For those looking for international best practices.

slimany:



where is it in the Law that doctors should solely head an hospital.

Nothing for instance says a Medical Doctor has to Head a Hospital!
You can put a person with strong Management and Finance background. Just be sure to put in a Medical Director (Not Chief Medical Director) Under him/her to provide the Medical Decision Making Direction.
I will give you an example, the CEO of Mediclinic Middle East, Mr. David Hadley is a Straight up MBA Medical Administrator. Not a Doctor;
But profitably leads the biggest Hospital chains in the Middle East! When it comes to Medical decision, he allows the Doctors take the lead. But he busy himself with looking at the financial and administrative aspect of things.
That way he is able to give all the resources needed by the Doctors to care for the patient, and to assure its done in such confines as to assure that the organization is financially solvent and making money for its investors.
Nigeria wants to have top rate Healthcare but
a) We don't want to Fund it. b) we put in untrained Medical Doctors to Administer the effort.
There has to be a paradigm shift.

That us very close to what exist in Nigeria government hospitals the only difference is the hospital administrator.

transformed:
Before they made the choice of not being a doctor dont they know that doctors head hospitals and head medical teams...why make a choice not to be a doctor and now turned back to reap age long leadership associated with doctors

So, because it's age long mean it's correct? or how do we continue doing something that's obviously not correct just because we have started doing them since time memorial.

1.Privatization of tertiary hospitals is a way forward. BUTH, ABUTH, Eko hospital etc are owned by private individuals but no strike or agitation.
2.Compulsory health insurance or subsidy for healthcare services.
3. Adopt healthcare model of a developing nation with good health care indices

yefasolution:
This is a selfish and unprofessional talk. Have you made your research on other countries health administration and wages structures?
Can a doctor work without others.
In a saner clime... you'll see a team of medical professionals including doctors, nurses, pharmacists and others working to solve health issues.
But here in Nigeria, doctors see nurses and other health practitioners as slaves or errand people who they can order around.
The bogus salary they earn gives them the advantage to study more, research,attend conferences and seminars...but other health workers are paid lower that they can't afford to upgrade on their expertise...
A few to mention among these challenges that should be tackled once and for all the health sector

My dear, have you received medical care in these saner climes, if yes you will understand that there is a marked difference between the doctor and others. Generally everyone is important and respected, but clearly the doctor is the headbof the pack. He hives others and every other person follows. By the way, a new specialist doctor is paid much more than any nurse in the US irrespective of his or her number of years of practice or expertise. And strangely, in the US, the specialist nurses do much more, they even get to see patients and give prescriptions unlike our nurses here who do much less.

amaham:
Privatise the whole system, bring in investors, make available universal insurance to make the privatise system affordable

universal insurance will never make it affordable

Teecomm:
They should accept MDs as their superior nih that's the solution

You can't compare a MD with a nurse, pharmacist etc
7years of study, and they've got experiences more than the rest
Let them even fork off, MDs will do their works for them buh they can't do the work of a MD....Simple!!

Did u say MD will do d work of nurses? I bet u they cant

dokyOloye:
Who told you that?
You mean a doctor can't dress the bed or administer drugs?
Abi na to check vital signs?

the diagnosis you make, is it not based on what the med lab scientist gives to you?
who cannot recognise and diagnose symptoms of minor cases we see everyday.
my point is the complex decisions the doctors make are based on other professionals

xreal:


Just read your comment again, does it sound right?

Is Radiology a specialty in medicine like Opthalmology, O&G, paediatrics and so on?
If so, pharmacy should then be a specialty in medicine.

Back to your comment, if Radiologist and Radiographers are of different Unions, then something is wrong.

Supposed workers if same profession in different union.

Let me stop here.

Get your facts.

You are the one that need to get your fact right. Radiologists are medical doctors who have gone through 5 yrs further training, called residency and are now specialists.radiographers on the other hand are bsc graduates who studied radiography.

ultron12345:
what about the fresh nurse that will be controlling a cleaner that has been working for over 20 years

Give us an instance sir

Dething:
Doctors should not be the only ones heading the Units. Why will the doctors be the heads of all Federal Medical centres? You will see a small boy Doctor who left school barely 5 years ago will be controlling a senior matron Nurse who has been working for 30 year with Masters Degree in Nursing. Johesu is right on that! Being a doctor is by choice, many people did not want to be doctors from the outset of their lives, they wants to Medical scientist, pharmacist, Nurse, Radiologist, etc. Must everybody be doctor to head a unit?

