Doctors Vs Health Workers: When Will The Feud End?
Some time ago the board of Medical Laboratory Science Council of Nigeria (MLSCN) announced the de-registration of all public and private medical laboratories in the country, with a view to re-inspect and re-register their facilities.

Reasons for this action, according to the regulatory body include: poor state of our training institutions; uncomfortable quality of test resulting from various laboratories in the country; and the activities of untrained hands, who have taken the advantage of the lapses to import and store all kinds of diagnostic reagents and chemicals under unfavorable conditions with adverse consequences to the patient.

The council made it known that its actions are within the law that established it as stated in Act 11 of 2003 with the charge among others to regulate the production, importation, sales and stocking of diagnostic laboratory reagents and chemicals as well as inspect, regulate and accredit all public and private medical laboratories.

The council then reiterated its determination to restore the credibility of the profession by ensuring that results are not only accurate but are reproducible, while putting in place an identification emblem for licensed and accredited laboratories which will aid the public in recognizing good quality laboratory facilities.

Good, as the intention of this regulatory seems, it actions generated public outcry from other professional bodies and few individuals.

Leading the pack of aggrieve bodies are the Association of Pathologists of Nigeria (ASOPON) and the Nigerian Medical Association (NMA). Both professional bodies through paid advert in the national dailies respectively directed their members not to grant access to public and private laboratories to MLSCN functionaries.

Among their desires is for the Medical and Dental Council of Nigeria (MDCN) to regulate medical laboratory science practice.

In a swift reaction, the Association of Medical Laboratory Scientists of Nigeria (AMLSN), a professional body of medical laboratory scientists condemned in strong term, the actions of both ASOPON and NMA describing it as “mischievous, unwarranted egoistic, unprofessional, and illegal”.

In a communiqué published after its EXPANDED National Executive (ENEC) meeting at Owerri (South East of Nigeria) and jointly signed by Dr. DM.F. Useh, Dr. B.E. Bassey and Uche Odionyema, the National President, Secretary ad PRO respectively, the AMLSN called upon ASOPON, NMA, health institutions and government at various levels not to ignore their core duties while it strongly urge MLSCN and all her members to proceed in the performance of their lawful duties and not to succumb to any form of intimidation and blackmail.

However, I noticed with dismay that this attack and counter attack on personality and professional bodies has once again brought to fore, the unhealthy rivalry among the healthcare providers not minding the patient whom they are all out to serve. An African proverb says “where two elephants are fighting, the grass there suffers”. But in this case, more than two elephants are fighting. One can only imaging what the grass (patient) will look like at the end of the day.

Only recently did the members of the Association of Hospital Medical Health Attendants of Nigeria cried out against shoddy treatment meted to them on daily basis by doctors, nurses, lab scientists, pharmacists and other healthcare providers in our different health institutions.

But the World Health Organization (WHO) defined hospital attendant as “all workers in the hospital setting, be it medical laboratory scientists, doctors, nurses, pharmacists etc that attend to the need of patients or clients”.

Then, if the world health governing body, sees everyone as performing the same duty – healthcare - why should there be segregation among our health workers? Why the disparity in our health institutions?

I think the sooner; the better it is for everyone to recognize that the days of one particular professional dominating affair in all facets of medicine and particularly tangentially relates areas are gone. Advancement in science, medicine and levels of acquisition of knowledge has made this a non-issue.

Management of medical institutions (particularly the Teaching Hospitals) should ensure that rightful professionals are placed in rightful position. This will ensure optimal performance and avoid the issue of square peg in round hole.

Governments at all level should also ensure the implementation of the approved scheme of service for all cadres in the hospital establishment. This will put an end, industrial disharmony ravaging our health institutions.

The health sector have been battered enough, therefore, all “attendants” should come together and put an end to professional disharmony in this sector of the nation. The inter-professional bickering which has rearing its head should end in the interest of the patients.

