Medical and Dental Consultants’ Association of Nigeria (MDCAN) Demand that the Federal Government of Nigeria Release the Report of the Presidential Committee of Experts in Inter-Professional Relationship in the Public Health Sector and Views and Decisions (White Paper) of the Federal Government of Nigeria Thereon

 

We act as Counsel to the Medical and Dental Consultants' Association of Nigeria (MDCAN) (here in after referred to as "our Client") on whose behalf we write this letter. 

 

We are compelled to write you this letter to demand that Mr. President and/or the Federal Government of Nigeria release the Report of the Presidential Committee of Experts in Inter-Professional Relationship in the Public Health Sector (Alhaji Mahmmud Yayale Ahmed Committee) and the views and decisions of the Federal Government of Nigeria on the recommendations that were made in the Report. 

 

The Presidential Committee of Experts in Infer-Professional Relationship in the Public Health Sector (headed by Alhaji Mahmmud Yayale Ahmed) was inaugurated by Mr. President on Wednesday, 18th September, 2013. The Committee worked for fifteen (15) months and submitted its Report to Mr. President in December, 2014Unfortunately, five(5)months after the submission of the said Report to Mr. President, same is yet to be released or issued by Government and the views and decisions of Government on the findings and recommendations of the Committee contained in the Report are yet to be officially published, let alone being implemented. 

 

Your Excellency, our Client is of the decided view that the delay, failure or refusal of Mr. President or the Federal Government of Nigeria to release the said Report make the views and decisions of Government on the Report's findings and recommendations known, with a view to implementing them, could amount to a dereliction of public duty, which may be cured by an order, of mandamus duly applied for and appropriately issued by a court of competent jurisdiction compelling the Federal Government of Nigeria to release the said Report, and the views and decisions on the Government thereon.

 

Law apart, our Client wishes to point out that the commendable initiative of Your Excellency In setting up the Committee. its painstaking work, and the tax-payer’s money that was expended will be In vain and the opportunity to resolve the lingering ego dispute In the public health sector Wilt be-lost, if Your Excellency does not cause the Report to be released and the views and decisions of Government thereon communicated and implemented, before the end of the tenure of your Administration. 

 

Our Client wishes to state that it would not only be a disservice to the crisis ridden  health sector in particular, but also Nigeria in general, if the laid Report and the  views and decisions of Government  thereon were discarded or jettisoned at the  tall end of the exercise initiated by Mr. President himself. 

 

This demand is borne out of the desire of our Client of fine a lasting solution to the perennial crisis of needless competition and untenable rivalry that is plaguing the public health sector in Nigeria. Our Client believes that the release of this Report and views and decisions of the Federal Government of Nigeria thereon may help cure the erroneous but pervasive assumption of non-existing rights being claimed by non-medical health workers in the sector, which have been the driving force of their virulent and poisonous agitations against the lead roles being played in the public health sector (and health sector in general) in Nigeria by medical doctors.

 

The complaint of domination, subordination, and discrimination which has now become the battle cry for the inordinate, and self-aggrandizing desire of non-medical health workers to fragment and segment our public health institutions, which until now, has been operating as integrated entities, into disjointed autonomous by the immediate release of the said Report and the view and decisions of Government on the recommendations that were made in the Report.

 

Your Excellency, we wish to provide a background to the demand we are making herein Mr. President may recall that he had set up a Presidential Committee of Experts in Inter-Professional Relationship in the Public Health Sector, headed by Alhaji Mahmmud Yayale Ahmed. While that Committee was working, taking views and memoranda of stakeholder, and conducting visits to other countries, including Ghana and South Africa, in order to gather facts relating to international best practices, norms and standards on the standards on the management of, and order of relationships of health care professionals in public health institutions, the Federal Ministry of Health continued to pander to the whims and caprices of Joint Health Sector Unions (JOHESU) and Assembly of Healthcare Professional Associations (AHPA), and indulge them, ostensibly to placate and propitiate them so that they do not continue to disrupt the public health sector by strikes. 

Meetings were being held, decisions were being taken, and circulars were being issued on contentious issues in the health sector, including issues being sat and deliberated upon by the Presidential Committee of Experts in Inter-Professional Relationship in the Public Health Sector. 

 

On the 5th of June 2014, the Joint Health Sector Unions (JOBESU) and Assembly' of Healthcare Professional Associations (AHPA), reportedly met in Abuja, FCI' with the Secretary to the Government of the Federation (SGF)i Senator Anyim Pius Anyim, OCON, Honourable Minister of Labour and Productivity. Honourable Minister Health, Chairman. Salaries. Income and Wages Commission, Head of the Civil Service of the Federation, and other top government functionaries. 

