AN OPEN LETTER TO THE PRESIDENT AND COMMANDER-IN-CHIEF NIGERIA ARMED FORCES. RE: JOHESU Strike: Unmasking the NMA Masquerade: International Best Practice

 

Your Excellency, the President and Commander-in-Chief, Federal Republic of Nigeria, good morning Sir.

 

Sir, from 2009/2010, when I was the National Chairman of JOHESU at its formative stage, I have made spirited efforts to refrain from joining words with the Medical Practitioners on their often touted slogan: International Best Practices and their often uncivilized name-calling each time JOHESU has issues with the Government. Right now I believe it is time to look at this term from the internationally accepted definition and application, so that your administration may summon the Political Will to deal decisively with this perennial inter-professional ego-based Public Relations crisis in the health sector.

 

Before I get into discussing what International Best Practice ought to and should be in the health sector of the Nigerian Economy, permit me to raise some rhetorical questions for you and all that could read this open letter to guide your/their ratiocinative thinking, while you/they read on:

 

A. While remaining the way it has been deceptively practiced in the Nigerian health sector, that the Doctors should always be the Chief Executives of our facilities and the Minister/Minister of State of Health, do the Doctors believe that their leadership would be maximally productive when they go to negotiate their welfare and conditions of service without talking about the welfare of the other important players in the health team of Nigeria?

 

B. Do the Doctors believe that their leadership would be quite productive when they turn around to display suppressive/oppressive life style by insisting that the other important players in the health team should not be paid what they negotiated for themselves for their welfare and conditions of service without any input from their supposedly team leaders?

 

C. What International Best Practice should the health team be discussing for the better service delivery: 

(i) International Best Medical Practice or 

(ii) International Best Administrative/Leadership Practice?

 

D. Which aspect(s) of International Best Practice should the health team be discussing in the present instance for the capacity to bring the health services of the country out of the woods?

 

Your Excellency, Sir, I believe that health service stakeholders, especially the medical doctors, should begin to avail themselves the understanding of International Best Administrative/Leadership Practices that will give birth to an effective health services delivery, so that your Administration can put the felt health needs of Nigerians on the right pedestal.

 

To understand the slant of this letter, let us raise and answer basic questions:

1. What should the International Best Practice represent in Nigeria?

 

2. What has been the International Best Practice in the Administration and leadership of health facilities that have worked well elsewhere in the Universe?

 

3. What have been the professional biases and course contents for the qualifications to be a Minister and/or hospital CEOs of Countries like UK, USA, Canada and India that have raised their health indices?

 

4. What are the skills required of a successful or ought to succeed hospital CEOs?

 

5. What is the difference between Management and Leadership for a better managed health facility?

 

Your Excellency, sir, according to https://en.m.wikipedia.org/wiki/best_practice, retrieved 12th May, 2018, Best Practice means a method or technique that has been generally accepted as superior to any alternative because it produces results that are superior to those achieved by other means or because it has become a standard way of doing things. Best Practice is used to maintain quality as an alternative to mandatory legislated standard and can be on self-assessment or benchmarking.

 

Your Excellency, applying this definition in the context of the Nigerian health service environment, International Best Practice should about the method, technique or standard of administration and leadership of the public hospitals for qualitative administrative practices, which must meet the universal or the international benchmark, capable of producing effective leadership in the personnel management of all public hospitals, building strong institutions and not strong individuals or strong professional groupings.  Nigerian standard should be such that will produce the same effective result, it replicated elsewhere in the universe.

 

The Nigerian Best Practice has to fall within the International Consensus on what constitutes a high level standard, method or technique for effective administration of the Federal Ministry of Health and/or public hospitals. The result should be optimum service delivery resulting from highly motivated workforce, inter-professional mutual interactions, absence of abusive supervision, absence of professionism against professionalism, absence of professional empire-building in order to suppress or oppress other professionals, equity in the opportunities for all professionals to actualize themselves in the leadership spaces of the institutions, absence of professional cocoons which give birth to mind your own business in what ought to and should be team playing environment, etc.