Every professional group has its distinct role. As players, they should all work like a team in order to achieve the ultimate goal which is ensuring qualitative and effective healthcare.
Mr. Okwor (President: PSN), He acknowledged that Nigeria has failed to improve its drug manufacturing industry, wondering why, if China and India can evolve into hubs for drug manufacturing, Nigeria cannot. “A well developed pharmaceutical sector positions us to make quantum revenue from pharmaceuticals while also stabilizing national security especially against the challenges posed by the fake drug syndrome,” he added.
Also one of the best former Minister of Health, Professor Eyitayo Lambo (2000-2007), said over 100 pharmaceutical production plants of varying capacities exist in Nigeria with an aggregate investment of N300 billion, employing 600,000 people. But he said only about 40 percent of the national essential drug needs are met by the local industry, which is too low, and contributing just about two per cent Gross Domestic Product (GDP) to the economy.
He said that the pharmaceutical industry received Foreign Direct Investment of about $1.5 billion between 2000 and 2008, with the domestic market worth about $11 billion in 2008 and projected to reach $15 billion in 2012.
He lamented the “poor and chaotic” drug distribution system within the industry, also describing the interpersonal rivalries among the various categories of health professionals in spite of clear differences in roles and functions as an impediment to quality healthcare delivery and national development.
He insisted that where there is high poverty rate, the rate of healthcare is low and that it is only quality healthcare that can create wealth, calling on pharmacists to aspire for leadership positions so that they can be in authority to implement policies that can change the poor indices against the pharmaceutical industry.
Professor Lambo who decried policy somersaults in the health sector, said any professional could be the minister of health, insisting it was only a “strategic management position and not a professional one,” insisting pharmacists must put their house in order for them to be recognized. He said the professional bodies should be complementary and not competitive,
“Unfortunately, there is lack of harmony in the health sector which aggravates the poor health indices in the country. There can be no development in the face of rancour, acrimony and hateful relationships as is now witnessed among health workers. This situation is inimical to the development of the health sector and by implication, the development of the nation,” however, saying the ministry had inaugurated a Presidential Committee three months ago to address the issue of harmony among professionals in the health sector.
The Nurses:
Here, we are not saying that nursing profession is independent of other Health profession. Infact, under dependent function of a Nurse, a Nurse is under obligation to carry out doctor's order, unless he/ she believes that the order is in error or would be detrimental to the patient, because a Nurse who carries out an inaccurate order may be legally responsible for any harm suffered by the patient.
A case where a physician gave an order that is against the body of knowledge of a Nurse and the doctor refuses to change because of his ego neglecting the queries issues by the Nurse.
This situation most of the time degenerated to rivalry between the Nurses and the doctors. Because, some doctor believed that, they are the head of the ward, which is not true! Every profession, including nursing, performing services needed by the societies. It means, every profession is important on their own. The Nursing profession consult it's own body of knowledge, part of which is specialized and unique to Nursing and part of which is held in common with other Health professions such as medicine, pharmacy, medical lab etc .It is this specialized body of knowledge, that set Nursing profession on higher pedestal than any other professions. It also establishes the direction and the limitation of their practice.
Nurses on the Health Bill
They have also criticised the section of the bill which prescribed that the head of the proposed Tertiary Heath Commission should be a medical doctor, suggesting that it should be made open to all the health professionals to aspire to.
But the NMA President said, as the head of the medical team and based on their trainings, medical doctors are more grounded to head the commission.
“As it is today tertiary hospitals are under hospital services division of the Federal Ministry of Health, if in the face of increasing number of scope of tertiary hospital, a commission is created to oversee this large area, what is wrong with that.
“The bill did not specify the qualifications, and experience of such medically qualified doctor to drive the process. Do the paramedical professionals equally want to take over the Hospital service division,” he queried.
For these two bodies, there is always something to prove. Any perceived “favouritism” shown to one is always met with stiff resistance by the other who would also demand for the same. It is this unhealthy rivalry that has given rise to the incessant strike action in the sector.
And it is this incessant strike action that has impinged on the health sector so much so that it has been identified as a major contributor to the country’s poor health indices.
A fact corroborated by the minister of Health, Prof Christian Onyebuchi Chukwu, when he disclosed that the multisectoral approach towards attaining the Millennium Development Goals (MDGs) was faced with a myriad of challenges which include lack of effective mechanisms for integrating multisectoral actions at all tiers of government on health and the challenge of unhealthy competition by the sectors which has led to duplication of effort rather than complementing each other.
While inaugurating the Presidential Committee on Industrial Harmony in the Health Sector and the Ministerial Committee on the Review of the Residency Programme in Nigeria, two years ago, the minister of Health, said that it was not his intention to preempt the committees but a careful look at the Terms of Reference showed that a fundamental requirement for peace in the health sector was a change of attitude.
He recalled that during the swearing in of ministers, President Goodluck Jonathan personally charged him to bring an end to the industrial disharmony in the health sector, as well as drastic improvement in the country’s health indices.
He said it was a commitment to deliver on what he called, “our primary responsibility which is the good health of our patients by all working as a team and complementing each other”.
He decried the situation where health workers were more interested in their salary structure while negating the good health of their patients.
He called for a change of attitude among health workers, adding that they should eschew all forms of negativity while attending to the public.The Committee was chaired by Justice Bello Abdullahi and Dr Roland Ndoma-Egba respectively.
Interestingly though, the report which was submitted since mid- last year is yet to be made public.
An action which has made the health workers to cry foul that the minister who of course, is a medical doctor was trying to doctor the report to favour his professional group.
As professionals, the interest of the patient and how to move the sector forward should be paramount in their minds.Until they sheathe their swords, the health of Nigerians would continue to suffer because as the saying goes, when two elephants fight, it is the grass that suffers.