Why are we acting like Doctors are super human? they simply chose to be! Others who chose other career have right to rule.

Young 2nd Lieutenants fresh from the Academy lead grizzly veteran Sargents. That's because there's a heirachy/structure in place. If you don't like it, go get a JAMB form and get an MBBS degree.

rottentomatoes:
PRESS CONFERENCE DELIVERED BY THE CHAIRMAN OF NIGERIAN MEDICAL ASSOCIATION (NMA), FCT CHAPTER, DR. CHIEDOZIE JUDE ACHONWA TO STATE THE POSITION OF THE NMA WITH RESPECT TO THE ONGOING STRIKE ACTION BY JOHESU AT THE CONFERENCE HALL OF FEDERAL MEDICAL CENTRE, ABUJA ON TUESDAY,22ND MAY 2018.
Protocol
It is no longer news that JOHESU has been on strike for over a month now over sundry demands which include among others equal pay with medical doctors, headship of our public hospitals. Since the strike commenced, the Nigerian Medical Association (NMA) FCT has been following up on matters arising from it. We would ordinarily have ignored JOHESU as it concerns her ongoing strike but we are at the moment constrained to respond and put the record straight to debunk JOHESU’s deliberate peddling of falsehood, twist of facts, misinformation and manufacture of non-existent figures just to hoodwink and get the sympathy of the innocent and unsuspecting public who may tend to believe their propaganda if we keep quiet. While unionism and activism is encouraged, it must not be carried to the extreme with the delusion that the system can always be brought to its knees for unreasonable, baseless and reckless demands to be acceded to. The NMA wishes to state clearly that the ongoing JOHESU strike is essentially against medical doctors in particular, and the peace-loving Nigerians in general. The unnecessary strike, we must let Nigerians know, is centered on quest for equal pay with Medical doctors as well as leadership (clinical governance) contestation in our hospitals.
Naturally when a sick person visits the Hospital, it is to see a medical doctor to get cured of his/her ailment. In getting the patient cured, several other factors come into play between the doctor and the patient. It is within these factors that the allied healthcare professionals play their supportive roles. It must however, be emphasized that these support staff only act upon the instruction or directive of the doctor. This is the standard practice world over, and is the concept of governance in clinical practice which Nigeria cannot be an exception. Apart from the fact that the training of a medical doctor is all encompassing (it covers all the fields of other healthcare professionals in addition to the core patient care and management), it is the doctor that is held accountable should anything go wrong in the overall management of the patient. Nigerians can therefore, be the judge as to who qualifies to be the leader of the health team.
While NMA appreciates the supporting roles being played by members of allied healthcare professionals and considers them important stakeholders in the health team, it is, however, in the best interest of this country for everyone to stay within their roles as team players. Nigerians need to understand that the Hospital is structured in such a way that every treatment/instruction must be directed from the medical doctor. No patient receives anything in the Hospital unless the doctor says so. The reason is not far-fetched. It is in the best interest of the patient so that he/she is not mishandled. The outcome is better imagined when a doctor gives instruction on patient’s management and the other healthcare workers also give separate and possibly conflicting directives on the same patient. It is akin to the proverb ‘’too many cooks spoil the broth’’. The unwarranted leadership contest in the health sector by JOHESU in recent years has led to several untold hardships on our patients with attendant avoidable loss of lives in some of our public health institutions. Comparison of Nigeria health indices between the remote past and recently shows that we fared better in the former when there was orderliness, strict observance of roles, and obedience of doctors’ command with respect to patient care. Questions must be asked while this unfortunate scenario doesn’t play out in private or public-private Hospitals. The answer is obvious; everybody knows his/her boundary and must conform to laid down rules and organogram.
Concerning the quest by JOHESU to earn equal pay with doctors, it must be reiterated that NMA has never been against any wage or salary increase or adjustment for health workers. Rather, NMA has, in her numerous engagements, severally advocated for wage or salary increase for all Nigerian workers. It must be emphasized that what JOHESU is asking for is not necessarily increment in salary per se, but equal pay as doctors. They want government to pay them exactly the same amount as paid to doctors. Is a court clerk paid the same wage as a judge, or an air hostess as a pilot? The answer is definitely NO. It should be expected, therefore, that NMA will never allow JOHESU to use subterfuge and backdoor approach to become doctors. The universities are out there with clearly spelt-out guidelines for anyone who wishes to study Medicine and Dentistry. We wish to encourage JOHESU to take advantage of that rather than employing this back door approach to become ‘’doctors’’.
The concept of wage relativity is used in wage management to ensure that only equal job of equal value attract equal pay. This was succinctly and clearly stated in the judgement of National Industrial Court of Nigeria in 2006 and affirmed by same in 2013 in matters involving JOHESU. Relativity exists between the salaries of healthcare workers in the hospitals and their counterparts in other agencies and parastatals of government. Engineers, administrators and accountants in hospitals (members of JOHESU) earn between 2 to 3 times the salaries of their counterparts in the core public service. Whether this is deserved is not the question, but for the purpose of this conference, is it not contradictory, deceitful and ironical that the same healthcare workers who on one hand accepted an advantaged salary over their counterparts outside the health sector on same levels and steps will turn around to reject salary difference with the doctor who does a superior and different job from them?
