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)
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