Evidence-Based Healthcare Services.
More often than not, we blame the doctor for every treatment failure we have. We tend to overlook the role the medical laboratory scientists play in the health care delivery. Most of the reasons for the all- round tripping medical tourism being experienced in the country today could be linked to the poor medical treatment. Many Nigerians have lost confidence in the ability of the Nigerian doctors to treat them well so they’d rather go to the foreign land where they believe things cannot go wrong to get the desired care. However, we sometimes forget that the basis or bedrock for any treatment is test or diagnosis and that a doctor’s evaluation or judgment is based on that. And pray, tell, what happens if a patient gets a misdiagnosis from the lab? Your guess is as good as mine.
Now, it’s a global world. Times are changing so also are the ways we used to do things. Gone is the old order for the new one.
Perhaps, knowing the importance of their work to a patient, , the Medical Laboratory Science Council of Nigeria (MLSCN), announced that it was to collaborate with John Hopkins University and Association of Medical Laboratory Scientists of Nigeria (AMLSN) , to implement a web-based Continuing Professional Development (CPD) programme funded by the United States Agency for International Development (USAID).
According to the registrar/ chief executive officer, MLSCN, Prof Anthony Emeribe, the project named K4 Health/ Nigeria Web- based Continuing Professional Development Programme (CPD) for Nigerian laboratory professionals is a United States Agency for International Development (USAID) funded seed project providing opportunities for medical laboratory scientists to continuously improve their knowledge, update and sharpen old skills and acquire new ones. He said this was to ensure that medical laboratory scientists remain at the cutting edge of professional knowledge and competence to render accurate and reliable diagnostic laboratory services to the patient and the society.
Emeribe noted that as a responsible association, he was urging his members to cultivate the habit of pursuit of excellence in professional practice in the interest of the patient and the society.
He said that through this programme, the association in conjunction with Medical Laboratory Science Council of Nigeria(MLSCN) is launching a vanguard for mandatory professional medical laboratory education for every medical laboratory scientist in Nigeria.
“Nigerians will benefit tremendously from this project due to enhanced access to CPD which will result in improved skill and proficiency of laboratory professionals,” Emeribe said.
The association also reiterated its call for the introduction and incorporation of laboratory services at the primary health care level in Nigeria.
The president of the association, Dr Goodswill C.Okara, said that the practice of treating every patient that complains of fever for malaria or typhoid is antiquated, saying, “our people in the rural areas are deserving of appropriate laboratory services in the 21st century.”
He said every medical laboratory scientist will henceforth show evidence of having acquired a specified minimum number of credits before renewal of practicing licence in a given year.
According to him, without fulfilling the minimum number of credits, practicing licence will not be issued by the council.
On the Health Bill
The Assembly of Healthcare Professional Unions in a swift reaction called on President Jonathan not to sign the National Health Bill into law as it contradicts existing laws.
Its spokesman, the National Vice President of the Association of Medical Laboratory Scientists of Nigeria (AMLSN), Dr. Godwill Okara, told journalists during a press conference on May 23 that if signed into law the bill will lead to industrial disharmony.
The Assembly of Healthcare Professional Unions consists of nine associations including the Association of Medical Laboratory Scientists of Nigeria (AMLSN), the Pharmaceutical Society of Nigeria (PSN) and the National Association of Nigerian Nurses and Midwives (NANNM) and the Association of Radiographers of Nigeria (ARN).
Okara, flanked by representatives of all the nine associations, described the bill passed by the Senate as "garnished poison", noting that it contains "provocative and conflicting provisions that must be removed". According to him the NMA rushed the Senate into passing the bill for the purpose of sidelining other key professionals in the health sector, a situation he said, was unacceptable to his members.
He decried the fact that despite the unions meeting with the House Committee on Health, writing to the President, the Senate President, and its spirited efforts to present their position to the then Senate Committee on Health none of their presentations was used as input in the Bill. He however acknowledged that President Jonathan through the inauguration of the Presidential Committee on Industrial Harmony had shown interest in preventing strikes in the sector, just as he has noted that the Senate passed the Health Bill in good faith but said that the lawmakers were unaware of the full implications if signed into law.
