NMA Strike: Patients’ Needs versus Staff Needs in Nigerian Hospitals

The current industrial strike by medical doctors in Nigerian public hospitals is an unfortunate development, none the less; it is serving to put focus on erstwhile subterranean trending issues in medical care services provision in Nigerian hospitals. At the core is the attempt by non medical doctor personnel to force a policy change in how hospital services are managed. Without a formal policy declaration by government, what JOHESU et al are wanting to foist on the health system is a change of direction on how our hospitals are managed from a patient centered focus to a staff centered focus, using the strategy of staff benefits considerations.>> The initiator of the ruckus is JOHESU et al. The first salvo fired is a direct challenge of the traditional role of medical doctors as the head of the health team. We need to remind ourselves that the formal health sector in Nigeria has adopted “Allopathic” (aka Western Medicine or evidence-based medicine) model for provision of medical services in our hospitals. Allopathic medical service is a STRUCTURED practice organized and structured to focus on providing EFFECTIVE evidence based solutions to patients’ medical problems, not staff benefits.

The Allopathic model groups patients’ problems into “specialty” units of closely related medical problems to streamline and facilitate patient problem management, e.g. Paediatrics, Surgery, Obstetrics & Gynaecology etc. Consequently decisions on how to deploy resources required to provide services also follow through from anticipated patient needs generated from these units, etc. This way it is possible to plan holistically for which services to provide. If the required resources could not be made available, e.g. equipment, supplies, staffing, etc., then that hospital would not offer to treat patients having problems in that specialty area.

Let’s start off this discussion with the most basic scenario – the patient has a medical problem and approaches the hospital for solution. To solve that problem, someone has to move into the role of the individual that would provide direction and vision (& supervision) of how to solve that problem. In a group, the person who fills that role is known or called a leader. Now which among the several professional groups in the health team provides the direction, vision and supervision to solve a patient’s medical problems? It is of course the medical doctor, because that is what his training prepares him for. The medical doctor is unequivocally the natural leader of the health team.>> The ONLY professional group in Allopathic medicine trained and licensed to provide global direction, vision and supervision for solving the patients’ problem is the medical doctor. In a way, that follows from the global, holistic approach to patient problem solving that is ingrained in medical doctor training. Doctors are trained to employ a very broad approach in looking at a patient’s problems, unlike the other health professionals whose training are narrowed to focus solely on their specific service (professional) area. The medical doctor is leader of the health team not because of his sex, religion, numerical strength, how charming he is, number of university degrees or polytechnic diplomas, etc. or some other spurious criteria, but because of the ROLE he plays in overall patient care!!!

This is why under the medical doctor’s direction and orders, the other members of the health team are mobilized toprovide solution to the patient’s health problems. I am yet to hear of any Allopathic based hospital where it is the Nurse or Pharmacist that the patient initially consults about his medical problems and consequently the nurse or pharmacist determines treatment modalities, initiates and provides medical treatment, admits the patient, mobilizes and supervises the medical doctor and other members of the health team while she monitors patient’s recovery progress and discharges the patient on getting well.

There is a serious, unnecessary role envy here that is now threatening to distort and disrupt provision of effective medical services in our hospitals. This is a leadership fight not in terms of solving the problems of the patients, but about who controls the resources (and clinical privileges) needed to solve the problems of the patient. JOHESU et al want a change of direction in how hospitals are run so the hospital becomes a social enterprise where resources meant for provision of medical services to patients are dished out based on the numerical strength of staff categories and NOT on the number and complexity of patients’ problems. They want hospital decision making bodies (e.g. Medical Advisory Committees and DCMAC positions) aligned using the staff-centric model rather than the patient-centric model that has been in use since Government adopted the western Allopathic model for provision of medical services in Nigerian hospitals.>> Medical doctors as the leaders of the health team have a responsibility to ensure patients interests come first and cannot allow that change to staff benefits-centered approach to happen. The other professionals in the JOHESU coalition are NOT looking at the relatively limited ROLE they play in providing solutions to the patient’s medical problems; instead they are focused on their personal benefits from contributions to the solutions of a patient’s medical problems. What is the problem JOHESU members are having with getting their PATIENT-CENTERED professional contributions channeled through unit and departmental meetings/heads receiving due attention from the MACs as structured to now believe it is by limiting the contribution of the leaders of the health team that would now solve that problem? The Medical Advisory Committee is not a tea party for discussion of staff benefits, it is a high level decision making body for the purpose of providing> direction and vision to solving patient care problems in the hospitals!