Historical trend of salary award/adjustment and relativity:
Pre-independence to 1974: Practitioners of Medicine and Dentistry (medical and dental practitioners) were grouped in Senior Service Scale A which was the apex for remunerating public officers. The relativity between the salaries of medical doctors and graduates of other health sector was 1:1.58 at the entry point and 1:1.65 at the terminal point
1975: Udoji committee eroded the relativity in the health sector, and the ratio dropped to 1:1.27 at the entry point and 1:1.07 at the terminal. The NMA protested which led to the setting up of the Justice Atanda Fatai-Williams presidential committee to look into the complaints in 1990.
1991: Due to the findings of that committee, circular 1, 1991 containing two separate salary structures in the health sector was released. This was following the approval of the memorandum by the Federal Executive Council at its 11th meeting in 1990. It was an attempt to correct the distorted relativity. These were:
Medical System Scale (MSS) for consultants and below
Medical System Super Scale (MSSS) for consultants Special Grades I and II.
(A and B were contained in a single circular).
Health System Scale (RUSS/HSS) for other health care workers.
The relativity at the entry point was 1:1.28 and 1:1.2521 at the terminal.
1993: The 45% award on salaries for public officers in 1992 was implemented on the 8th of February 1993 for doctors to restore the relativity between MSS/MSSS and other salary structures.
However, on the 9th of February 1993, a 15% award was applied to other salaries through circular CND.26/S.5/Vol.IV/380 without corresponding application to MSS/MSSS. This brought down the relativity at the entry point to 1:1.1 and 1:1.94 at the terminal.
1995: The industrial arbitration panel award of professional allowances eroded the relativity. Consequently, NARD/NMA demanded for the restoration of 1:3.33 ratio prior to the award. In response government did a comparative analysis of salary/wages worldwide and found a relativity range of 1:2 to 1:2.7. Government eventually signed an agreement with NARD on a relativity of 1:2.5
1998: The Federal government carried out harmonization of salaries. The MSS/MSSS were harmonized into HATISS for doctors in tertiary institutions and HAPSS for those in regular public service. The NMA and NARD protested to the Federal Government on what they called ‘’drop in salary’’ for those who were paid HATISS. The Association rejected the HATISS structure and asked government to pay her members with HAPSS pending a possible correction of the error they observed in HATISS. This was approved by government.
NARD complained of a distortion in relativity as a result of the harmonization of salaries. The National Salaries, Income and Wages Commission(NSIWC) did half-hearted correction of the observed errors in the conversion of MSS/MSSS into the HATISS structure. These corrections were rejected citing inadequate address of the relativity problem observed. The relativity at the entry point was 1:1.2, at all other grades it dropped to 1:1
2001: The relativity of 1:2.5 (4:2:1.7) for call duty allowance was sustained.
2006 and 2013: JOHESU went to court to seek pay parity with Doctors at the NICN but that wasn’t granted.
2014: The NMA persistent protest led to the setting up of the Alhaji GoniAji presidential committee to look into her complaints in 2013. Consequently, the Federal government signed an agreement with the NMA on relativity at each grade level with CONHESS as the reference. A circular on the correction was issued on the 3rd of January, 2014. Relativity was 1:1.2 to 1:1.5
In all it dropped from 1.58 to 1.2 for fresh doctors, and from 1.65 to 1.5 for consultant Special Grade 1 and or a Professor of Medicine on full appointment in a Hospital.
We wish to, at this juncture, remind the government that NMA will not accept any attempt to further distort or erode the existing relativity as agreed and signed in the collective bargaining agreement of 2014. It is important to note that this agreement was reached with a lot of comprise and sacrifice already on the part of Nigerian doctors. It is worthy of note that members at the recently held NMA ADM unanimously resolved to utilize every means legitimate to forestall any attempt to disregard or breach the said agreement. It must be placed on record that NMA has put before government issues that border on universal health coverage, improvement of health facilities and equipment as well as issues regarding conditions of service. It is our hope that government, while engaging in dialogue on these matters with a view to making progress, will not precipitate another crisis by bowing and acceding to pressure from JOHESU.
Doctors in the FCT have been going about their legitimate duties in all public health facilities. They have had to go extra miles to cover for the absence of the allied health professionals in order to ensure service delivery to patients. Management of our public health institutions have been visited and encouraged to create an enabling environment for doctors to carry out their duties and we are very much satisfied with their cooperation. We wish to seize this opportunity to call on patients who may have mistakenly fallen for the propaganda of JOHESU that the entire health institutions have been locked down by their strike to visit and access care from our Hospitals.
We urge the allied health professionals to be reasonable in their demands, suspend their strike, return back to work to join the doctors to continue the good work for the benefit of the masses.
Dr. Chiedozie Jude Achonwa Dr. Abdullahi Nasiru
Chairman, NMA-FCT Secretary, NMA-FCT