 

 The meeting reportedly addressed three broad issues: (I) grant of consultancy statuses to other health care professionals and approval of payment of specialist allowance to other health care professionals Other than medical and dental  practitioners, in all tertiary health Institutions in the Country; (2) abolition of the 

Post of Deputy Chairman Medical Advisory Committee (DCMAC) in all Teaching Hospitals, Medical Centre, and other tertiary health institutions, in the Country; and (3) references of a number of matters, Including the review of  the .procedure and process of appointment of Chief Medical Director and of Teaching Hospitals, Appointment of Directors of and  Departments in the hospital the Abdullahi Bello Presidential Committee Report on Harmony in the Health Sector and the interpretation of the phrase "medically qualified" to the Yayale Ahmed Committee. Some "agreements” were said to have been reached at the meeting. 

 

Three of the “agreement” have grave implications for the management and Survival of the health sector in Nigeria. 

 

Firstly; the meeting was said to have communicated that a circular No. MH/PW/138/Vol.111/79 0/16th May, 2014 bad bun re1eued by Government formally restoring consultancy statuses to other health care professionals, other than medical and dental practitioners, In line with this so-called circular, JOHESU/AHPA have directed that all their member who are due and have satisfied the existing criteria, as upheld by a court judgment, for consultancy positions, should apply for the payment of the allowance with its accrued arrears with effect from 1st January, 2010 in line with the CONHESS Circular Reference SWC/S/04/S,410/Vol. 11/349, dated 8th December 2009.

 

 

Secondly, the meeting was said to have accepted JOHESU & AHPA’s position and demand, and accordingly agreed to abolish the post of Deputy Chairman Medical Advisory Committee (DCMAC), JOHESU/AHPA’ position is that the establishment and existence of that post is unlawful, and that no further appointment should be made into the post.

 

Thirdly, the meeting was said to have agreed to refer a number of issues to the Yayale Ahmed Committee. These issues include the review of the process of appointment of Chief Medical Directors and Medical Directors and Medical Directors of Teaching Hospitals and the agitation of JOHESU & AHPA that appointment of Chief Medical; Director and Medical Directors be made from permanent staff of the teaching hospitals rather than from the universities the alleged lopsidedness of advertorial for appointments of CMDs/MDs, which is skewed in favour of medical and dental practitioners, and the agitation of JOHESU & AHPA that the appointment process be made open to all “competent and qualified” health professionals; the Abdullahi Bello Presidential Committee Report on Harmony in  the Health Sector; and the interpretation of the phrase “medically qualified”,

 

In continuation of the pandering and appeasement stance of the Federal Government towards the demands of JOHESU and AHPA, in July, 2014, the Federal Ministry of Health, and in particular the Office of the Honourable Minister of Health, issued at least three (3) circulars communicating Government decisions or positions on issues bordering on matters that f3ll within the Terms of Reference of the Presidential Committee of Experts in Inter-Professional Relationship in the Public Health Sector. 

 

The first circular was a Circular, Ref: No HMH/ABJ/155/VI1347, captioned” Clarification of Government's Position on the Appointment of Deputy Chairman Medical Advisory Committee (DCMAC)”, dated 4th July, 2014, and addressed to the Chief Medical Directors Medical Directors of Federal Tertiary Institutions., it was communicated that " the decision of Government is therefore that all the positions of DCMAC that were established, in line with circular SME/546/Vol 111/485 dated 20th January. 2014, up to 9th June, 2014 are validated by this letter; and that " in order to give way for the ongoing deliberations on the matter by the 

Presidential Committee of experts in inter-professional relationship in the public health sector, no new position of DCMAC is to be established by my hospital until the outcome of the deliberations".

 

The implication of that communication was that no new positions of DCMAC was going to be established until the Presidential Committee of Experts in Inter- Professional Relationship in the Public Health sector would make findings and recommendations in respect of the position of DCMAC 

 

 

The second circular was a Circular, Ref: No HMH/ABJ/155/VI1I/348, captioned” Appointment of Deputy Chairman Medical Advisory Committee (DCMAC)", dated 14th July, 2014, 'and addressed to the Chief Medical Directors, Medical Directors of Federal Tertiary Institutions., it was communicated that “the decision of Government is therefore that all the positions of DCMAC that were established, in line with circular SMH/546/V01.III/485 of 20th January; 2014, up to 9th June, 2014 are validated by this circular (HMH/ABJ/155VII/348 of 14th July, 2014." The implication of that communication was that the Ministry of Health was directing that no position of Deputy Chairman Medical Advisory Committee (DCMAC) created or appointment of DCMAC made after the 9th June, 2014 is valid. medicalworldnigeria.com