"The Bill will not only conflict with existing regulatory laws in the healthcare industry, but will increase the crises in the health sector. The victims of the crises will be innocent patients, healthcare professionals and the larger society that patronise our health facilities" Okara said. To further show their disapproval of certain sections of the bill, two days after addressing the press, the unionists in their thousands protested against the president assenting to the bill at the Eagle Square, Abuja. As early as 10am, the protesting health workers converged at the entrance of the Eagle Square, carrying placards with inscriptions: 'No to conflicting sections in the health bill,' 'Health Bill more crises in the health sector,' 'Mr. President don't sign the health Bill,' while singing solidarity songs.
Okara reiterated the stand of his group that the first part of the bill, which seeks to regulate and set standards for the practice of various health professionals, was unnecessary since there were professional organisations set up by the government to regulate the practice of various health professionals.
"The bill also assigned the power to prescribe functions and duties of various health professionals to itself. We believe the National Council on Establishment is already saddled with the responsibility to do that, and giving the same duty to any other body is duplications.
"We are also against the aspect of the bill which states that the National Hospital Commission should be headed by a medical doctor. We believe this position should be made open for every professional in the health sector to aspire to. We have complained to the Minister of Health on this issue, and nothing was done till the Senate passed the bill.
"We are, therefore, appealing to Mr. President not to assent to the bill until these grey areas are expunged. We are going to forward our letter to the President through the Secretary to the Government for the Federal," he said.
Unperturbed by the complaints of the other unions NMA which in February led women groups to the National Assembly to protest the non-passage of the bill immediately responded in a strong manner labelling as 'crass' the call made by the other health professionals that the bill should not be signed by the president. Without mincing words, Idris, who responded to the threats of the Assembly of Health professionals during a press briefing on May 26, said the Assembly of Health Care Professionals and unions opposition to the bill was selfish, adding that Jonathan should sign the bill into law.
He said, "Mr. President should not be distracted by unnecessary wrangling and threats. It is our fervent hope and expectations on behalf of many voiceless Nigerians that the president signs the bill to law." He posited that it was unfair for the other health professionals to accuse doctors and the Federal Ministry of Health of designing the bill with ulterior motives. For him, those who passed the bill should be commended, as it will improve healthcare delivery in all parts of the country as well as greatly reduce the infant -maternal mortality rates.
According to him unlike what had been said by other healthcare professionals who staged a protest over the bill, it does not "Abrogate any laws of the regulatory bodies." He equally said that opposition to the section of the bill which reserves the chairmanship of the proposed National Tertiary Hospitals Commission for doctors was unnecessary. He maintained that the doctor was the head of a medical team, "Excerpt in Nigeria there is no part of the world where the leadership role of doctors is brazenly assaulted by other healthcare professional," he said.
So far, none of the contending factions have softened its position over the health bill. Many are of the view that for the bill to bring about the much touted transformation to health sector, all professionals must agree to it, rather than the situation where some perceive that the bill as marginalising their profession. Many have expressed fear that if nothing is done to make the health bill acceptable to all, the war of words will not abate with patients suffering from the continued rivalry among health care professionals. Time will tell if the president will sign the bill. Though not a few stakeholders believe that Jonathan ought to seek means of assuaging the feelings of those aggrieved by controversial sections of the bill by finding a middle ground even it means his seeking an amendment of the bill.
The Patients must be our concern.

link for the federal government panel report on solution to professional disharmony in health sector. www.nigeriannma.org/vip/report.pdf

i think we need to deliberate extensively on this topic because it is the bane of the health sector

I strongly agree with you.Every profession is unique only if we stand to appreciate its worth.There should be a constitutional review on who should be the oveeseer of the health sector.it could be any body amidst the health worker provided he has all it takes to make it better.

D reason fr disharmony in d health sector is majorly becos of Physicians;dr ego is too much,dey always claim dey knw it all forgettin dat U can't b jack of all trade,...$ oda things. Secondly U can't be a judge in ur own case;a situation we're chief executives of health institutions,minister of health,minister of state fr health,board members of hospitals $ directors in d ministry of health ar all Physicians jeorpadizes oda professionals in d health sector..ds ar purely manegerial positions $ nt professional offices.. A Physician can be d head of clinical services bt d administration of d hospital shld be rotated amongst evry professional group!

Justice must prevail