.

See what this doctor is saying, they are not asking for equal pay for christ sake or sentiment and arrogant has deafen your ear too.

How is proposed 190k for a pharmacist for example equal to the 260k of a doctor at the same grade level, and their's also one allowance which is 4% of doctors salary and 2% of of pharmacist salary, how does 4% of 260k equal to 2% of proposed 190k. How is this salary + allowance equal? my people.

Again, how is (260k+ 4% of 260)equal to (190k + 2% of 190) at the same grade level? A doctor should please answer me.

This strike will not end soon.

Teecomm:
They should accept MDs as their superior nih that's the solution

You can't compare a MD with a nurse, pharmacist etc
7years of study, and they've got experiences more than the rest
Let them even fork off, MDs will do their works for them buh they can't do the work of a MD....Simple!!

I hope MDS would be able to perform bed pan rounds? with their ego
that was how one proud doctor remove thermometer from patient armpit,put it in the mouth say he wants accurate reading. No cleaning whatsoever
just stop all this doctor claiming high position talks,and face reality and truth. we all need each other.

kolmart:
The so called doctors are telling the world that we are agitating for parity how can that be possible for example if a doctors is already earning N10 and FG increase their salary with N5 making a total of N15, is it bad for the JOHESU who is earning N7 and also asking for N3 increment to make it N10 doest that mean parity? some people are just opened their mouth and saying all sort of rubbish without even get to the root of the matter are the doctors who are now crying fowl can publicize their salary and that of the JOHESU for the world to see? some ignorant people will be supporting the doctors without doing their finding. Doctors salary has been increased between 2014 and 2018 twice why the salary of JOHESU remain same since 2014 are the FG telling us that we are not working or important in the hospital setting? those people in support of doctors if i may ask can they go to hospital and seek doctors alone without the assistant of JOHESU and come back home completely medically ok? This is question we must ask ourself, can all of us become a doctor? let us use brain to comment not head or emotionally there is different from PARITY and EQUITY Johesu are agitating for Equity not Parity please listening attentively

Strangely a patient can go to the hospital, see a doctor, get fully treated and leave without the other health workers. Not because they are unimportant but because the doctor has been trained to do everything other health workers can do and much more.
For instance the teaching hospitals are operational and functioning fully while JOHESU have been on strike. We are even carrying out major surgeries without JOHESU. What else is required to prove my point?