 

The third circular was a Circular, Ref: No. MH/PM/138/VOL.111/85 dated 18th 

July, 2014 addressed to all Chief Medical Directors and all Medical Directors, and captioned' "Compliance with Judgment of the National Industrial Court of Nigeria 

(NICN) on the Appointment of Non-Medical Officers as Consultant Payment of Specialist Allowance". The Circular communicated as follows: 

 

Further to the recent judgment of the National Industrial Court of Nigeria 9NICN) dated 22nd July, 2013 on the above subject, all CMDs and MDs are by this Circular requested to comply with the following•(1} all those health workers whose appointment as Consultants was withdrawn as a result of directive of the Ministry (please lee attached Circular) should be reverted to their former posts pending the outcome of the appeal filed by the Ministry; (ii) all such health workers as in (i) above should continue to enjoy approved Specialist Allowances; (iii) In accordance with the Court ruling, any future appointment to such positions is at the discretion of the Ministry,• and (iv ) the designation of Consultant should only be used for personnel with quall n register able with Medical and Dental Council of Nigeria" 

 

The implication of that communication is that the Ministry of Health was directing 

that all those health workers whose appointments as Consultants were withdrawn as a result of directive of the Ministry should be reverted to their former posts, and should continue to enjoy approved Specialist Allowances pending the outcome of the appeal filed by the Min18try, even after the implementation of that reversion, as agreed and decided in the said 5th June 2014 meeting with Joint Health Sector Unions (JOHESU) and Assembly o} Healthcare Profession Associations (AHPA) has been restrained by a clear order of Court•. 

 

Our Client has severally communicated her disagreements with these decisions to the authorities of the Federal Government of Nigeria, including Mr. President. 

 

Our Client's consistent position is that granting arbitrary', anti-health care delivery concessions in the health sector by agents and agencies of government, just to placate and appease some workers in the health sector, even when, those concessions, on the long term, will inevitably lead to the destruction of the health care delivery system in our Country is not good for Nigeria. Our Client has repeatedly maintained that it is high time the system stopped granting concessions that will ruin the health care delivery system to a resentful and conspiratorial segment of the health sector workforce on the altar of political expediency, and in the illusion that doing 60 is the best w y to guarantee industrial harmony. 

 

As our Client has consistently maintained, she is an association of medical and dental consultants, who, exclusive of other professional in the health sector, are known And addressed Il8 "consultant". Negotiating and agreeing with non-medical and dental practitioners in the health sector, and designating them “consultants”, such that there will now be multiplicity of consultants in the teaching hospitals, is not acceptable, and even if it were, this cannot be done in the absence of associations of medical practitioners (NMA, MDCAN, et cetera).

 

Before a person can be appointed a consultant in the medical profession, s/he must have obtained the requisite degrees of Bachelor of Medicine and Bachelor of Surgery (MB., BS), must be a fellow of a post-graduate medical college, and must have the required professional experience and expertise as a medical doctor. The post graduate medical colleges in Nigeria College, West Africa Post-Graduate College of Surgeon, and the National Post- Graduate Medical College of Nigeria.

 

Under the scheme of service, as contained in the relevant circular, issued by the Federal Ministry of Health Medical consultants who have the requisite qualification and who must have undergone a minimum level of professional training, are the ones, exclusive of other health professionals, to whom patients are assigned, and who, upon that assignment and management duty, it is the medical consultant that will determine who apart from himself, has to join him to manage his patient, depending in the diagnosis, and wheter the patient is suffering from a single ailment or multiple ailments. If the medical doctor to whom the patient is assigned is a consultant in the field of medical covering the patient’s ailment or multiple ailments. If the medical doctor to whom the patient is assigned is a consultant in the field of medicine covering the patient’s ailment, but the diagnosis reveals that the patient’s primary ailment has implicated other organs of the body and occasioned secondary or consequential or specialisted to assist him in managing his patient.

 

Designating or appointing nurses, pharmacist or physiotherapist or laboratory technicians "consultants" in the health sector is, therefore, an aberration, and a perversion of the order of care in the health sector. Under this order of care, there 18 no rule that can accommodate this designation or appointment of non-medical doctors as consultants or specialists, even if some managers of public hospitals in Nigeria want to invent the absurdity. In the medical profession, nurses, pharmacists and physiotherapists are not trained to make diagnosis and prescribe treatment. 

Members or our Client, therefore, have genuine fears that the constitutionally guaranteed right of patients to life will be in jeopardy if non-medical doctors are appointed as consultants. 

