PREAMBLE: The Nigerian Medical Association (NMA) held her National Executive Council meeting in Ilorin, Kwara State, from 25th to 30th August, 2015. The theme was “National Health Agenda: Purpose, Means and Targets”. In line with NMA tradition, the formal opening ceremony was preceded by: (1) a free medical outreach to the Malete Community in which over 1500 vulnerable Nigerians received free treatment for sundry ailments including over 120 surgical operations; (2) courtesy visits to the State Governor and the Emir of Ilorin by the NMA officials, (3) the continuing professional development (CPD) seminar. (4) The New NMA hall/Building was commissioned by the NMA President. It  was the highest NMA office to be commissioned so far in Nigeria. At the formal opening ceremony, the NMA Kwara donated a 3-KVA electricity generating set to the Malete Primary Health Care Centre for improved care to patients.

 

His Excellency, the Governor of Kwara State, represented by the Secretary to Government formally opened the NEC meeting. The Registrar of the National Postgraduate Medical College and a past President of the Association Dr. Wole Atoyebi (Professor of Surgery), delivered the Key Note Lecture on the Theme. He affirmed that Nigeria has had several health policies since the first 10-year plan of 1946 and lamented that the Health sector has not met most of its objectives mainly because of the absence of an enabling Legislation and Political Will. He concluded that salvation may have arrived by way of the Nigeria Health Act 2014, and hoped that the present administration shall proceed to implement the provisions of the Act in full, without delay.  The NEC meeting, Ilorin 2015, ended with a dinner in honour of NMA’s distinguished member, HE Senator Dr. Abubakar Bukola Saraki CON, (Turaki Ilorin), the President of the Senate of the Federal Republic of Nigeria.

 

After extensive deliberation on sundry issues affecting the Association, the Health sector and the Nigerian polity, NEC made the following observations and recommendations:

 

OBSERVATIONS:

The Nigerian Nation must be continually commended for eliminating the Ebola Virus Disease in the shortest time recorded by any nation and for sustaining the Ebola-Free status of Nigeria so far. The Association however, observed a gradual but steady dismantling of the necessary alert systems and public health preventive measures. The NMA observed that the nation is yet to give deserved honor to the heroines and heroes of the Ebola disease outbreak, especially  Dr Stella Adadevoh, and regretted that such non-recognition of personal sacrifices kills national zeal and patriotism.

 

NMA commends the tremendous strides recorded in the polio virus eradication programme particularly the “zero case” situation of the last one year.  It noted that such splendid results could only have come through active cooperation and collaboration of all tiers of government with the active workforce at the National Primary Healthcare Development Agency and the development partners, and called for its sustenance until the country is declared polio-free.

 

The NMA commends Nigeria for the progress made towards achieving many of the MDG targets and encouraged her to continue on the current trajectory of progress, especially as it will join the rest of the world to embrace the imminent successor global initiative tagged, Sustainable Development Goals (SDGs) at the United Nations General Assembly in September 2015.

 

The NMA rejoices once more with all Nigerians for the existence of  a National Health Act, which was signed on October 2014. It however, calls on governments and all other stakeholders to ensure diligent implementation of its provisions without delay.  NMA demands that Government must demonstrate ownership of the implementation process of the Act by releasing the necessary resources and funding, and cautioned against leaving this great social responsibility to her citizens to donor partners or charities alone to fund.

 

More than 10 years since National Health Insurance Scheme (NHIS) was launched (2005), the implementation has been flawed, covering less than 10% of the 170 million Nigerians today. NMA demands that Health Insurance must be made compulsory for all Nigerians, in line with the successful traditions of all other health systems across the World. Universal Health Coverage (UHC) is not achievable without compulsory health insurance that guarantees medical care to all citizens at the point of need. Even the United States of America is finally joining with other high income countries by implementing such a policy through the ‘Obamacare’ Act. The NMA further demands that the Government should implement the funding-mix mechanism for Health that was clearly explained in the communiqué of the Presidential Summit on UHC in Abuja in March 2014. This lays out how the health care needs of every segment of the population would be equitably covered including the unemployed, elderly, and the disabled.

 

The primary and secondary tiers of the Nigerian Health system are bedeviled by political neglect, lack of clinical governance, faulty supply chain and inadequate financing. These lead to non performing primary tier, overstretched secondary and tertiary tiers of healthcare, inability to deliver on their core mandates, thus resulting in grossly reduced effectiveness and efficiencies. The situation in Nigeria, where the least qualified, least skilled and experienced health workers (e.g. the JCHEWS, CHEWS and CHOs) ‘head’ most of the Primary tier of care centres is the unfortunate recipe for the current underperforming Nigeria Health System.All over the world, every successful health system that Nigeria aspires to, runs and operates a medical doctor-led Primary Health Care. The medical doctor is the only diagnostician in the health team which explains why these countries position medical doctors at the entry point (gatekeeping) of care. This is not merely about ‘headship’, rather, it is about giving patients the best possible clinically governed care once they enter the health system, and is the only certified direction for progress. The recent agitation by the Community Health Workers to head the primary health care agency in parts of the country is therefore, not only laughable, but retrogressive, dangerous and totally unacceptable.