Angelfrost:


You need to learn how to be objective. Physicians are just an arm of healthcare delivery, with clearly defined boundaries of profession. No pharmacist or nurse with proper training claims to be a physician. Everyone is merely demanding for fairness. To claim that your field of practice is superior to that of others is infantile and stupid! That's why johesu went on strike, so that your doctors can prove how superior they are by diagnosing, testing, prescribing, dressing wounds, even acting as gate-keepers, and morticians... It is only in a backward country like this you hear such tripe.

kolmart:
The so called doctors are telling the world that we are agitating for parity how can that be possible for example if a doctors is already earning N10 and FG increase their salary with N5 making a total of N15, is it bad for the JOHESU who is earning N7 and also asking for N3 increment to make it N10 doest that mean parity? some people are just opened their mouth and saying all sort of rubbish without even get to the root of the matter are the doctors who are now crying fowl can publicize their salary and that of the JOHESU for the world to see? some ignorant people will be supporting the doctors without doing their finding. Doctors salary has been increased between 2014 and 2018 twice why the salary of JOHESU remain same since 2014 are the FG telling us that we are not working or important in the hospital setting? those people in support of doctors if i may ask can they go to hospital and seek doctors alone without the assistant of JOHESU and come back home completely medically ok? This is question we must ask ourself, can all of us become a doctor? let us use brain to comment not head or emotionally there is different from PARITY and EQUITY Johesu are agitating for Equity not Parity please listening attentively

Strangely a patient can go to the hospital, see a doctor, get fully treated and leave without the other health workers. Not because they are unimportant but because the doctor has been trained to do everything other health workers can do and much more.
For instance the teaching hospitals are operational and functioning fully while JOHESU have been on strike. We are even carrying out major surgeries without JOHESU. What else is required to prove my point?

chara019:

I hope MDS would be able to perform bed pan rounds? with their ego
that was how one proud doctor remove thermometer from patient armpit,put it in the mouth say he wants accurate reading. No cleaning whatsoever
just stop all this doctor claiming high position talks,and face reality and truth. we all need each other.

My dear, I have been carrying the bed pans oh and sincerely its not rocket science. Infact I have been very satisfied with my patient management cos I do everything myself. I am sure the vital signs charted are right. Maybe because I am a perfectionist it suits me well. Again, the patient load is low so it works well for me, I cant say about when they become more.

careerwoman:


Please stop spreading false facts. Entry level for doctors is CONMESS step 1 and is currently 184,074

Entry level differs from internship(housemanship?). Dr!

xreal:


Do you know the rigours pharmacist go through before being certified? Same goes to medical health records professionals who renew their certificates every year (either employed or not).

Relate with the physiotherapist, Radiologist and you will know how vital their role is in the hospital.

Don't let us mention nurses.

Being a medical doctor is by choice, just as being a medical laboratory scientist is.

Discrimination shouldn't be that obvious in a government established hospital.

Yes, doctors can earn more from call duty allowances, pharmacist also run call, virtually most of these professionals run one of either overtime, call, and so on. The difference can come from there and not salary scale.

Also if I am a Radiologist, let an experienced radiologist head my department and not a medical doctor.

I am sure if JOHESU keeps quiet as they had been, a medical doctor will head the works department ( if that hasn't been happening already).

Brother, radiologists are doctors
You're talking about radiographers

drI:



You are the one that need to get your fact right. Radiologists are medical doctors who have gone through 5 yrs further training, called residency and are now specialists.radiographers on the other hand are bsc graduates who studied radiography.

Oh.
Not again.

This matter has been trashed long ago.

Don't distract my attention.
Nigeria must WIN this match.

xreal:


Just read your comment again, does it sound right?

Is Radiology a specialty in medicine like Opthalmology, O&G, paediatrics and so on?
If so, pharmacy should then be a specialty in medicine.

Back to your comment, if Radiologist and Radiographers are of different Unions, then something is wrong.

Supposed workers if same profession in different union.

Let me stop here.

Get your facts.

