http://nigeriacommentary..com/2014/07/collapse-of-nigerias-healthcare-why.html?m=1



A Nigerian Socio-Political commentary
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Thursday, July 3, 2014

Do we really need to have this conversation? Are we not being immodest having this discussion? Is our position understood by the public? How are we perceived in the court of public opinion?

I had tried to resist joining the fray in the conversation between Medical doctors under the aegis of the Nigeria Medical Association and the paramedical and allied professionals grouped together as JOHESU, the Joint Health staff Union. I however became constrained after asking myself the foregone questions. Indeed, opportunities to provide some perspective and insight are too golden to let slip by. Posterity, and indeed the profession would not judge us kindly if we are silent in these troubling times.

I quickly make open my affiliation to the Nigeria Medical Association as a member of about ten years standing. Equally, do I readily admit to the myriad of problems in Nigeria's healthcare generally, and specifically related to medical education, examinations, organization, practice and regulation. My opinions, thoughts and biases have been expressed variedly in publications and discourses over time.

I shall not address the 24 demands of the NMA specifically, but give an overview of why Medicine remains first among equals, primus inter pares, and preeminent in the sector and indeed in the larger society.
If Nigeria were a knowledge based society as it should be, most anomalies that are seen will not be seen; a place where princes walk, and slaves ride on horsebacks!
It is because of such anomalies that these issues arise at all, and must be discussed.

Why really are differing admission criteria set for different undergraduate university programs? Why are certain choice courses like Medicine, law, engineering, accountancy not open to all comers? Why, inspite of interests expressed is everyone not able to study medicine and are instead given programs like nursing, laboratory science etc? Why?

1. One reason is because these are professional courses that are held in very high esteem in and by all societies. An admission into any of these confers a lifetime of respect, rights, privileges and responsibilities on the individual so lucky in the eyes of society. In particular, Medicine is an occupation of benevolence, and is only second to the clergy in influence, at least historically.
Very great value is thus placed on these occupations, and such professionals occupy class One of every society (of course, maybe except Nigeria).
It is this value that translates to premium renumeration, rewards and salaries, headship and leadership in the hospital, sector and society, and the fiduciary relationship with clients.

A natural barrier to entry is consequently placed, to limited the number and quality of persons who gain admission. The barriers to entry are reflected in the choice of subject combinations, credit requirements, JAMB cutoff points, financial requirements, demonstrated leadership potential, motivation or drive inter Alia.
Pharmacy remains the only discipline that comes close to Medicine in the healthcare industry in terms of these requirements.

2. Entry level requirements for each discipline differs equally; because of the value of each ones' contributions, roles and responsibilities. Whilst a three year associate degree is sufficient to become a registered nurse (even though bachelors programs exist), a Bsc program for Medical laboratory science, ditto for optometry and pharmacy ( 5 years) the minimum for Medicine is a professional or doctoral degree( minimum of six years). While a case may be made for a professional or doctoral degree for pharmacy(Not yet available in Nigeria) the same cannot be said for other allied medical disciplines.
It is pertinent to underscore the fact that, unlike the other programs, a semester system is not the norm in medical schools because of the sheer demands of the program, and to be able to accommodate completion in the six years duration for training. Thus, while other undergraduates relish the inter semester breaks, the average medic slaves away to survive the brutal demands of the program.
The curricula includes microbiology, chemical pathology, hematology, morbid anatomy, public health, pharmacology, surgery, Medicine, clinical clerkship etc cutting across all areas and providing a panoramic view of every area, something necessary for proper leadership.
Yours truly spent eight years, inclusive of a one year ASUU strike!

