Re: Bill for an Act to Amend the University Teaching Hospitals (Reconstitution of Boards etc) Act Cap U15 LFN 2004
Open all Frontiers of Restriction in Healthcare now
The PSN is in receipt of a memo dated 29th June 2022 issued by the Medical & Dental Consultants Association of Nigeria (MDCAN) which lamented and called for a rejection of the proposed amendment of the University Teaching Hospitals Act Cap U 15 LFN 2004 in any form. In its memo, the MDCAN insinuated that the amendment bill “did not come to it as a surprise because a group of workers in the Federal Tertiary Hospitals in the country is hell-bent on destroying these hospitals because of their perennial and insatiable quest to take over Federal Tertiary Hospitals through the back door”.
After a critical appraisal of all issues raised by the MDCAN, the PSN as a veritable stakeholder in Health wishes to posit as follows:
1. We find it imperative to inform that the UCH, Ibadan was the foremost set-up in terms of a formal structure for the Federal Health Institutions (FHIs) in Nigeria.
The UCH, Ibadan was established in 1952 with an independent Board of Management. An autonomous CEO, who was designated House Governor, was placed in charge of the systems.
The House Governor/CEO were non-Physicians and they led UCH, Ibadan to commanding heights and positive reference points.
It is noteworthy that the UCH, Ibadan grew to become one of the top five facilities in the commonwealth nations. This encouraged the Saudi Royal family to access Health at UCH, Ibadan. What is the story today?
2. While it was success stories with non-Physician CEOs at the helm in our Health institutions, same cannot be said with the 37 years of holocaust that Physicians have dominated the headship of the hospitals based on the reigning obnoxious decree 10 of 1985 which was invented by late Olikoye Ransome-Kuti to legalise discrimination, unfair practices, and slavery on non-Physician Health workers by the “almighty Physicians” in Nigeria since 1985.
The legacies of the headship of Physicians in hospitals in Nigeria includes:
A. Discriminatory Salaries and Benefit Packages for Health workers.
B. Distortion and Stifling of the career prospects of all non-Physician Health workers in Nigeria.
C. Prohibition of skill acquisition, Training Programmes and Consultant Cadre for non-Physician Cadre.
D. Decapitation of DRF and related schemes
E. Lopsided representations in the Board of Managements and TMC of the FHIs.
This memo will be restricted to the many aberrations directly related to the University Teaching Hospital Act to enable stakeholders discern wisely.
A. Prior to the advent of decree 10 of 1985, Pharmacists and Physicians entered the civil service on GL 8 for internship/houseman-ship while proceeding to GL 9 after Youth Service. This was the status-quo for over three decades preceding the birth of late Kuti’s coup with the devastating decree 10 of 1985. In the era before 1985, the plethora of other graduate workers entered the public service on GL 08 after Youth Service. Today, without a fundamental change in curriculum in Medical Practice, the Physicians have explored the leadership role placed on them at the FMOH and FHIs to create a new order where Physicians start internship on the equivalent of GL 10 and proceed to GL 13 after Youth Service, Pharmacists who hitherto were on the same entry grade level as Physicians now start internship on GL 09 and move to GL 10 after Youth Service. The other Health workers who are not Health professionals still start on GL 08 and it takes over 12 years for any of them who enjoys regular promotion to attain the entry point of a Physician. This is why in less than 15 years an average Physicians who attains Consultant status is already on the equivalent of GL 17 as Director.
A quick check of the numbers of Physicians who are Permanent Secretaries in the Federal Civil Service will confirm this analysis and the monumental injustice done to non-Physician Health workers in our country. The Call-Duty allowance and other benefits of a House Officer who just entered the civil service is much higher than that of the most senior Director in the non-Physician cadre, such that the total emolument of any Physician is over 150% of that of his equivalent in any of the non Physician professional cadre. In 2009 when the current salary structure of Physicians on CONMESS and non-Physicians on CONHESS were structured, it was agreed that any adjustment on one scale would be reflected on the other one. For eight and a half years, Health workers under the aegis of JOHESU/AHPA have met a brick wall in their quest for the amendment of CONHESS because the leadership of the FMOH and FHIs have collaborated effectively to truncate their agitation for an amendment of CONHESS.
B. From 1985 to 2014 (29 years), no non-Physician Health-worker domiciled in the FHIs was able to get to the peak of their careers as Directors on the equivalent of GL 17 because the leadership of the FHIs deliberately misapplied decree 10 of 1985 which was the operating instrument in the sector contrary to Public Service Rules (PSR) which provides that any University graduate can get to the apogee of his career on GL 17. The CMDs hinged the decision to stagnate the careers of Pharmacists and others who in some instances spent 15 years on one grade level on the premise that decree 10 provided for only two Directors which were in the clinical services and administration Directorates. This apparently destroyed the careers of many Health workers until it was redressed in 2014 after a torturous JOHESU led Health workers strike.