Listen to correction. Radiologists are specialist doctors.

chara019:

I hope MDS would be able to perform bed pan rounds? with their ego
that was how one proud doctor remove thermometer from patient armpit,put it in the mouth say he wants accurate reading. No cleaning whatsoever
just stop all this doctor claiming high position talks,and face reality and truth. we all need each other.

Are you now saying a Nurse can't make the same mistake
They claim high positions cos of their years of studies....I will still that again
For example
You can't compare me as Doc that spent 7years studying with a nurse that spent 5years in school now....I had to spend an additional years to know what a Nurse doesn't know......you can't consider us as the same now

Another example
We finished university and we were given BSc...you went ahead to further and you obtain your MSc....So you think we are both the same

Areaboyfriend:

CASE SCENERIO:
A 35 year old woman was rushed into the hospital with a ruptured ectopic pregnancy, she likely to die if who is not available?
a) nurse
b) pharmacist
c) doctor
d) lab scientist
e) physiotherapist.



PLEASE NOTE, I AM NOT A HEALTHCARE PROVIDER.

With all the drs surrounding patients in our hospitals, people still die! Some na Dr kill dem self.
LOL

Dething:
Doctors should not be the only ones heading the Units. Why will the doctors be the heads of all Federal Medical centres? You will see a small boy Doctor who left school barely 5 years ago will be controlling a senior matron Nurse who has been working for 30 year with Masters Degree in Nursing. Johesu is right on that! Being a doctor is by choice, many people did not want to be doctors from the outset of their lives, they wants to Medical scientist, pharmacist, Nurse, Radiologist, etc. Must everybody be doctor to head a unit?

Why are we acting like Doctors are super human? they simply chose to be! Others who chose other career have right to rule.

It is myopic to base the leadership role of an individual on age.

WesleyPepper:

Listen to correction. Radiologists are specialist doctors.

Is Nigeria leading the match?

sogodihno:


So a nurse is to a cleaner, what a doctor is to a nurse? U don't understand that their is difference between skilled and unskilled worker ni.

Have you considered how long it takes a pharmacy technician to catch up with a newly employ pharmacist?

Essentially, I think the basis of your argument is flawed. You referred to a newly employed doctor telling a nurse what to do as a demeaning thing. The doctor owns the patient and he is expected to take charge. Telling someone what you want then to do should not be viewed as demeaning.

Perhaps you expect such decisions to be based on negotiations with the other health workers.

A better analysis and solutions to the current crisis by Dr Ibrahim Toli. Enjoy it.
Never ending health crisis

GL 1
GL 2. CONHESS 1
GL 3. CONHESS 2
GL 4. CONHESS 3
GL 5 CONHESS 4
GL 6 CONHESS 5
GL 7. CONHESS 6
GL 8 CONHESS 7
GL 9 CONHESS 8
GL10 CONHESS 9 CONMESS 1
GL12 CONHESS 10 CONMESS 2
GL13 CONHESS 11 CONMESS 3
GL14 CONHESS 12 CONMESS 4
GL15 CONHESS 13 CONMESS 5
GL16 CONHESS 14 CONMESS 6
GL17 CONHESS 15 CONMESS 7

For the benefits of those asking us what is really happening currently in the tertiary health sector. The conflict centres around MONEY and LEADERSHIP positions which in turn is link to money. Other confounders are gross indiscipline, ego, lack of job description, failure of supervision and conflict of interest. As a whole, it is a systemic failure needing urgent, radical and wholistic repair to prevent complete collapse.

There are currently two salary structures in the public tertiary hospitals in Nigeria. They are called CONMESS for medical doctors and CONHESS for all other hospital workers including those in the administration and accounts. CONMESS was born on 29/09/2009 via the circular SWC/S/04/S.410/220 while the CONHESS was born on 08/12/2009 through the circular SWC/S/04/S.410/Vol.II/349 of National Salary Income and Wages Commission (NSIWC) respectively. Both the two salary structures are consolidated and derived from the traditional grade level (GL) system as shown above. Note that there is no GL 11 in the traditional grading system for all civil servants which is taken care of in both CONMESS and CONHESS, hence the APPARENT lack of level skipping in them.

The States and local government councils are still using the traditional grading system and pay less than the FG. To my knowledge only Yobe State has just started paying health workers exactly as the FG!