 

I am not unmindful that universal Best practice could be interpreted from two major perspectives: (a) as pertaining to the universe or all society world-wide or common to all members of a group or class. Certainly, I do not intend to believe that NARD, NMA and sometimes the MDCAN are defining the International Best Practice from the latter perspective.

 

Your Excellency, Sir, we have to draw inferences from countries like the United Kingdom (UK), United States of America (USA), Canada and India to answer question 2 now. These are countries to which majority of our political office holders and even the Medical Doctors scamper to for effective medical services. Before we begin to draw the inference, let us pause to consider a brief, but enough clarification of what universal Best Practice should be in the Nigerian health industry Administration. 

Best practices should and have to be standards for programme and service evaluation in the execution of Nigerian Public Policies. From time to time, Nigeria Policymakers should and have to adopt International Best Practices as processes of reviewing their policies against International extant alternatives. To continue to apply old strategies or policy framework when the environment is changing is not acceptable. It is often counter-productive as it is being experienced in Nigeria of today.

 

According to Best Practice Wikipedia, https://en.m.wikipedia.org retrieved 12th May, 2018, Best Practice is a form of Program Evaluation in Public Policy. It is the process of reviewing policy alternatives that have been effective in addressing similar issues in the past and could be applied to a current problem.  Having said this much, let us look at examples of countries which place value on who should head their public health facilities for effectiveness. Medical Doctors in Nigeria canvass that only Medical Doctors, against all other professionals should head Nigerian health Ministries and hospitals, including all secondary and primary health institutions. But is that really the International Best Practice? 

 

1. UK: Presently, Jeremy Richard Streynsham Hunt (MP), born on 1st November 1966 is a British conservative party politician and cabinet minister, serving as the Secretary of State for Health and Social Care (what we call Minister of Health in Nigeria) since 2012. Hunt was born in Kennington and studied Philosophy, Politics and Economics at the Magdalene College, Oxford. The Minister of State, Health and Social Care, United Kingdom, is Caroline Dinenage (MP) from January, 2018, born 28th October 1971, and studied Politics and English at the Swansea University.

 

Your Excellency, Nigerian Health Sector has not done better than the UK’s because both the Minister and the Minister of state in the United Kingdom are not Medical Doctors.

 

2. USA: The Secretary of State, Health (Minister of Health in Nigerian Parlance) is Alex Michael Azar born June 17, 1967, has his B.A. Degree with highest honour in government and Economics from Dartmouth College and JD Degree at Yale Law School in 1991. The US Deputy Secretary of State (Minister of State) Health is Eric David Hargan, born June 3, 1968 and has his B.A. in Philosophy from Harvard University and his JD from Columbian Law School.

 

The Minister and Minister of State, Health in the US of America, are not Medical Doctors; yet, in charge of the wonderful Health Sector of the American Economy, never to be compared with the horrible Nigeria’s by any means or standard.

 

3. Canada: Ginette Petitpas Taylor (MP) is the Minister of Health (Minister de La Sante) overseeing health-focused government agencies, including Health Canada and the Public Health Agencies of Canada, as well as enforcing Canada Health Act. The Minister is responsible for maintaining and improving the health of Canadians. G. P. Taylor (MP) holds a Bachelor’s Degree in Social Work and assumed office as Minister of Health on August 28, 2017. The Deputy Minister of Health, Canada, is Simon Kennedy who holds a Bachelor’s Degree of Public Relations from Mount Saint Vincent University and Master of Science in Communication Management from Syracuse University.

 

Your Excellency, Sir, the Minister and Deputy Minister of Health, Canada are not Medical Doctors, yet their health services and the Nigeria health services are not anything to be compared with the Canadian’s.