3. "Necessity" or need for on-the-job training. Please take note of the "necessity". Besides the initial doctoral or professional degree obtained, further residential training is necessary in all fields of medicine, ranging from public health, obstetrics and gynecology to Laboratory Medicine. A minimum of 4 years is required at the earliest, and up to 8 years depending on the specialty, with further differentiations and super specializations being necessary occasionally. These are the minimum mandatory requirements for practice of medicine. How then can the laboratory scientist, no matter his pedigee now lord it over the Laboratory doctor? Since when did technicians and draftsmen begin to be the boss of engineers? This is the only analogy that is apt!
Because the public sector is where anything goes literarily, members of JOHESU capitalize on this, employing the game of numbers and raw brawn to place increasingly outrageous demands on government.
A private sector driven health industry will put sanity into our heads, and water will find its level!

4. Demand, supply and rarity of skills. Because of all the aforementioned reasons, the supply of specialists, otherwise referred to as "consultants" is very limited, whilst the demand continues to be heavy. A world Health organization recommended ratio of doctor to clients is about 1: 500. But for instance, in Nigeria, the ratio of psychiatrists to the population is about 1: 1.2 million Nigerians (less than 200 psychiatrists to 167million Nigerians)
A similar abysmal picture is seen in in most specialities of Medicine in Nigeria, not least of which reason is the low renumeration compared to work load, poor work conditions etc.

5. Roles, responsibilities and demands of the job.
The physician takes full responsibility for the health of patients in his care. This includes a fiduciary relationship in which he is obliged to act in the patient's best interest at all times, and bears full responsibility for clinical and ethical judgments, and takes responsibility for litigations.
It is he who statutorily confers the sick role on an individual in any society among other things.

Without prejudice to the rights of others to self determine and aspire, "relativity" between medical doctors and the other disciplines must be preserved. A situation where brigandry becomes the deciding factor on who gets what, rather than appropriate job evaluations, enlightened assessment and international best practice is not and cannot be acceptable. The choice of doctors as head of the health team is a result of their conceptual understanding and panoramic view bestowed not by choice, but necessarily of training.
For the same reason a non accountant will never be the accountant general, and a non lawyer never the state attorney or chief justice, should a non medical doctor become the head of hospitals, particularly the tertiary hospitals.

Post script

The points above are what is used in job evaluations, not some wanton and arbitrary parameters. Not the charade which ranked "Medical doctors slightly lower than physiotherapists and laboratory scientists". Such will never fly if not with some hired pretenders. The government must look to hire world class consulting firms like KPMG, BCG, or even PWC to conduct such evaluations.

Within the hospital precinct, relatively basic functions of Nurses, laboratory technicians, physiotherapists, pharmacists are needed. A PhD in any of these has no place or use in the general hospital setting. Maybe so in the universities.

I do agree that doctors need to place greater emphasis on interpersonal and interdisciplinary relationships, communication, and generally view themselves as privileged custodians of a sacred duty, not as taskmasters and overlords. Our approach and manners towards others go a long way in eroding or enhancing this respect already conferred on us.
We need to reemphasize communication skills already embedded in the curriculum.

I also do agree that doctors who wish to head the hospitals must possess something other than the medical degrees. Something to help them be better managers of human, financial and material resources. Indeed I suggest that a faculty for hospital administration/management be created in the graduate medical colleges as a distinct residential track and/or postgraduate taught masters programs in Hospital management/administration be availed some universities.

Finally, the choice of career can mean so much; the difference between personal fulfilment, satisfaction or otherwise. It may mean the difference between how far one wishes to go, and how far he actually goes. Thus, the role of career counselors in secondary schools cannot be over emphasized.
He who sowed mangoes cannot now come reap plantains, or can he?


Timi Babatunde

My chief, you have said it all.

Let our resolve to right the illegality of past mistakes and to preserve this" our" noble profession as passed down to us by our forebears not be capitulated by our leaders.

This is a fight we must carry to a logical end if we must continue to remain relevant in the health industry of Nigeria despite our battered image.

Another wave of brain drain in the health sector sure stares Nigeria in the face if the fallout of this strike goes contrary to the norms in civil climes.

This guy is living in the olden days.