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Read This by hechman(m): 3:46pm On Jul 24, 2014 |
Addressing The Crisis In Nigeria's Health Sector...Part 1 Put modestly, the health care sector in Nigeria is currently on life support. Something has to be done fast and decisively to revive the sector and to provide for Nigerians the kind of health care system that is befitting for any self-respecting population of humans. The problems bedevilling the sector are enormous: ranging from poor funding by the government – with resulting poor equipment and lack of specialist medical personnel-- to brain drain and lack of industrial harmony among the workers in the field. I am not sure if there is any other sector in Nigeria that has been traumatised by industrial disharmony more than health care. The sector has been literarily brought to its knees by inter-professional bickering and struggle for supremacy. While the doctors contend that they – by virtue of their training and responsibilities—are the natural heads of the sector, other health workers including nurses, pharmacists, laboratory technicians/ technologist, radiographers, and practically every other non-physician staff argue otherwise. While this rages on, the health care sector continues to suffer with attendant loss of innocent lives; the lives of our women and children, our fellow Nigerians. It is no surprise therefore that the life expectancy of any child born in Nigeria today is amongst the lowest in the world, only higher than that of a child born in Angola and Afghanistan; yes, Afghanistan. Just recently doctors under the auspices of the Nigerian Medical Association (NMA) embarked on a 5-day warning strike and were due to embark on a total indefinite strike beginning January 2014 but was suspended following the timely intervention of the government, who we have learnt has committed to further discussions with the union. A few weeks earlier, another body of doctors (those undergoing specialist training in tertiary institutions in Nigeria) under the aegis of National Association of resident Doctors (NARD) embarked on a total indefinite strike that lasted several weeks and, without a doubt, ensured untold hardship on many innocent Nigerians. This was also preceded by another strike in the health sector which was orchestrated by other health workers under a large and amorphous body called the Joint Health Workers Union of Nigeria (JOHESU) comprising, literally, all other health workers with the exception of medical doctors. Now, again, we have a threat of strike by JOHESU hanging over our necks. Should we as Nigerians keep quiet and allow these professionals being paid by our money to continue this wanton disregard for our sensitivities? I don’t think so. I think it is high time we turned our search light on them and insist that the right thing is done. The causes of the crises in the sector can be put down to a number of issues (from a layman’s understanding); 1. The issue of superiority in the sector i.e. who should lead the health care team? 2. The issue of welfare i.e. how should welfare packages for different cadre of staff in the sector be determined. 3. Their career progression; how do we ensure that every health care worker gets to the pinnacle of his/her career without creating bogus and redundant workforce, especially at the top? Even though this list is by no means exhaustive it very much captures the key areas of contention in the health sector. As ‘ordinary’ Nigerians we have a right to weigh in on these issues and to lend our voices too. More so because whatever goes on the health sector affects each and every one of us but perhaps most importantly, because these health workers are mostly paid from our tax payers’ money. So, I will dissect each of the issues raised above in subsequent paragraphs hoping to be as objective as I can possibly be. I have read extensively on the organization of health care systems in other parts of the world and have asked a few representatives of the contending parties what their main grouse is/are hence, this opinion, even though strictly mine, can be considered as well-informed. On the issue of superiority in the health care sector and the appointment of staff into leadership positions; I will argue that the word ‘superiority’ is a misnomer and should never be used in the context of team work. Provision of health care, like it is with almost everything else, is team work. Within the team are several professionals each with his/her own area of expertise. But as it is with every field of human endeavour there must also be a leader for every team. While leadership is not usually a birth right certain qualities entrust leadership on certain groups of people in the natural order of things. In the health care team, the medical doctor, from my understanding and by virtue of his training, job function and experience is no doubt the leader of the team. Is this arguable? I don’t think so. While all other health care workers (including the pharmacist, laboratory technicians/scientist, nurses, physiotherapist etc.) will appear to have training in specific areas of patient care, the doctor, it will appear, has training in ALL aspects of patient care. Don’t get me wrong, every member of the team is equally important but due to the central role that the doctor plays in the team then it is impossible to strip him/her of the leadership role. For instance, when a person is sick and needs to go to a hospital, the patient goes to see a doctor. The doctor, from his assessment of the patient will determine if the patient needs admission or not; tests or not; drugs or not; physiotherapy or not etc. This central role must not be taken for granted and should be respected by all and sundry. I am aware that in some parts of the world a patient can as a matter of fact go to the hospital to see a non-physician