 

4. India: The incumbent Minister of Health and Family Welfare of India is Jagat Prakash Nadda born December 2, 1960 and holds LL.B from Himachal Pradesh University Shinila. The Minister of State, Health, in India, presently is Smt. Anupriya Patel, born April 28, 1981 and holds a B.A., M.B.A., of the Delhi University and Chhatrapati Maharaji University Kapur, Uttar Pradesh and her profession is political and social work.

 

Your Excellency, Sir, once again, the Minister and Minister of State India, are not Medical Doctors, yet they are the people in charge of the wonder-working health facilities to which all our well to dos run to, for medical services that address their health needs.

 

5. Your Excellency, Sir, we can get below the exalted seat of the Ministers to looking at the offices of the Chairman of Boards and Chief Executives of Public tertiary, secondary and primary health service agencies of countries that look at International Best Practices progressively:

 

a) Carlos A. Migoya is the President (Chief Executive) of Jackson Memorial Hospital, Miami, which appears to be the largest public hospital in the USA, with about 1,678 beds. (Becker’s Hospital Review, 2015). Carlos A. Migoya has an undergraduate Degree in Finance and Master of Business Administration in finance from Florida International University.

 

b) Greg Haralson has been named the Chief Executive of Memorial Herman Southwest Hospital, Houston, the second largest public hospital in the United States of America, with about 1,200 beds. (Becker’s Hospital Review, 2015). Greg Haralson holds a Master of Science (M.Sc) in Healthcare Administration, Trinity University (1998 to 2000) and Bachelor of Science (B.Sc), Texas A & M University, (1992 – 1996).

 

Your Excellency, a few examples above give a true picture of what International Best Practice in Hospital Administration is, in the outer spaces to where our public office holders, including the Medical Doctors and Heads of our Tertiary Health Institutions run, for healthcare services that best address their health needs. Your Excellency, Sir, this is the time we stop subscribing to the dummy being sold to the Nigerian People that the International Best Practice is that medically trained personnel alone should head and lead the Nigerian hospitals/health facilities. To continue to bask in this euphoria does us more harm.

 

The extant  International Best Practice is that the Ministers and Chief Executives of Public hospitals should be left for personnel trained in Human Resource Management, Public Relations and Communication Management, Business Management, Public Administration, Philosophy, Psychology; of course personnel trained in Social Sciences.

 

 All primarily medically trained personnel, who have interest in becoming the Chief Executive of Nigerian Public hospital/health facilities should wait, go back and have at least a two year postgraduate training in Human Management, Public Relations and Communication Management. Hospital management is not about Medical Practices. It has more to do with human relations and material management for productive outcome.

 

In view of the above, Your Excellency, the extant International Best Practice is that anybody who must be the Chief Executive of our Public Hospital must possess the following Professional biases and skills, because to administer a hospital requires the ability to manage businesses, deliver quality healthcare and following regulations. According to http://work,chron.com/qualifications-required-hospital-administrators-5435.html, publishing Luanne Kelchner, our hospital Chief Executives ought to and should possess:

 

a) an undergraduate degree in healthcare administration of which programme must include coursework in hospital management, budgeting, accounting, planning, legal regulations, information systems, human resources, etc which have to be followed with an internship, providing an opportunity to work in a hospital setting and gain experience in an administrative role.

 

b) According to US Bureau of Labour Statistics, a Master’s degree in health administration is a common qualification for the administrators, which takes about two or three years to obtain after obtaining a Bachelor’s Degree. The Master’s Degree course works usually include courses in finance, legal issues, leadership, marketing, human resources, and research.

 

The above shows that an effective hospital administration is not about medical sciences and has less do with medical sciences. Hospital administration is nothing about Medical practices. The skills often required of the hospital administrators, among others, include:

i. Skills to understand legal regulations.

 

ii. Good oral and written communication to work with a variety of professionals.

 

iii.  Interpersonal skills to motivate all hospital personnel.

 

iv. Skills that make them problem-solver that can find solutions to administrative challenges.

 

v. Skills that make them remain current in the technology used to maintain health information systems.

