Posted on: Mon 04-07-2022

THE POSITION OF THE ASSOCIATION OF CLINICAL AND ACADEMIC PHYSIOTHERAPISTS OF NIGERIA (ACAPN) ON THE "BILL FOR AN ACT TO AMEND THE UNIVERSITY TEACHING HOSPITALS ACT CAP LFN 2004", AND NEED TO FINALLY BRING SANITY AND PUT A STOP TO NEEDLESS RETROGRESSION IN THE HEALTHCARE SECTOR IN NIGERIA

The Association of Clinical and Academic Physiotherapists of Nigeria (ACAPN) recently received with delight the call for public hearing by the National Assembly on the "Bill for an Act to amend the University Teaching Hospitals ACT CAP U15 LFN 2004" which seeks to finally bring sanity to the Tertiary Health Institutions amongst others. Specifically, the bill which is sponsored by Honorable Bamidele Salam representing Ede North/Ede South/Egbedore/Ejigbo Federal Constituency of Osun State, seeks to "(i) change the nomenclature of the Head of Tertiary Health Institutions in Nigeria from Chief Medical Director; (ii) redefine the qualification of the Head of Tertiary Hospitals; (iii) provide a definite tenure of office for the Heads of Tertiary Hospitals; (iv) include students of Health Sciences in the training programmes of Tertiary Hospitals; (v) Include hospitals established post-enactment of the extant legal framework in the schedule and for other related matters; and (vi) restructure the composition of the Governing Boards of the Federal Government Tertiary Hospitals."

Physiotherapy, a frontline healthcare profession provides care, treatment, diagnosis, prevention and rehabilitation of various disease conditions (either congenital or acquired) and the application of physical agents and modalities including the topical application of drugs and ions through the human skin to induce healing or remediation of symptoms. The domain of care of physiotherapy spans through care in the cradle, youthful conditions and sports injury care, cardiopulmonary and respiratory care, pain management in non-communicable, neurological and orthopaedic conditions and in rehabilitation of the aging including palliative care in the dying population. Physiotherapists are in virtually all specialty areas in healthcare and work in close and personalized physical contact with their patients and clients and thus retain close confidentiality with them.

We believe that the headship of tertiary health institutions among others should be by merit and not by preservation. It should be for healthcare professionals who have what it takes and with sufficient personal development in healthcare administration and management. Unfortunately, but as expected, a group of professionals mainly medical doctors (under the auspices of MDCAN and APCOM), who are hell bent in seeing that the current abysmal status quo is maintained. In their usual manner of always throwing tantrums, they have occupied the news space citing everything, but sensible critique to the proposed bill. In saner climes, these group of professionals who have dominated the Nigerian health sector in the last 47 years should have taken responsibility for the widespread rot and decay in the health system and therefore stay mute. Sadly, because no one or group of individuals have been held responsible, they continue to repeatedly push out the already worn out, boring and archaic argument of medical doctors being the `Oga at the top' and owning patients etc. They do not realize that the world has moved past the era of "Master and Slave" in providing healthcare to the era of evidence-based practice and collaborative approach to healthcare research, delivery and administration.

The continuous dominance of the health sector and its accompanying arrogance by this group of physicians has successfully but sadly brought the Nigerian health sector down to its knees. We do not have to cite the millions of dollars that Nigerians have continued to spend seeking healthcare from even countries that we should not have business going to in the first-place year in year out. Unfortunately, these group of power mongers falsely claim to know everything about other healthcare professions and have therefore continued to deceive the public in this regard. The APCOM in their release even claimed 'they are the only professionals that have received training in the art of other autonomous health professions including physiotherapy'. What a joke! We are really a country of comedians. Even going by basic logic, how does one equate the training medical doctors receive during the six years (undergraduate) training with the combined training of all other health professions (such as Physiotherapy [now upgraded to 6 years], Optometry [6 years], Medical Laboratory Science [5 years], Nursing Science [5 years) etc.). Meanwhile, these professions have post-graduate training up to Masters and Ph.D. degrees available. They have also continuously improved their knowledge and clinical base over the years. Is it possible that a physician with stroke or who has a relative with stroke can rehabilitate himself or his patient by himself? Certainly no, but he needs the services of a physiotherapist among other healthcare providers.

