Professor Afekhide Omoti is the Chairman, Nigerian Medical Association (NMA), Edo State Branch. In this interview with MICHAEL EGBEJULE in Benin City, he x-rays the challenges and proffers solutions in the hitherto comatose health sector and the lingering feud between health professionals, which has crippled a section of the health sector. Excerpts:

WHAT is your take concerning the position of CMD wherein government in a Memorandum of Understanding (MOU) recently signed and emphasized the position of CMD should be taken from hospital based professionals and that advertisements to that effect should not be skewed in favour of one profession?

Firstly, I think it is unfortunate that some health professionals are going on strike over who becomes the CMD of a hospital. Kindly note that Medical Doctors are not currently on strike. Doctors are working. It is time we resolve all areas of disagreement and work together in harmony.

At a time when the government is trying to improve on health services to the average Nigerian and when the National Health Bill has been signed into law, all hands should be on deck to render quality care to all Nigerians. The act of National Assembly clearly prescribes that a medical consultant should occupy that position. This is evidence based.

In the USA where some hospitals are run by non-doctors and others by doctors, those hospitals run by doctors have been scientifically proven to be better managed and perform much better. This is obvious because only the medical doctor has sufficient training in every aspect of medicine and surgery as well as all other support activities of the hospital. All other professions are grossly deficient in all aspect especially in surgery.

I can tell you that no health professional will deny that the doctor is the natural leader of the health team. Doctors will accept that all health professions are important. Patients come to the hospital to see a doctor, and that is not in dispute. In any case, a high powered panel, the Yayale Ahmed Committee has just submitted its report on this issue. All health professions submitted and defended their memoranda.

Let us await the white paper on their report. At present we have no idea about their recommendations. We hope it will be objective. Delivery of health service is a team work and all professions have their roles to play. All are important but there cannot be two (2) captains in one ship. Nigeria has got this one right. Doctors should head hospitals.

On the CONHESS 10 skipping, other health professionals are denied being promoted from CONHESS9 to 11. Rather, they have to go through CONHESS 9 to 10 as against what has been in practice since 1981. However, NMA benefited following the CONHESS10 skipping that gave rise to the adjustment in the salary structure of the NMA. Sir, what is your position as it seems there is a big discrimination in the health sector?

Let me put the issue in the correct perspective. NMA never supported the skipping of any level. In our opinion, it was illegal. A mistake was made some years ago when moving from one salary structure to another that resulted in skipping. The other health professionals benefited from this but medical doctors did not. So NMA asked the government to extend it to medical doctors if they were not willing to reverse it.

It was initially applied to medical doctors at the same level as other health professionals, but it was realized that, that was the entry point of a post NYSC doctor. Since you cannot skip your entry point, the government, against the will of the doctors moved it to the next level. In fact, the doctors actually rejected this. Now we hear from JOHESU that it is discrimination against them. This is an irony. There was no deliberate act to discriminate against anyone. Doctors had no choice in the matter.

In fact, most doctors did not benefit from this including me. Another misinformation being spread to whip up sentiments is that this was the adjustment in salaries received by the doctors recently. Nothing can be further from the truth. What the senior doctors (not all doctors) were paid was a corrected error in tabulated allowances of some doctors as an adjustment in allowances due to relativity which was breached many years ago.



In fact, in the interest of peace, the doctors had to forgo many years of arrears and agreed to start from 2014. Doctors neither ask for, nor did they get an increase in salaries, and I want to emphasize that. To show how cooperative the doctors are with government, they accepted only 2 months relativity allowance for now for the whole of 2014.

How do we come out from all the series of strikes in the Health sector and save the health of the public who are at the receiving-end each time JOHESU or NMA embark on strike?

It is my personal opinion that strike in the health sector by any group should very rarely be heard of. Now we have a situation where all the professions in the health sector have ganged up against the medical doctors and are demanding essentially things that are unacceptable to the doctors. This has resulted in a vicious cycle where each group alternately goes on strike. I must emphasize that most of the hospital staff on strike have nothing to benefit from this JOHESU strike.

Most of the professions on strike know that they cannot become CMD's or Consultants, yet they are on strike. Many of them have been misinformed about the purpose of this strike. Just interview the ordinary health worker and you will discover that they have the wrong impression of the reasons they are on strike. Most of them are just being used for the benefit of a few.

The solution to this problem needs to be comprehensive. Take a look at the private hospitals, also take a look at company hospitals including NNPC, Shell and even Military hospitals. Why do these disputes not occur even though these hospitals are being headed by the doctors. The problem is only in government hospitals. This is because the various unions now know that government will grant their requests even if it is unreasonable, if they go on strike.