staff. This is especially true with non-disease conditions like pregnancy where a woman can be registered to see a trained nurse midwife and not a medical doctor. However, this arrangement, like I have observed, is meant to ‘free-up’ more specialist personnel i.e. the obstetricians, for more serious conditions like surgeries, eclampsia or pre-eclampsia. Interestingly, even where complications are observed in such a person, the patient is immediately registered to see a doctor. As such, it will be disingenuous to suggest that patients go to hospital to see any other health professional other than the doctor. On their part, doctors need to take this leadership role seriously and to carry all members of the health team along. They shouldn't undermine the role of the others because, as has been shown by the many strikes by other health workers, the perceived central role of the doctor cannot only be frustrated but can be sabotaged by other members of the team. If progress must be made in finding lasting solutions to the superiority debacle in the health care sector then all health workers – and the public—must be aware of their roles and stick to their brief. One of the areas where the superiority squabble is most evident is the medical laboratory. Here, the laboratory scientists argue that the regulation and headship of the hospital laboratory should be an exclusive preserve of the scientist while the pathologists argue otherwise. To be able to address this issue we need to know what exactly these two professionals do and how their training differs. According to a Wikipedia article “A medical laboratory scientist (MLS) (also referred to as a medical technologist, a clinical scientist, or clinical laboratory technologist) is a healthcare professional who performs chemical, hematological, immunologic, microscopic, and bacteriological diagnostic analyses on body fluids such as blood, urine, sputum, stool, cerebrospinal fluid (CSF), peritoneal fluid, pericardial fluid, and synovial fluid, as well as other specimens. Medical laboratory scientists work in clinical laboratories at hospitals, doctor's offices, reference labs, biotechnology labs and non-clinical industrial labs” while “Pathologists are physicians who specialize in the diagnosis and characterization of disease based on the examination of tissues removed from diseased body parts or biopsy samples. They can also diagnose certain diseases and conditions through the laboratory analysis of various bodily fluids such as the blood, semen, saliva, cervical fluid, pleural fluid (around the lungs), pericardial fluid (around the heart) and ascetic fluid (collected in the abdomen in liver disease). It will therefore appear that while the laboratory scientist specializes in conducting the analyses on samples, the professional who is trained and licensed in making the actual diagnosis of the disease is the pathologist. And to be a pathologist one has to be a ‘medical doctor’. So, while it will make sense to have a laboratory scientist head the technical/analyses aspects of the medical laboratory, the headship of the pathology department as a whole (which encompasses more than just the laboratory) should be by the pathologist. I have read extensively on this and can confidently say that my findings reveal that the pathologists are the heads of pathology departments across the world. Why must the case be different in Nigeria? Recently the media was inundated with news about the agreement by the president to appoint a Surgeon General (SG) of the Federation. Having read the arguments by the minister of health regarding why such an office is necessary, I was –and still am— convinced that such an office is indeed required. I however do not understand why the health workers can’t get their acts together and ensure that the best health care practices are bequeathed to generations yet unborn. It is heart- wrenching to note that establishment of this office is one of the reasons why JOHESU is going on strike. It will appear that their grouse with this decision is that the SG will necessarily have to be a medical doctor. But again, going by the job description of this office shouldn’t it be the medical doctors? I have simply googled this and what I discovered is that the Surgeon General is the chief public health officer of the United States of America and from inception since 1871 till date ALL the appointed officers have been medical doctors. So, why must the case be different in Nigeria? In the United Kingdom (UK), the equivalent of the United States’ Surgeon General is the Chief Medical Officer and this is “the most senior advisor on health matters in a government”. The Chief Medical Officer in the UK is a qualified medical doctor whose speciality is usually in public health, and whose work focuses on the health of communities rather than health of individuals. From my understanding, these positions are necessary in order to separate the office of the Chief Public Health Officer from unnecessary administrative bureaucracy and politics that is inherent in the office of the minister of health (which shouldn’t be an exclusive preserve of medical doctors as long as a separate office for the CMO or SG has been established). So, the question still remains that, if in other parts of the world, the medical doctors who have been trained by the state, are entrusted with the responsibility to safe-guard the health of the public, why must the case be different in Nigeria? Sahfeeyah Musa is a member of Thought Leadership Forum, a group established to promote strategic, conceptual and ideology-driven leadership in the Nigerian polity; She writes in from United Arab Emirates (UAE) Leave a comment here. Send feedbacks & articles to editor@skytrendnews.com. Follow @SkytrendNews on twitter and be our fan on facebook. |
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