 

NMA  is saddened by the non-payment of several months of salary and allowances to doctors and health workers by some Governments. The Association demands that Governments at all levels must implement the extant circulars on doctors’ remunerations in their employment. The NMA further notes that unless universal applicability of conditions of service in the public health sector is achieved, as it is for the Judiciary and Political Office Holders, the aspiration of improved medicare for rural dwellers would continue to be a mirage. Highly skilled health professionals need to be encouraged to take up responsibilities in the rural areas as Nigerians leaving in such areas are no less human that the privileged ones in the cities.

 

NMA appreciates the unfolding ‘healthy’ working relationship between the Lagos State government, under HE Governor Akinwunmi Ambode and NMA Lagos State Branch as reported. Council was further gladdened by the promise to end the illegal practice of casualization of Human Resources for Health and recruitment of additional medical workforce, believing that the new spirit of understanding and cooperation holds promises of better performance of Health workers and improved healthcare delivery in the state.

 

NMA  notes with sadness that a national targeted Public Private Partnership in Health Policy (PPP), passed by the National Council on Health (NCH) since 2006, is yet to be fully operational. The policy presents Nigeria with a smart healthcare financing option which countries that have successful health systems have practiced for many decades. The NMA demands that Governments at every level in Nigeria should embark on full implementation of the targeted PPP policy in health without further delay in line with already approved guidelines, processes and procedures. The era in which rabble-rousers that masquerade as labour union and Associations activists intimidate governments to abandon excellent and people-oriented programmes should be a thing of the past; Change has come.

 

The pronouncements of successive Inspectors General of the Nigeria police for medical practitioners to attend to gunshot victims promptly seem not to have been adequately disseminated and obeyed by police personnel as medical practitioners are still unduly harassed for doing so. The NMA will appreciate more enlightenment and information dissemination to all commands, divisions and posts/units.

 

NMA frowns at the clandestine moves by the Pharmacist Council of Nigeria to disrupt the smooth running of dispensary units in hospitals on the pretext that their ‘Council monitors pharmacy shops across the country’. Medical Doctors have legal right to have dispensary units for their patients in their facilities. It therefore, calls on the PCN to respect professional boundaries and authorities as it will no longer tolerate any further attempt to put the lives of patients on the line.

 

The NMA laments the incessant industrial action that is bedeviling the Nigerian health sector, primarily due to Governments’ failure to implement agreements reached with health workers and failure to establish a National Health System with appropriate infrastructure, equipment, human resource, orderliness and welfare that ensures  functional health care delivery for every Nigerian, irrespective of where they live, socialize, and work.

 

NMA notes that the Bill on sexual offenders has attracted differing views about its suitability for a multi-cultural and multi-religious Nigeria, particularly as it borders on early marriage and defilement of the girl child. The NMA demands that every Nigerian child, including the Girl-Child, irrespective of ethnicity, religion or culture MUST be protected in all ramifications by any Act that is passed by the National or State Assemblies. The Nigerian Constitution is very clear on the definition of who a child is.

 

The NMA deplores in the strongest possible terms the endemic corruption and impunity in all facets of governance in the Nigerian Society, and demands urgent remedial solutions. As has been said by President Buhari, ‘if Nigeria does not kill corruption, corruption will kill Nigeria’’. The NMA supports every move by the present administration to give a deadly blow to corruption which seems to have assumed a life of its own in  the country. It therefore, calls on both the National Assembly and the Judiciary to cooperate fully with the Executive to remove this cankerworm from the fabric of our national life.

 

RECOMMENDATIONS

The NMA recommend that:

the Federal Government, as a matter of urgency, should facilitate the full take off and implementation of the National Health Act 2014. The arrears of funding should be released without further delay.

 

Health Insurance for every Nigerian from cradle to grave should be made compulsory.

 

Governments at all levels in the country should revamp all tiers of the Nigerian Health system including the primary health care tier, and make them functional for effective delivery of health services at the grassroots.

 

Governments at all levels should put incentives in place that will attract doctors and other health personnel to primary health care centres. An effective medical doctor-led primary health care tier, will relieve the avoidable excess burden on already overstretched secondary and tertiary health tiers of the health system.

 

A close partnership between it, government and and other relevant agencies/agents to restructure and plan for the actualization of an effective primary health care delivery system in the country.

