1. Introduction

The attention of the Nigerian Medical Association (NMA) has been drawn to a newspaper advertorial by the Joint Health Sector Unions (JOHESU) and Assembly of Healthcare Professional Associations (AHPA) on pages 56 & 57 of the Punch Newspaper of January 7 2015. We are deeply concerned that a report just submitted to Mr. President has allegedly found its way into the hands of JOHESU and AHPA even before the government has had time to study its contents. We consider the comments on the report at this stage as rude, sad and highly regrettable. 

2. Confidence and respect for the Yayale Ahmed Committee:

Notwithstanding this worrisome and ugly development, the NMA wishes to restate its trust and confidence in the ability and capacity of the distinguished members of the honorable committee chaired by a highly seasoned world class public servant and patriot, and membership drawn from Nigeria's best in their various disciplines to have, most probably, done an honest, clean and great job. 

 We observe with disbelief that the brazen transparency, unparallel accommodation of all stakeholders' input and strict compliance with global best practices which necessitated the Committee's study tour of various local health institutions and several countries of the world with efficient healthcare delivery didn't strike a note of reckoning to our agitating friends. We therefore, condemn in its entirety without any equivocation the aspersions cast on the integrity of the members of the Committee.

3. Bane of the Nation's Public Health Sector:

It should be of great concern to any well-meaning citizen or organization in this country that our health care system has been reduced to a pariah of an ideal health care system by persons entrusted with the responsibility of discharging the duty of care, due to inordinate ambitions, agitations and self-serving mentality of what the health care system should be as against international best practices. We wholeheartedly refuse to accept that Nigeria is a banana republic where noting good can happen, and where anything good can happen, and where anything goes. As leaders in the health sector and the custodian of the people's health, we wish to assure Nigerian public that we shall do all in our powers to safeguard their health. Without order in the sector and strict adherence to best practices , all efforts and investments therein would be a colossal waste. We thank Mr. President for finding space and time to seek out fundamental solutions to a protracted clogging issue crippling the Health sector.

4. Global Best Practice:

The Institutionalization of international best practice and clinical governance in our health care system will just be one of the uncommon transformations currently going in different sectors of the economy in the country. We urge all workers, unions and associations in the health sector to align themselves with progressive move initiated by Mr. President, Dr Goodluck Jonathan in the overall interest of our people.

We shall reserve our comments on the main work of the Honorable Committee until government makes a pronouncement on the recommendations or we are obliged with a copy. Once again we stress our high regard for all the esteemed members of the Committee, and patriotically commend Mr. President, Dr Goodluck Jonathan for this bold step towards bringing to an end the intractable but avoidable crises in the health sector, and the many strides in innovative governance despite the so many inherited and emergent challenges facing the country.

5. Yayale Ahmed Committee Report:

We are not in a position right now to comment on the veracity or otherwise of the comments, allegations and suggestions put forward by JOHESU since we do not have a copy of the report and have not read it. 

Nonetheless, the Terms of Reference given the Committee at their inauguration leaves no one in doubt as to the genuine desire of Government to take the issues in the Public Health Sector most fundamentally and holistically. However, going by our understanding of the character of the agitating organizations and the principal actors, we would not be surprised to learn that they would have misrepresented or out rightly falsified the alleged contents of the report in an effort to curry underserved and unnecessary sympathy of members of the public as well as influence the white paper. This is a strategy that has failed to achieve any positive result over the years, and has brought the health care system to its knees. Continuing along this line will be giving life to the widely held view that the agitators have an agenda of ensuring that the health sector under President Goodluck Jonathan's administration will never know peace. Their penchant for fueling unrests in the sector is a well-known phenomenon, but we do not see them succeeding this time.

6. Attack on the Yayale Ahmed Committee's Report:

This unprovoked attack occasioned by very premature insinuation of whatever lapses which only JOHESU and AHPA have allegedly seen has also gone far to confirm to all Nigerians the true identity of those truly engineering and fueling the crises in the sector. We had since 2011 posited that some demands and strikes by majority of Allied health workers have political undertones as these demands were self-serving, egocentric and of on value whatsoever to the advancement of health care. A situation where every professional or health worker in the health sector aspires to be designated a Consultant without clear definition of roles and command of authority continues to beat the imaginations of well-meaning citizens of this great nation and beyond. It is verifiable globally that whatever roles any health worker plays in the care of the patient, the bulk stops on the Consultant's table, who is accountable for the care of the patient. It sounds even more legally meaningful than logical for the patients, our clients, to have a particular professional to be held accountable and responsible for the care s/he receives. This is a global best practice which puts the responsibility of ultimate decision making and therefore culpability on the Consultant. Nigeria should not be an exception to this system of organization which is natural in the healthcare setting. It is also pertinent to note that whereas the term Consultant may connote some other meaning in the secular world, it has a single strictly applied meaning in the hospital. Since this is what JOHESU and AHPA are fighting against, our assertion that they do not mean well for Nigeria cannot be faulted. We have appealed times without number that the Health sector is unique in structural and functional organization and nomenclature. The whole world respects this, let's do same in Nigeria. 

7. Public Private Partnership in Public Health Sector:

Let us once more use this opportunity to call on government to hasten the implementation of innovative governance in the public healthcare institutions taking a deep look at areas for public private partnerships (PPP). The closure of pharmacies and in some areas, laboratories, since these two unions embarked on strike for about two months now have provided a golden opportunity to truly determine what service areas that could be targeted for concession and for other PPP arrangements to enhance quality care, reduce cost of governance, drastically reduce service interruptions and without any adverse consequences. Patients have procured their drugs from registered pharmacies outside the hospitals without pains and in settings blessed with pathologists and laboratory medicine resident doctors, laboratory services have gone unimpeded. There are lessons to be learnt from this. 

8. Job Description:

We have also posited and advised that job designations/descriptions and professional roles should be defined by the direct employing authority at the point of engagement rather than being left to a broad assumption in the mind of the newly recruited. The era of generic job description and universality of schemes of service and cadres which is susceptible to all forms of abuses has become obsolete. 

Borrowing from international human resource management ideals in this regard would save the nation so much pains and anguish festered on it by the suffocating fight for recognition, award of roles and appellations and other self-seeking agitations which are witnessed in the public health sector today.

Private health institutions in Nigeria, as elsewhere, have long adopted these international best practice, which explains the peace, harmony and efficient service delivery witnessed in that setting which is also serviced by the same admixture of professionals as in the Public health sector. This is the time for government to call JOHESU/AHPA to order and tell all enemies of Nigeria that enough is enough.

9. Appreciation of Nigerian Doctors:

NMA wishes to appreciate all her members in the public health sector who have continued to render medicare to Nigerians to the best of what the prevailing circumstances could allow and reassure our compatriots that we would continue to give our all to care for them. All doctors are urged to remain vigilant, and to ensure they participate fully in the forthcoming elections by ensuring that they exercise their franchise according to their convictions.

10. 2015 Elections 

We also appeal to all Nigerian youths to refuse to be used by any politician, no matter how highly placed or related, to foment trouble or violence before, during or after the elections. Your families need you. Some of the children of the politicians are probably already abroad for political reasons. Let all losers in the election recourse to the law for redress. Violence is not an option.

Finally, we call on all candidates for the forthcoming elections to base their campaigns on issues and not on personality or resort to use of foul languages.

We wish Nigeria and all Nigerians a very peaceful and prosperous 2015.

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Signed

Dr Obitade OBIMAKINDE

Chairman, Publications and Publicity Committee, 

Nigeria Medical Association.