The Nigerian Health Sector; Just Before The Waterloo

It's been over two weeks now since the Nigerian Medical Association pulled her members away from work throughout the country making a lot of the common Nigerians groan under the agony of seeing their loved ones suffer from illnesses without getting proper care and some even loosing precious lives in the process.

Much as many may feel that the worst has come, it is instructive that we take a critical look of the present predicament and understand that the worst is yet to come. Judging by the facts of the issues that has led to the present action of the NMA, it is clear to me that if urgent and decisive steps are not taken then the Nigerian Health sector is just about to meet its waterloo.

No doubt NMA and her doctors have received the worst bashing from the general public; which has been fueled by the support of the Union of the Joint health workers under the aegis of an amorphous body called JOHESU. This situation is so because people lack dept into the issues that has caused the present action of the doctors and of course the fact that they cannot phantom why the doctors would appear so callous as to abandon their patients.

If we must avoid impending doom it is imperative that we take a critical impartial analysis of the present issues, so that we can take decisive steps to avoid the worst coming to being. Rather than just always criticize the doctors for withdrawing services, it is better to first understand the issues dispassionately; next we can then query the decision of the doctors to have taken withdrawal of service as the option to pursue their agitation.

For all those who have good knowledge of the goings-on in the health sector of Nigeria, it would be clear that whatever crisis we are witnessing now is a result of conflict that has long bedeviled the sector and has been brewing for over two decades ago.

Without prejudice to any of the disputing sides, i make bold to say that health service requires the collaborative efforts of various professionals and other allied workers whose only goal is to come to a positive outcome of patient care. Every part of this whole has its integral role that it plays and one part may not claim superiority over the others.

However, in any scenario where we have different people coming together to achieve a single goal, there must be direction and this direction must be provided by leadership. The problem in the Nigerian health sector is that leadership has been misconstrued as superiority and as noted earlier, this problem has been on for decades. I also make bold to say that both sides are guilty of this misnomer.

Much as we try to have a clear understanding of the distinction between leadership and superiority, we must however also have a clear mind as to who to Captain the ship. It is commonsensical that only one captain is needed to direct this Ship, and anything other than that leads to chaos; which is exactly what we must avoid.

It is also commonsensical that the best person to captain the ship is the most knowledgeable person about the entire process and without doubt that positions falls to the doctor. That the doctor is the one with the most knowledge of the patient is what the other health professionals find discordant to their ears and this has been the bane of the long standing conflict. But no one gets annoyed or argue when the lawyer says that he is the only learned person. Why should this concept be a problem within the health sector.

The common man may however find it petty that such issues should be taken so seriously by the doctors and more so resulting in such serious action as withdrawal of services. I must however paint the full implication of the issues as it affects the medical profession and ultimately how it affects the care of the patients too.

What the other health workers are asking for is not just a name, but to use and be accorded what is due to the term consultant. Other than that they also believe that it is their right to also head the health team. (Using the term health team gives a clearer implication of this request.)

Let us all be clear that the term consultant may refer simply to an advisory role between a professional and its client. Within the hospital setting however this is not so. The term consultant refers to a specific role which describes a relationship between a patient and a physician who has completed his specialization in a particular part of medicine. It is a position of responsibility as well as authority.

The implication is that if a doctor does not become a specialist, irrespective of many years of practice or getting to the highest position in service, it still does not confer on him the title consultant. What do we then make of a Nurse or pharmacist who wants to attain the same status. It has been believed that because these other health workers now pursue postgraduate degrees up to attaining a PhD it is therefore expected that it is okay for them to receive such status. But pursuing an academic career is completely different from specialization. Even a medical doctor who decided to attain a PhD does not get the title consultant.

The implication of having other health workers attain the status and role of consultant is that it provides more than one captain to direct the ship. For instance the consultant pharmacist may believe that he is a specialist in the field of drugs and therefore may decide on what drug a patient may or may not be given. Everyone else including nurses and laboratory scientist may decide on themselves what they want or do not want for the patient. There exists no other word for this other than chaos!!

How would a patient get well with conflicting orders? Indeed who would be ready to get on board a ship with more than one captain. Well I wouldn't, even if the ride is for free. Let it be clear that the scenarios painted above are not just suppositions, they are realities that already exist even before the conferment of this title. The doctors have however been able to save the situations in the past by referring the other team members to their specific roles and responsibilities. Now that the title has been conferred on other health workers it has been impossible to get proper direction for patients' care in places where this happened and patients have been at the receiving end of it all.

With respect to the issue of headship, a clear distinction must be made between the head of administration of a hospital and the Chief Operating Officer. The position of the head of administration of the hospital has been occupied by people other than medical doctors. The NMA has no issue with anyone with the requisite skills to occupy that position. But when it comes to the chief operation officer of the hospital; by whatever name it is called, Medical Director, CMD, CEO of CFO, that position we maintain should be headed by a Medical doctor.