However, from training, experience, supervision of contributions from other professionals and daily encounters with the different patients, medical doctors have a more global perspective on patient needs and know that different patients have different medical problems, different service needs, equipment, supplies, etc., so the medical doctor is best positioned on the overall patient needs and the need to mobilize the different types of health resources requiredto provide solution to the patient’s problems. So why the grousing that highly experienced doctors representing different patient problems populate the Medical Advisory Committees? That is how the different patient problems getthe due attention required in terms of direction and visionary solutions.

There is no official policy decision by Government yet to change from patient problem-centered management of our public hospital services to a staff benefits-centered model, so those who are going through the back door to seek and obtain court decisions that basically changes or distorts current health policies for management of hospital patients services should be advised to first seek a formal change in the National Health policy from hospital services based on Allopathic model to another that favours their aspirations, e.g. Traditional Herbal Healing, etc.

Now on to the issue of who should be referred to as a Consultant. In the Allopathic hospital setting the “Consultant” is a role title that denotes the HIGHEST level of medical skill, knowledge and expertise to provide scientifically proven solution(s), direction and vision to solving a patient’s medical problem(s). It is not a social title bestowed on staff based on staff category, numerical strength or some other dubious criteria.

concluding path

Without any intention to belittle their contributions, the Nurse or the Pharmacist, etc. in the JOHESU Coalition does not possess the HIGHEST level of skill, knowledge or expertise to solve the patient’s medical problem. Patient’s medical problems are not named, grouped or labeled according to the service type to be received (i.e. nursing service patient or pharmacy service patient, etc.), but according to the disease or disease category they are suffering from (e.g. Menstrual disorder or Gynaecological problem, Depression or Psychiatric problem, Infant malnutrition or Paediatric problem, etc.).

In conclusion, Consultancy role is not about the highest level of staff service category or type but about HIGHEST level of knowledge, skill and expertise in treatment of patient’s problems e.g. Gynaecological problem, Psychiatric problem, or Paediatric problem, etc. hence the terms Consultant Gynaecologist, Consultant Psychiatrist, Consultant Paediatrician. etc. and not “Consultant” Nurse or “Consultant” Pharmacist … or even “Consultant” hospital Cleaner.

Thank you.

Oladele Olukayode OSOSANYA is a medical doctor and Public Health specialist with additional training in Health Education, Health Care Management & Administration.

Another medical docs weeping thread

Well...it seems the allopathic model of care is no longer working because with it we are currently ranked 191th by WHO. So I think it's time to review the National Health Policy and include complementary medicine too,other global health trends,.....why do Kenya, Tanzania, Malawi ranked above us....what did they do.
Quoting global trends......I don't see global trends on the post that will significantly reduce morbidity and mortality in Nigeria. Its just like the other posts that are staff centered not patient centered.
This is not the time of seeking
Who will lead....
Who will answer consultant......but
How much I should be paid for service I rendered should be more like it.

people should offer better option if they know one.
maybe I should ask, what happened to the anti retroviral manufacturing right that was revoked from Nigeria, na doctors cause that one too-this is the class of people that will ruin the healthcare system!

Morotov1: Well...it seems the allopathic model of care is no longer working because with it we are currently ranked 191th by WHO. So I think it's time to review the National Health Policy and include complementary medicine too,other global health trends,.....why do Kenya, Tanzania, Malawi ranked above us....what did they do.
Quoting global trends......I don't see global trends on the post that will significantly reduce morbidity and mortality in Nigeria. Its just like the other posts that are staff centered not patient centered.
This is not the time of seeking
Who will lead....
Who will answer consultant......but
How much I should be paid for service I rendered should be more like it.

You are very right.

The FG should channel funds into the development of Homeopathic Medicine, Natural Medicine,Ayurvedic medicine,Ethnomedicine, Functional medicine, Holistic medicine and research into these important fields of medicine as is done in China, India U.S.A etc, where our Politicians go for medical tourism.

No country with a solid health care system depends majorly on just one system of health practice- Allopathic medicine.

Nigeria is ripe for a functional Pluralistic Medical and health system.