The answer may be in privatization of the non essential services. Currently, a few services have been privatized and strikes have stopped in those sectors. Alternatively, all the health profession must be willing to accept international best practices and put selfish interest aside while the government improves the working conditions of all the health professionals while maintaining relativity in payment of allowances.

Government should either set up or encourage the private sector to set up regional pharmaceutical companies and regional laboratories where drug research and manufacturing as well as high tech medical research and laboratory tests can be performed. By doing this, other health professionals can have institutions that they can head, be able to practice their profession and have job satisfaction.

It will also benefit Nigerians by saving foreign exchange used to import drugs and do paternity and other tests abroad as well as providing employment for our teeming unemployed populations. Professionals must stick to their training and respect professional boundaries. Anti quackery laws should be strengthened and enforced and the regulatory bodies should be reduced in number.

It seems NMA is not sympathetic to the plights of Nigerians even in the face of daring situations like other unions in the health sector recently shelved their strike in the case of the Nyanyan bomb blast, also when the Chibok girls were abducted and when Nigeria was hit by the Ebola crisis but NMA went on strike despite the national emergency?



This is cheap blackmail which has been used as propaganda against doctors. Firstly the Chibok girls were kidnapped long before the doctors strike (July 1st, 2014). The other unions (JOHESU) are currently on strike and the Chibok girls remain kidnapped.

Secondly, during all the bomb blasts, the NMA directed all doctors in the affected states to respond immediately and they did. JOHESU is on strike, and bomb blasts are still occurring and Doctors are on ground to attend to the victims. This can easily be verified. NMA may not have called off its nationwide strike but directed doctors to provide full services in all national emergencies.

I admit that there were calls on NMA to call off their strike during the Ebola crisis started in Lagos state and much later in River state while NMA did not call off their strike. NMA directed doctors to volunteer to assist. I ask, who managed the Ebola patients? Was it not the Nigerian doctors?

Doctors were not invited from any country to assist Nigeria? In fact, in my state, Edo state, over 80 doctors volunteered and joined our Ebola response committee. In addition, NMA Edo State made the most significant contributions to the Ebola fight while the other unions did nothing. Edo NMA powered Ebola screening tents, PPEs, sterilizers, infrared thermometers and even published health education books and pamphlets in various Nigerian languages and distributed them to the major hospitals and to the public.

We spent millions of naira on this project and the news was carried by the Guardian newspaper and other national dailies as well as the National T.V Networks. I challenge any other union to tell us if they did anything beyond the normal call of duty like us. All over the country, the doctors were involved in public health enlightenment programmes which assisted in no small measure to effect the behavioural change necessary for the control of Ebola.

Reports have it that healthcare professionals when eventually promoted to directorship, are not given free hands to operate usually because they are not university staff which can be seen as against the law.

Doctors are not against the promotion of any health worker to any grade level. In the Federal Ministry of Health, I don't think there are up to eight directors. Now you are asking for a situation where each hospital will have over 100 to 300 directors.

How? Firstly, almost all medical consultants will have to be made directors because they are on the same salary grade as Directors or Permanent Secretaries. In my hospital (The University of Benin Teaching Hospital - UBTH), for example, there are about 170 medical consultants. Then in every other profession, pharmacy, laboratory scientists, physiotherapist, optometrists etc. you have to make many Directors.

To function properly as a director, you need to create directorates with all the paraphernalia of office and support staff. These Directors will also stop practicing their Professions and focus on administration. Can you begin to imagine the chaos and disservice to the Nigerian Populace? Can Government even afford to fund these hospital Directors in spite of the current economic hardship? Answer is no.

Nigeria and Nigerians will suffer for it. Promote them to any level, but they don't have to be directors. In hospitals, there are only two directorates, one is the director of clinical service who is a medical doctor and the other is the director of administration, who is not a medical doctor.



I must emphasize that doctors are not against any health profession rising to any salary grade. An example is the optometrist who can rise to level 17 and are designated as Chief Optometrist. Medical doctors also rise to level 17 and are designated Chief Consultant. Why can't other health professionals do the same thing and maintain professionalism rather than everyone becoming administrators.

I must let you know that many JOHESU members are our wives and husbands. Many of my best friends in the hospital are non doctors who head other unions and I have an excellent personal relationship with them and we respect each other. What is being portrayed by a few vocal JOHESU leaders is that there is war in the hospital. This is not true. We work together as a team.

There is no discrimination based on profession. In fact many doctors also complain of discrimination. Many doctors feel they are more commonly disciplined in the hospital by their doctor CMDs than members of other health unions. The kind of offences they get away with, doctors will not. Also being a University staff does not confer any advantage to anyone in the hospital.

E too long.

Nice...a very cerebral peice