This is a position of high responsibility and one in which the officer has to make judgment call that is not based on just administrative matters but that is based on the clinical responsibility of the hospital. We must have at the back of us our minds that the goal of the hospital is patient centered. It is ONLY (note emphasis) the doctor that has the COMPLETE knowledge of the patient and can take most responsibility regarding patient care. It is therefore a desideratum that the doctor only can occupy this position in other to deliver on the expected goal of the hospital and health systems.

One cannot but be puzzled and amazed at the rate at which other health workers have jostled for the top post. These are people who are indeed very protective of their position and roles. Would the pharmacist allow the pharmacy department to he headed by a pharmacy technician? Would the laboratory scientist prefer to take instruction form the technicians? We know the answer to these questions. I also know as a matter of fact that there is a law in this country that bars non radiographers from using radiological equipments even the technician within that department is not allowed.

It is dismal that while these group of health officials are highly engaged in professional territorial protection, they are also agitating for the job, authority and responsibility of the doctor. This and the chaos that may arise from it is what the doctors are protecting for engaging in the current industrial action.

Haven understood the basis of the industrial disharmony one must still ponder why the option of withdrawal of services has been taken by the doctors; especially when the grave consequences are well known.

In any reasonable society doctors are not to be allowed to go on strike under whatever condition. The onus however is not left to the doctors alone but also to the government and the general public. We must remember that the doctors are also a part of the society and become subjected to the same factors affecting everyone. The physician oath indeed recognizes this fact and provides that a physician should be well treated by the society as long as he plays the role of dedicating his time to patients care.

While one cannot take away the option of the doctors to agitating for their well being amongst other things, it is a terrible thing for doctors to withdraw services especially in a large scale. I believe that other methods must be available for the NMA to pursue its demands. We know that dialogue do fail but even when pushed to the wall the option of strike is very grave.

The organized labor NLC, TUC, etc and civil society groups should rather come to the aid of the doctors and serve as pressure groups to pursue the clear demands and aspirations of the doctors. But what would you have NMA do when those who we believe are supposed to be the intercessors are the ones who actually worked against the NMA.

As a matter of fact, while JOHESU had gone on strike a couple of times over this issue in the last one year, NMA has averted the same course by postponing an industrial action at least four times last year alone. NMA had continued to embrace the part of dialogue to pursue its demands. The game changer was the point when the Nigerian Labour Congress teamed up with the other health workers and threatened the federal government to sign the agreement with JOHESU even without prior fair hearing from NMA.

With the Federal government haven signed an agreement with JOHESU which is the complete reverse of the understanding with the doctors, NMA is left with no other choice than to take her destiny into her own hands. This is the reason for the current action of NMA and I sincerely await a dispassionate suggestion as to what other methods NMA could have adopted. The ultimatum given to the Federal government was a public document which was put on the pages of the news paper, Nigerians; including the civil society group did not deem it wise to intercede during that time frame and we all allowed the NMA to proceed on the withdrawal of services.

We all have a blame in this. The NLC, TUC and civil society groups have failed the country. We do not just claim to be a sane society without living up to such responsibilities. Up till today members of the civil society groups have not deem it fit to come into this present imbroglio.

As noted earlier, worse times are coming. How do we expect to achieve the team spirit with so much passion and acrimony. This is only a forbearer to unending disharmony. There is no team that can deliver without harmony, and there is no way the health sector can deliver on its goals without a team spirit. We must not wait to get to the end of the line. We must all act fast and decisively to forestall this grave consequence.

In other to move forward, the government must first find a way for the NMA to suspend its industrial action. One way is to ask that the whole team return to status quo ante. It is clear that only in settled waters do things mirror themselves, undistorted. Only in settled waters can we find a lasting solution to the problem at hand. No half measures.

The NMA as the rightful leader of the health sector must understand what leadership truly confers. It is a responsibility not only to the doctors but to everyone within the health sector. This is a role NMA has not truly delivered over the years. Only when the NMA assume this rightful responsibility can the other members of the team be ready to follow her leadership.

NMA and other health workers must come to a round table with a no winner no vanquish spirit. Together they can plot a future for the health system of this country. A future that cater for the needs and responsibilities of every member of the team, a future that is patient centered, geared towards improving quality in health care and elevation of the various professionals and allied groups within the health workforce.

This is the only dream that is truly positive. The only vision that can be pursued and lead to a positive future. Lets all swallow our pride and act wisely. Posterity be our judge.

Dr. Tque Majolagbe, Youth Forum; http://ENDS.ng [Every Nigerian Do Something]