 

In line with her  belief in effective and efficient multi sectoral and multi disciplinary health system the Federal Government should release the White Paper on the Yayale Ahmed-led committee on disharmony in health sector and implement its recommendations without further delay.

 

the bill on sexual offenders should be revisited and reviewed clause by clause, to excise any provisions that enshrines abuse of the Girl-Child by authorizing early marriage and defilement of the girl child. NMA refers to available scientific evidence base of the fact that early marriage of the girl-child before the constitutional mature age of 18 years is froth with preventable and deadly health complications to the victims.

 

Government at all levels should expedite action on payment of backlog of salaries and allowances that are being owed their workers, medical doctors inclusive, as this will motivate workers to work harder and deliver optimally, and avoid strike actions.

 

On universal applicability for doctors, the NMA demands that government should establish a Health Services Commission, remove health from the concurrent list and move it to exclusive list of the Nigerian constitution. .

 

the War Against Corruption as championed by the President Buhari-led Government should be wholistic and devoid of any political, ethnic or religious sentiments or respecter of any person no matter how highly placed. The  NMA is ready to work with the government to achieve its anti-corruption aims, in all sectors of the economy including the Health sector. The NMA therefore, urges President Buhari to continue undeterred, leaving no stone unturned in curtailing official corruption which has impacted negatively on health care delivery and the social determinants of health.

 

MISCELLANEOUS

WHO AIDS Day:

 

December 1 is World Health Organization’s (WHO) day for HIV. National Executive Council (NEC) decided to observe this day in collaboration with National Institute of Medical Research (NIMR). A 3 man committee was set up, viz; Dr. Adewunmi ALAYAKI, Dr. Adeyeye ARIGBABUWO and Dr. Mrs. Dumebi OWA to liaise with the Director General of the Institute, Prof. Innocent UJAH.

 

Diaspora:

National Executive Council (NEC) ratified the proposal of giving Association of Nigerian Doctors in United States of America (U.S.A.), United Kingdom (U.K.) and Canada a seat each at NEC, the Chairman Diaspora Committee Dr. Bappa Usman is to coordinate.

 

Physicians’ Week:

Physicians’ Week which usually takes place last week of October will hold this year from Sunday 25th to Friday 30thOctober, 2015. The topic is “Towards Eradication of Measles in Nigeria

 

Immunization Campaign.”

 

For further details, visit the NMA website.

 

State MDCN Monitory Team:

All state Chairmen, should ensure reactivation of Medical and Dental Council of Nigeria (MDCN) monitoring team. They are to maintain standards of Primary, Secondary and Private Health Institutions in their states.

 

Attitudes and Relationships:

National Executive Council (NEC) considered the issue of discipline among doctors. The following vices are rampant: absenteeism, lack of respect for seniors, humiliation of junior ones, improper dress code, and lackadaisical attitude towards work.

 

Strikes should be discouraged as the only weapon of negotiation, while doctors in the positions of authority should meet the demands of their employees promptly. We also demand that all circulars that have been issued by the Government be cashed backed and given the appropriate heading in the budget of 2016. All Institutions should primarily look inside for solutions, even though external forces could come to their aid.

 

Taxation:

NEC observed that there are crippling codes of taxation of health institutions; these affect both public and private medical practitioners. Health Institutions render essential services and not supposed to be targets for excessive taxation by Government agencies..

 

As a measure to discourage Medical Tourism, Government should facilitate soft loan to upgrade the standards of our private health Institutions so as to meet up with International standards.

 

CONCLUSION.

NMA sincerely appreciates HE Senator, Dr. Bukola SARAKI, Senate President, Federal Republic of Nigeria; HE Alhaji Abdulfatah AHMED, the Executive Governor of Kwara State; the Secretary to the Kwara State Government; the Emir of Ilorin, Alhaji Sulu GAMBARI, and other Royal Fathers; the Chief Medical Director of the University of Ilorin Teaching Hospital, Prof. Abdulwaheed .O. LATINWO; the Medical Director of General Hospital, Ilorin, Dr. Abdulfatai OLOKOBA, Prof. Abdulganiyu AMBALI – Vice Chancellor University of Ilorin, Prof. Abdulrasheed NA-ALLAH, Vice Chancellor Kwara State University Malete and other dignitaries from the Government and Private Sector for their support of NMA Ilorin 2015 event.

 

Special appreciation goes to the Executive and the members of Kwara State NMA branch for being good hosts, and for their efforts in the successful medical mission.

 

Finally, the NMA also appreciates her members from the 36 States of the federation and the Federal Capital Territory for their presence, contributions, and support that made the Ilorin 2015 meeting successful.

 

Signed:

Dr. Kayode OBEMBE PRESIDENT                                                                   

Dr. Adewunmi ALAYAKI SECRETARY GENERAL