When patients die or are dissatisfied with care, it is the Consultant that is sued rather Than the nurses. Being medical doctors who swore to the Physician's Oath, and being medical and dental consultants-the eminent class in the medical profession, members of MDCAN are duty-bound to protect lives of Nigerians and non- Nigerians who are passing through Nigeria's health care delivery system. 

 

Your Excellency, the oddity' and aberration of this agreement by the Federal Government of Nigeria and JOHESU & APHA on extension of consultancy statuses to all health professionals is not only that it is profession any and administratively perverse. It is also a legal absurdity. 

Following the determination of Suit No. NICNI ABJ/l38/2012 (The Trade Union Members of the Joint Health Sector Unions (JOHESU), namely: {I}.Medical and Health Workers Union of Nigeria; {1} National Association of Nigeria Nurses and Midwifes; {3} Senior Staff Association of Universities Teaching Hospital, Research Institutes and Associated institutions; {4} Nigerian Union of' Pharmacists, Medical Technologists and Professions Allied to Medicine; and (5) Non-Academic Staff Union of Educational and Associated Institutions V. Federal Ministry of Health) on Monday, the 22nd day of July, 2013, by Bon. Justice B.A Adejumo (Presiding Judge), Bon. Justice B.B Kanyip and Hon, Justice M.N. Esowe, wherein the National Industrial Court held that a few non-medical and dental practitioners aberrantly appointed as consultants In University College, Hospital, Ibadan should continue to enjoy that status, the Federal Ministry of Health (that is the Federal Government of Nigeria) appealed that decision; and our Client, MDCAN, upon her application to set aside that judgment being refused, also has filed an appeal against the laid judgment. 

 

In any case, that Judgment, merely gave a judicial backing to the few non-medical officers in the Federal tertiary health institutions, particularly at the University College Hospital, Ibadan, (who are about ten in number) to continue to function as "consultants". No more no less. The judgment, by any stretch of elastic or liberal interpretation, enforcement or imagination Is not and cannot be a legal authorization or cover for appointment of fresh non-medical consultants, which the NICN bad held is at the discretion of the Ministry of Health, guidelines and criteria wise. 

 

Your Excellency, our Client also has consistently rejected the quest to abolish the post of Deputy Chairman Medical Advisory Committee (DCMAC). Our Client's position is that the creation of that post, which has been in our teaching hospitals for more than twenty years, is within the administrative powers and competence of the governing boards of the teaching hospitals as defined in their respective governing statutes establishing them. This position, which facilitates smooth management of the teaching hospitals cannot be scrapped because of the whims and caprices of non- medical doctors, on the flimsy ground that they are excluded from consideration in the filling of that position. For the avoidance, of any doubt, it is instructive that the University Teaching Hospitals (Reconstitution of Boards, Etc) Act, Cap U 15, Vol. 15, Laws o/the Federation of Nigeria, 1004.1 provides in Section 7 (4) [Functions of the Board] that " Subject to this Act, the Board shall have power to do anything, which, in its opinion, is calculated to facilitate the carrying out of Its functions under this Act"

 

Regarding the issues referred to the Yayale Ahmed Committee, which relate to the process of and eligibility for appointment of Chief Medical Directors and Medical Directors of Teaching H08pitafs and the agitation of 10HESU &. ARPA that their members, who are not medical practitioners, be eligible for appointment, our Client's position is that the issue of headship and management of the teaching hospitals is not a political or labour issue that can or showed be negotiated with an amalgam of atl80ctations of non-medical practitioners in the health lector. 

 

Our Client always has expressed her well-considered view that when amalgamated unions or associations of non-medical doctors gang up and make the undesirability of appointing university based medical practitioner as chief medical directors and medical directors of teaching hospital, their principal demand, then the very foundation of those tertiary health institutions (as teaching hospitals) is being threatened. It is only a system that has no knowledge of how the health sector functions that can live such an attempt any serious consideration, let alone according to such demand.www.medicalworldnigeria.com 

 

Your Excellency, our Client want you and the Federal Government of Nigeria to meet  her demand herein by releasing the said Report and officially communicating and publishing the views and decisions of Government on the Report before the end of your tenure in office.

 

TAKE NOTICE that if this demand is not met, we shall not hesitate to institute a legal action against the Federal Government of Nigeria with a view to compelling Government to perform the public duty of releasing the said Report and officially communicating and publishing the views and decisions of Government on the Report.

 

Our Client is grateful to Your Excellency for taking a swift action on the issues raised in this letter 

 

Yours faithfully,

 

Signed

Jiti Ogunye, Esq

Principal Solicitor & Counsel