I will be using the traditional grade level system for ease of understanding. Very very few people including those in the Accountant General of the Federation's office easily comprehend the interrelationship of the 3 salary scales.

Between 1998-2013, doctors and any other hospital worker of equivalent level had identical basic salary while between 2009-2013 they had identical basic salary, hazard and teaching allowances. The differences were in call allowances where doctors earned higher and specialist allowance to medical consultants or specialists on GL 15-17 only. Note that doctors on GL 15-17 that are not specialists are not PAYED specialist allowance. In 2014 relativity was restored where the basic salary of doctors became 20-50% higher than equivalent levels of other hospital workers from GL 13-17 only. There had always been differential pay relativity between doctors and other health workers from 1960 to 1998 at various ratios. In the years 1998-2013 that was when relativity was lost. When it was restored in 2014, the conflict resolution compromise was to forgo 25 years of arrears.

After graduation from medical school, a doctor practices for 12 consecutive months under supervision of a specialist or a very senior doctor of no less than GL 15 before given licence to practice independently. These group of doctors are called house officers. Pharmacists, degree nurses and medical lab scientist have similar program and they are called interns. They are employed at GL 10 for doctors and GL 9 for the other 3 until around 2013-2014 except for degree nurses that started internship around 2016-2017. Both earn salary for one year only because of the services they offered, but they are not regular staff and hence not the entry points in to civil service.

The entry points (post NYSC) for doctors in to civil service were GL 12, pharmacists GL 10, medical laboratory scientists GL 10, degree nurses GL 9 and non degree nurses GL 8 in the tertiary public hospitals. In contrast entry point for degree holders in other ministries is GL 8. In 2013 the National Industrial Court of Nigeria (NICN) passed a judgement for skipping of GL 12 for health workers on CONHESS ie any other hospital worker except doctors. So the entry point of pharmacists, medical lab scientists (and degree nurses around 2017-2018) still remains GL 10 with skipping of GL 12 around 2013-2014. In view of this, the entry point of doctors now shifted to GL 13 between 2016-2017. Other health workers are variously employed at GL 8-9.

Medical doctors can pursue their post graduate studies through Residency Training Program (RTP) or traditional postgraduate degrees of MSc and PhD otherwise they join the public service like any other degree holder. Doctors that join the RTP in tertiary and teaching hospitals are called Resident doctors. They gain entry only after passing an exam with a pass rate of 35-45% and average waiting time of 2-4 years. They are doctors under training to become specialists. They are temporary staffs throughout the training and get promoted only after passing exams, 2-4 years after starting the program in the first stage and 3-5 years in the second stage. This is a privilege enjoyed by 15-25% per exam. The specialist exams are conducted twice a year in Ibadan and Lagos. Other health workers including specialist medical doctors are permanently employed in the hospital. The latter are also University lecturers for teaching, research and supervision of undergraduate and postgraduate students including non doctors.

Medical doctors with first degree in the University are employed as Lecturer II similar to PhD holders while every other degree holders are employed as Graduate Assistants, in the military doctors occupy the rank of equivalent of army Lieutenant and 2nd lieutenant in others, DSP and ASP in police, in Custom and Immigration same, SIO1 and SIO2 in DSS respectively.

The other aspect is that of leadership.

a) At present both the substantive and State ministers are medical doctors (prerogative of Mr President).

b) The following are departments in the Federal Ministry of Health (FMOH), ii, iii and iv are headed by medical doctors http://www.health.gov.ng/index.php/department/84-departments.

i) Department of Procurement with two divisions; capital and recurrent.

ii) Department of Family Health with five divisions; Child Health, Gender adolescent school and elderly care, Health promotion, Nutrition and Reproductive Health.

iii) Department of Health Planning Research and Statistics.

iv) Department of Public Health with eight divisions; Non-communicable diseases, Neglected Tropical diseases, Occupational health and safety, Port health services, National Tuberclosis and Leprosy Control Programme, National Malaria elimination programme, HIV AIDS and Epidemiology services.

v) Department of Finance and Accounts.

vi) Department of Human resources.

vii) Department of Food and drug services.

c) The following are agencies under FMOH http://www.health.gov.ng/index.php/department/79-the-ministry. Agencies i, iii and iv are headed by medical doctors.