 

vi. Must have strong organizational skills, in order to work with and through people in order to achieve the sat organizational goals, etc.

These Skills for Effective Hospital Management/Administration has Less or nothing to do with Skills for Medical Practice. 

 

Your Excellency, permit me to begin to draw the curtain on this open letter to you by citing Prof. Robert Sulton, a Professor of Management Science and Engineering of the Standford University, who say: The behaviour of Assholes damages individual wellbeing and also impacts corporate profits, mostly because it reduces people’s commitment and drives out the best employees… Assholes can drive the good people out. They also damage the organization’s reputation. And they are more expensive than they tend to look.  

 

Your Excellency, you will agree with me that the behaviours of NMA since the crisis in the health sector appear more asshole than anything else.

 

 Your Excellency, the members of NMA who are obviously in the leadership of the Nigerian health Sector, for now, appear not to understand what leadership is all about. They display attributes that make them appear not to understand the difference between Management and Leadership; that leadership must be added to it, to make an effective Management team.

 

With due respect, assuming they are ignorant of their position as leaders of the Present, giving them the benefit of the doubt that they are not being selfish, let me call to their minds what leadership is all about.

 

For the above let me quote myself verbatim from my earlier article – Providing needed leadership in Management of Tertiary hospitals in Nigeria: what is leadership? What are the characteristics? Where and when can a leader be found in a tertiary hospitals?  Leaderships according to Albarran (2002:86) is a broader topic than Management Leadership is the art of influencing, holding and uniting the interest and the actions of an individual or a group, in efforts towards achieving goals in any given situation, while Management simply means the processes of working through and with people to achieve goals This point to the facts that most successful organizations have strong and effective leaders and not just managers. There are formal and informal leaders. The formal leaders are those found in managerial positions and the informal leaders are those who do not occupy Managerial positions, but have wisdom and experience, which afford them the opportunities to influence and continually unite the efforts of others progressively towards achieving set objectives.  This means that leaders can be found within managers and from the subordinate staff, who are not in management positions. The hospital managers should make efforts to identify the leaders who are not part of the management and make good use of them. Leadership, according to Bennia (1994) as cited in Albarrain (2002:86) consists in three basic qualities – vision, passion and integrity. Leaders are visionary and as such foresee and know where their organizations want to go. They do not allow setbacks and obstacles to stand against the progress of their organizations. They have understanding and are always accommodating. Passion is the other trait of a good leader. Leaders are known to love and enjoy what they do.  They coordinate their subordinates and execute their tasks with passion. Leaders are conscious of integrity. i.e. they have self-knowledge, have the quality of saying what they think openly and honestly (that is candor) and exhibit maturity in all they do. (Nwobodo, C.N. 2010 UNTH News Vol.5, No 3, 15-17).

 

Finally, Your Excellency, can NMA answer the following questions, relative to the present JOHESU Strike?

a) Are our doctors leaders or just managers?

 

b) What prospects do our Health Ministry have because of their roles?

 

c) Are they working to build good succession or creating opportunity to show that only Medical Doctors are fit to manage and lead our hospitals?

 

d) Are they providing the opportunity for those who report to them to grow?

 

e) Are their behaviours, pillars or caterpillars against the teamwork spirit needed in the health sector?

 

In all honesty, Professor Ike Nwosu (2006) says it all, that the days of Professional jealousies, Professional suspicions, Professional myopicsm, professional cocoons or Professional Mind-Your-Business or don’t touch me and Professional empire building based on mediocrity, ignorance or fear of being swallowed are gone forever. And we must realize and accept this. LeyRoy Eims (1996, pp. 52 – 53) concludes it all by saying: All the people involved in the enterprise must know what their jobs are, what the leader wants them to do… then they must make sure that everyone who works with them knows where they fit in the project and exactly what is expected of them… the key to it all was clear direction to a qualified man.

 

Signed

Nwobodo Chinedu Nyia

National Publicity Secretary/PRO 

Medical and Health Workers’ Union of Nigeria