It is also disheartening that excellent care delivery to our patients, which should be the major focus is not the case, but rather the physicians are preoccupied with their pecuniary gains, hence seek even the most absurd propaganda to maintain the current status quo despite the steady decline in the state of health care delivery nation-wide, making a mockery of the intellectuals this great nation is blessed with!! They only want to earn 10 times the pay of all other health professionals, even those of them who provide very little services in the hospitals. They have enjoyed the fruit for too long and will "fight to death" to continue to feed fat on the system. Do they really care about the high morbidity and mortality rates in the country? Do they really care about the corruption in the system? Do they really care about the dirty wards/toilets in the hospitals? All they care about is dominating the Boards of the various hospitals and making all other category of staff subservient, thereby making the hospital environment very hostile. How skillful they are in managing the affairs of the hospital has been exemplified in the woeful failure of our healthcare system since their succession as the head of the hospitals!! Little wonder medical tourism is now the order of the day! If we can take a walk into the past when hospitals had administrators heading it, that was the period, Nigeria's health institutions received its fair share of medical tourism as other neighboring countries found it good enough to patronize it. Today the story is completely different. Today, our very own politicians and countrymen/women do not even patronize our hospitals. Are we going to let this injustice to the masses continue? These same physicians go abroad and are happy to follow whatever system they meet in operation and the arrogance simply disappears. In order to justify their perpetual occupation of the healthcare system, they cite very funny analogies just to keep the current rot. Their counterparts abroad who are more impactful are even more liberal and increasingly continue to be so. So many areas of healthcare delivery are welcoming more and more team players, as the body of evidence of patient management continues to grow. They would never acknowledge that the current DG of the WHO is a biologist. It would also interest you to know that one of the recent past presidents (Prof. Thierry Troosters) of the European Respiratory Society (a professional association of respiratory healthcare providers) is a physiotherapist. if it were here in Nigeria, your guess is as good as mine! The examples are countless.

The Nigerian healthcare system thrived best with unarguably best inter-professional cooperation in the few years when a non-medical doctor, Prof Eyitayo Lambo, a Professor of Health Economics occupied the seat as the Honorable Minister of Health. The health ministry, tertiary institutions and all MDAs within the health care delivery system enjoyed an unprecedented lasting peace. Within the few years he was in office, the Physiotherapy professional Association sought audience and was granted same twice in a space of one year. Unfortunately, before his appointment as Honorable Minister and after his tenure, Physiotherapy National Association has been virtually unable to have audience with Nigerian Health Ministers who were over 95 percent medical doctors by training.

Moreso, most healthcare policies are made and imposed on other professional bodies as majority of the decisions are taken in the ministry by majorly doctors who occupy most directorate levels.

As far as we are concerned, the job of headship of Tertiary health institutions should be left to individuals in the health care system who have proven background and experience in healthcare administration and management of human and financial resources and should have nothing to do with medical specialization. This is more as the undergraduate and postgraduate medical curriculum does not have courses in management and administration as is obtainable in the curriculum of physiotherapy and other healthcare professions. Finally, the Association of Clinical and Academic Physiotherapists of Nigeria appreciates the National Assembly for thinking in this positive direction to save the healthcare system. We wish to urge them to remain steadfast by reversing the seeming institutionalization of the headship of Tertiary hospitals and institutions to just one group among the many groups which has been the bane of the unending industrial strikes and bickering in the health care system in Nigeria and has unfortunately led to a 'dead healthcare system'. The time to revive our healthcare for the benefit of the ordinary Nigerian is now. We must think and take the bold step right now! God bless the Federal Republic of Nigeria.

Signed

Dr. U.A.C. Okafor, (PT. Ph.D)

President

Dr. Jibril Mohammed, (PT. PhD)

General Secretary 

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