i) National Primary Health Care Development Agency (NPHCDA).

ii) National Agency for Food & Drugs Administration and Control (NAFDAC).

iii) National Health Insurance Scheme (NHIS).

iv) National Institute of Medical Research (NIMR).

d) All the chief executives of tertiary hospitals are specialist medical doctors (Act of the National Assembly). There are 13 Federal Specialty Hospitals, 21 Federal Medical Centres and 22 Federal Teaching Hospitals http://www.health.gov.ng/index.php/department/83-parastatals.

e) The following are directorates in the tertiary hospitals

i) Director of Clinical Services and Training/Chairman Medical Advisory Committee headed by specialist medical doctor. There are divisions like 2 deputies headed by specialist medical doctors, (deputy) director nursing headed by a nurse, (deputy) director pharmacy headed by a pharmacist.

ii) Director of Administration headed by an administrator with divisions that include establishments, account and supply, audit, expenditure, works, nutrition, kitchen, laundry, security, etc.

f) Headship of clinical departments, clinical and training laboratories in the tertiary hospitals for teaching, training and research of undergraduate and postgraduate students. They are all headed by specialist medical doctors/unversity lecturers and in the laboratories they are also called Pathologists with units headed by optometrists, radiographers, medical scientists, technicians etc.

In my opinion the solutions to the unending crisis in the health sector are mainly,

1. Implementation of the Presidential Committee of Experts on Inter-Professional Relationship in the Public Health Sector report by Yayale Ahmed committee submitted to FG on 19/12/2014.

2. Invitation of "foreign" experts like PricewaterhouseCoopers and Agenda for Change for proper job evaluation and placement.

3. Consideration for law amendments and the movement of all tertiary hospitals under affiliated universities. They also have their issues, but they seem to be relatively more stable. There is high academic loss in the current setting.

4. Strengthen and make wholistic coverage the National Health Insurance Scheme (NHIS), and then privatise all tertiary hospitals. Both LGA, States and FG shall concentrate in primary and secondary health care services especially the former. In my limited opinion, this is the best long term solution to our low quality health care services in Nigeria. There shall also be active support for purely private investments in health. The investors will decide who heads or leads who, what, which and how.

5. Positions of leadership in the FMOH, parastatals and its agencies can be tackle by the FG as it deems fit.

You can correct me where I erred. May God forgive my mistakes.

Aknowledgement: Dr N.L. Orhue, my friends in other climes.

ibrahim Toli
doctoli@gmail.com

tsquaure:
Do you live in nigeria at all . pharmacist, nurses lab technicians do diagnose, prescribe and manage patients and get away with it . some own hospitals where they sit and see patients. I KNOW I HAVE SEEN THIS O .

It's like you've been leaving in the moon...If they didn't educate you well enough in medical school you should have read on your own that there are levels of care and of course they diagnose, prescribe and manage patients at their area of competence. They can recognise when there's danger and when there's a need for referal. You claim international best practices while closing your eyes to independent non medical prescribers in those climes.
The world is changing and we're evolving with it. NMA hasn't seen anything yet cos we're getting to the era where there'll be independent non medical prescribes even in the hospital.
That's our end goal.

Doctors have always been better treated in civil service dts y every intelligent science student wants to read medicine.

Juhesu shld be forced to resume or they shld be fired n their jobs advertised nonsense.

Do u kw how poorly lecturers are paid yet ASUU are not complaining.

Entry level doctor earning 260k dts d salary of a lecturer with 9 years post PhD teaching experience.

chukel:
For those looking for international best practices.

So what is johesu clamoring for?
Wanting same pay

Deniceone:

With all the drs surrounding patients in our hospitals, people still die! Some na Dr kill dem self.
LOL

Nurses, doctors, pharmacists, lab scientists all make mistakes.
But answer the question(maybe in your mind).

Even the best US hospitals are managed by physicians.
https://www.sciencedaily.com/releases/2011/07/110706104808.htm

chukel:
For those looking for international best practices.

Stop deceiving the people. The figures in the column for doctors are for specialists and not entry level doctors. Entry level doctors earn just a little higher than what is obtainable for other health professions. I'm beginning to wonder if part of the training in medical school involves a special course in telling of lies.