal and state Ministries of Health. The arguments and counter-arguments of each body and their role in the current debacle would be brought under focus.
The demands of JOHESU in its on-going industrial action include but are not limited to;
- Harmonization and upward review of salaries.
- Professional autonomy, viz. creation of directorates as provided for in the enabling acts of each professional body.
- Consultancy status and recognition of Specialist training for other professionals in the heath sector.
- Headship of health institutions.
Harmonization and upward review of salaries: It is on record that prior to 1991; Medical doctors (NMA) entered the civil service at GL 09 step 3 while Pharmacists (JOHESU) entered at GL 09 step 2. This was when the ministry maintained only one salary structure for all healthcare professionals. Apparently this allowed for relativity in the salary structure in line with the principle that those officers who spent one more year in training entered the service a step higher than their counterparts who didn’t. The reality now however, is that there are two separate salary scales; one – CONMESS, for the NMA and another – CONHESS, for the JOHESU. Enter the challenge: the CONMESS has enjoyed an upward review of salaries twice now (2014 and 2017), whilst same (though agreed upon) have not been implemented for the CONHESS! Thus the equation has been influenced astronomically in favour of Medical doctors, to the point where the salary differential is now nothing but unjust. Whatever argument the NMA and Ministry of Health have for their collective misinformation of the public to the end that JOHESU is asking for ‘pay parity’ is out rightly fallacious and unjustifiable!
Professional autonomy: It is worthy of mention that the Ministry of Health, is the only one in Nigeria where officers are stagnated from reaching the peak of career ladder in the scheme of service. Most health professionals except medical doctors get stalled at the rank of ‘Chief’ (GL 14) where they would remain for about 12 years till retirement; denying them the right to attain the three other ranks above this, viz.; ‘Assistant Director’ (GL 15), ‘Deputy Director’ (GL 16) and ‘Director’ (GL 17). The refusal of the Ministry of Health to create separate directorates for each profession has further aggravated this issue. Big question: Why would an accountant in the Ministry of Finance progress to the level of ‘Director’ and his counterpart, say a Nurse or Lab. Scientist in the Ministry of Health is stalled at ‘Chief’ cadre?
Consultancy status and recognition of Specialist training for other professionals: A consultant may be described as a senior professional with relevant Post-graduate training, who bears responsibility for the design, development, delivery and direction of a particular service. The roles and functions of healthcare professionals viz. Medical Lab. Scientists (MLS), Nurses, Pharmacists et al., are being modified as global healthcare practices move towards a multidisciplinary approach to patient – centered management. Training and recognition for the Consultant Biomedical Scientist (Consultant MLS if you may) has been ongoing for over three decades in the UK NHS system. The same applies for the practice in Iran, Austraila and many other ‘first rate’ medical destinations. Neighboring Ghana and the US are fast moving towards this direction with the advancement of the professional Doctorate of Clinical/Medical Laboratory Science (DCLS), which is set to become the benchmark for advanced practice; just as the Doctor of Nursing practice (DNP) and Clinical Pharmacy (Pharm.D), initiated decades ago. Drivers for this change have been identified to include; the need for a reconsideration of professional barriers to further develop skills necessary for patient benefit and efficient healthcare service; the need to provide advanced career opportunities to help retain experienced and expert practitioners. It is worthy of mention that there are Nurse Clinicians in the US who run outpatient clinics and have a more advanced role in the healthcare continuum. Contrary to what the NMA would have the public know, these and many more form the basis for JOHESU’s clamour for ‘consultancy status and recognition of specialist training’ for its professionals. A position that has been endorsed by the West African Health Organization (WAHO).
Headship of health institutions: Positions of Healthcare administration like those of Chief Medical Directors, Permanent Secretaries, Commissioners and Ministers of Health are nothing but that: Administrative functions! They are not clinical positions/headships! It is worthy of mention, that heads of international medical organizations have not always been Medical doctors. Case in point is the current Director General of the World Health Organisation (WHO): Dr Tedros Adhanom, a Biologist and Public Health researcher, who had also served as Minister of Health for our ‘sister-country’; Ethiopia. It therefore defies logic for the NMA to claim monopoly over leadership of the Ministries of Health, whilst using same to oppress and antagonize other professionals it has deemed not of ‘its kind’. “Ignorance (permit me to add GREED) allied with power is the most ferocious enemy justice can have” – James Baldwin. It is this same greed that has made many (notably most members of the NMA) to misuse their office for professional treachery, instead of pursuing honestly, innovative ways of improving availability and accessibility of qualitative healthcare for all.
In spite of the sumptuous challenges bedeviling the nation’s healthcare system in the form of professional antagonism and high-handedness of government; it is inspiring to note that discerning members of the public, including some key stakeholders in the sector are grasping the nuances of the whole debacle. The Governor of Kwara state, Abdulfatah Ahmed, recently appointed a Nurse as the state’s Commisioner for Health. I am still awaiting the NMA to expectedly, go on a tirade and media rant to misinform the public; that a Nurse and indeed any other health professional whom is not a Medical doctor is not capable of healthcare administration. The Lagos state Governor, Akinwunmi Ambode recently approved career progression to the Consultant cadre for Pharmacists in the state. By these collective actions, they have set the pace for the Federal and other state governments to follow.
The dynamics of healthcare provision globally are changing, and there is empirical evidence for the economic and clinical benefits. If we are to truly develop and guarantee the best level of care for the patients we serve, issues like those raised by the JOHESU must be assessed based on their own merits and not upon biased sentiments and the stammering egos of Nigerian Medical doctors (the NMA), who should know better!