C. Physicians who led the FHIs have largely explored the wicked and selfish clauses of decree 10 of 1985 to decimate all other professions in healthcare. Every reference to training of workers in the enabling decree 10 covers exclusively training of medical students at undergraduate and post-graduate levels. Physicians are sponsored by Government to embark on Residency Training, but stumbling blocks are placed on the path of other Health professionals. The FMOH issued a Residency Training circular for Pharmacists in 2015, but the CMDs in almost all the 56 FHIs denies Pharmacists access to Wards and other facilities which belong to Government to the detriment of the patient’s good quality care. In some instances, Resident Pharmacists in Training pay upwards of N50,000 to access the facilities in hospitals where they work. In one of the South-South States where a seemingly liberal CMD allowed Residency Training for Pharmacists, he has been intimidated, harassed and given timelines to withdraw such recognition. Despite all hardships imposed on the career paths of Pharmacists who pay out of pocket over N3.5M to run their Fellowship programmes at the WAPCP, the Physicians-CMDs under the aegis of the Committee of CMDs (whose registration is still pending at the Corporate Affairs) and their bosses at the FMOH have now perfected a conspiracy to finally truncate the approvals of the National Council on Establishment, the Office of the Head of Service of the Federation (OHOSF) and the immediate past Permanent Secretary of the FMOH for Consultant cadre for Pharmacists. The approval of this Consultant status has not come with appropriate benefit package except for the UCH, Ibadan which has implemented it to the letter. It is a shame on Nigeria that Ghana has extended this privilege to its Consultant Pharmacists for over a decade while same is also implemented in Sierra-Leone amongst many other countries. The usurpation of the privilege of skill acquisition is not limited to Pharmacy as Medical Laboratory Scientists who are autonomous professionals have been denied rights to become Heads of their Laboratories. Physicians (Pathologists) have insisted it is their right to head laboratories just like other Physicians (Ophthalmologists) want to continue to dominate Optometrists) and Radiologists suppress Radiographers with the backing of CMDs in FHIs to the disadvantage of optimal care to the patient. The non-availability of drugs which currently ravages public sector Pharmacies in the FHIs is certainly one of the best pieces of evidence of the unchecked tyranny of Physicians as CMDs in our hospitals. Perhaps it is striking to put on record that the DRF scheme designed to make drugs available in FHIs has been decapitated and destroyed because funds for drugs are usually diverted by CMDs to user department of cronies who can be manipulated at their whims and caprices.
As it is with the DRF, so it is with Laboratory reagents, dressings, and other consumables. The greed and avarice of CMDs of the FHIs and their bosses at FMOH earned the Health Sector the sobriquet of the most corrupt sector when ICPC conducted an audit of all the MDAs. It calls for concern that despite this prevailing anomie in our sector, not more than one CMD has been arraigned (MD, Federal Medical Centre, Owo) for formal charges of corruption by ICPC.
D. One of the factors that catalyze the draconian emperor lifestyle of the CMDs is that they are backed by an inner circle of a protective ring formed by their Physician tribe on the Board of the Teaching Hospitals. Out of the statutory 13-man board structure of the FHIs, about eight are reserved for Physicians. This is the same horrible structure at the FMOH where at least 7 out of 10 departments are headed by Physicians. The office of the C-MAC reserved for Physicians now unlawfully diversifies into creation of Deputy C-MAC which are about 6 in some FHIs.
Physicians are ridiculously designated Deputy C-MAC (Energy), Deputy C-MAC (Hospitality) and similar aberrations. The MDCAN in its very provocative statement canvassed better funding and improved infrastructure but failed to justify and account for whatever “little” Government makes available to its exclusive club members who live like oil sheiks and merchants in our various cities and capitals. While MDCAN and NMA still live in the stone age that they own patients and are lords of the Manor in Healthcare, their global body the World Medical Association (WMA) incidentally led by one of them, Dr. Osahon Enabulele posits that the “Physician has an obligation to cooperate in the coordination of medically indicated care with other Healthcare providers treating the patients”. For a fact like the WMA manual postulates. the spirit of the amendment bill to the University Teaching Act is grounded in the belief that Pharmacists, Nurses, Medical Laboratory Scientists, and other Health professionals are considered to be more versatile in their areas of patient care than Physicians and see no reason why they should not be accorded their rightful treatment.
The job of administering or managing a hospital has nothing to do with surgical skills. You do not bring in your wealth of experience as a Specialist Physician with stethoscope to run the hospital system. It is same with other Specialist Health professionals whether Pharmacists, Laboratory Scientists, or the other experts in the team. All that will be needed to succeed will be the depth of administrative skills or deep managerial acumen. This is why Physicians have failed as head of the hospitals in Nigeria. Indeed, if Physicians were good managers, it would have impacted on their private hospitals which often times fail under their wretched business management. The incumbent DG of the World Health Organisation (WHO) is a Scientist with bias in Microbiology. This 1986 graduate of an Ethiopian University has no background in care provisioning, but he continues to succeed on his job at WHO because of his managerial expertise. Finally, the gregarious socialisation of the respective components of the health sector which should be a confederacy of brotherhood has been annihilated by the likes of MDCAN and its acolytes. MDCAN, NMA and others have completely mutilated the configuration of our cultural historicity with regards to a Team Concept as it is known globally. The commonality of our brotherhood remains jeopardised beyond repairs every-time we evaluate our current realities because of the unfortunate posturing of Physicians. In the circumstance, the conundrum which the FHIs have become needs to be rescued with the proposed amendment bill which must succeed if the current regime of impunity must give way to well managed institutions for the better therapeutic outcomes for the teeming number of patients, we all swore to manage their care. We strongly believe that in the best interest of the masses, the National Assembly will be guided by world best practices, pass this bill for the common good of all and bring back the glory.
Prof. Cyril Usifoh, FPSN FPCPharm FNAPharm