Dr. Michael Okara is the national president, Association of Medical Laboratory Scientists of Nigeria (AMSLN). In this exclusive interview with The Guardian, he speaks on the culture of impunity that has plagued the health system for a long time and the need for government to call the bluff of Nigeria Medical Association (NMA) if the sector must move forward. JOKE FALAJU writes. Excerpts:

 

HAS the government called the association to any meeting in respect of the recent strike by doctors over certain aspect of your own demand?

THE meeting we held yesterday (Monday) with the governor was to hasten the assent of our health care appropriation, it was a scheduled meeting on the on ongoing talk with the government and not specifically because of the ongoing strike by the Nigerian Medical Association (NMA). 

 

In the cause of the meeting, both the Secretary to the Government of the Federation, Ministry of Health officials mentioned that they have been discussing with NMA. But fundamentally we had made government realize that the earlier they call all the actors in the health sector to order; to make them realise there is need to respect the rule of law, and statutorily respect government circular and schemes of service, the better for all. 

 

What we are seeing in the health sector is just a fallout of the culture of impunity that has permeated the system over time – where doctors feel that because they are at the head, by way of been the Chief Executive Officer (CEO) of the hospital, they can decide what they can implement and what not to be implement, to a point that government circulars are jettisoned and trampled under feet and the Ministry of Health could call them to order. 

 

So, the problem we are seeing now is something that has gone out of hands. We have been hammering on these things for quite some time, telling government, the Ministry of Health in particular to summon courage and exercise political-will and call the Chief Executives of Hospital to order. The hospital is not there private estate or institution; they are organs of society run by government rules and regulation to be adhered to by the letter. 

 

If you look at the 24-point demand of the NMA, 80 per cent of them bother on what has statutorily been approved for health professionals in the sector. It portends a great danger when an employee would turn around to tell the employer what should be approved for him and what should be approved for other employee. 

 

To say the least, it is very ridiculous, but the Minister said publicly that the issue of appointment of consultants of other health professionals had been the practice since the 70’s. They are in government circular when all of a sudden Medical and Dental Consultant Association of Nigeria (MDCAN) had a meeting in August 2010 at Zaria and decided that no other professional should be appointed consultant in the health sector, that if they do not reverse it, they would made the health sector ungovernable. They arose from the meeting and wrote a letter to Health Minister urging him to withdraw and revoke the appointment of other health professionals as consultant.

 

The same people in the medical school taught us and curiously enough they bowed to the pressure and directed all hospitals to revoke such appointment. Some of them have been consultant for over two decades even over 30 years. I have some of my colleagues that have been consulting in Ibadan since in the 80’s while I was a student. But all of a sudden their appointment was withdrawn, the matter became a subject of litigation, the National Industrial court ruled that the circular by the Ministry of Health was illegal and that the appointment of consultant across profession in the health sector was of international best practice, and that the circular should be set aside and those who were appointed as consultant merited, and continue to merit it and be paid according to negotiated allowance. Government in its wisdom complied with the court ruling.

 

The NMA and MDCAN thought that it is by disrupting services and creating problem in the health sector that they will brow beat and arm twist the government in do their biding. We are just watching if government would decide to succumb to such blackmail and disobey court judgment then it’s an open situation to anarchy in the health sector. 

 

We are law-abiding citizen, that circular was released in Dec 16th 2010, we patiently followed all due process of law, it was the federal ministry of labour that referred the matter to the court, we waited for over three months, before government gave order in Aug 2013, following that judgment, government now issued circular to all hospitals to comply with that judgment, even though they said they were going to appeal judgment but pending the outcome of appeal, and the pronouncement by higher court the judgment subsea. But MDCAN went to court, asking for a stay of prosecution, but the court threw out their motion that they were not an interested party in the matter, that they were just over reaching themselves. So they thought what they could not get from court, they can achieve by going to strike.

 

Has NMA appealed the Judgment?

NMA has different technical arm within their group, when you say NMA, the people who stampeded the ministry of health to stop the appointment of other health professional cadre as consultant and they went to court, and the court threw out their motion that it lacks loci, they went to court the second time for stay of implementation of the MOU government signed with JOHESU on the 5th of June. 

 

They were asking for an expiate order to refrain government from implementing those agreement, but court said because of the weighty issue involve in the motion they were canvassing, they would not grant such order, that all the party should be put on notice to appear in court to argue the matter, that pending the date the case would be argued in court, nobody should go on strike. 

 

The same MDCAN, who went to court and got the order, flouted the court and went on strike. University College alone has over 250 honorary consultants. If they were working as court ordered, the strike by the NMA would not have had much impact, so you see they are working hand in gloves with NMA to disrupt health services. And that is what JOHESU have been crying and shouting over time that if you allow the culture of impunity to be floated in the health sector, it would get to a time that government itself would not be able to handle it. 

 

If it were doctor that in 2010 that the appointment they had held for decades was revoked, the following day they would have gone on strike. We were discussing with government, gave notice, gave ultimatum once the ultimatum was apprehended according to labour laws then we back out, when virtually the Federal Ministry of Labour and Productivity referred the matter to court, we engage the service of a lawyer, the Anthony General of the Federation was represented, federal ministry of health was represented, we waited for over 13 month for the issue. 

 

The public will need to know that t he root of this problem is the culture of impunity NMA and their members are imposing on the health sector. The situation where professionals believe they are above the law is an open invitation to anarchy. We have refrain from indulging in self-help even though NMA is not a registered trade union.

 

There was a judgment by the National Industrial Court, Enugu division on the 20th of June, when the NMA went on strike the Attorney General of Enugu dragged them to court and the judge ruled that NMA was not a registered trade union and had no right to declare strike and had no right to bargain welfare issues for members and that was a prerogative of registered trade unions and that they were not one. They did not appeal against that judgment, and that the judgment subsists. 

 

When MDCAN on their volition decided to go to court and the court gave an order that they should not embark on strike pending the time the motion they brought to court was listened and argued out and they decided to go on strike on the 1st of July, we expected the FMOH and FMOLP to approach the court to issue them a bench warrant, but they did not do all that.

 

Our ground is that double standard is not good, when it comes to other health professionals they know the road to court, then when it is doctors they would be pretending and bowing to the whims and caprice of the doctors. People make it look as if it is superiority context; they go to tell the public that other health professional wants to be Chief medical director of hospitals. What is wrong about it? To be a chief executive of hospital is only an administrative thing, didn’t we attend the same University, it is just like going to the University, the people in management say it is their exclusive prerogative to be the vice chancellor of the university, that those in fire, health and engineering do not have the acumen to manage the university. 

 

It is the international best practice that professional health administrator administer hospital. Orthodox medical care did not originate from this country, Nigeria does not exist in the moon, professional health service administrator were running our hospital as chief medical directors, this kind of incessant pride was not the order of the day. 

 

In 1985, late Prof. Ransome Kuti was pressured by the NMA to use his position as the minister of health in military regime to use his position to convince the Banbagida Regime to enact a decree; a decree has no input of the people, stakeholders, able to manipulate government in power, they took over the professional administrator and ever since the health sector has been on a decline. Unless government make bold to take the bull by the horn and call them to order this nonsense will continue.

 

It happened in Kenya, in Kenya there is not a single hospital that is headed by a medical doctor. The Kenya government put down their feet and called the bluff of doctors.

 

Our training curriculum now is heavily loaded such that if you put the core courses into tangential courses, you will never be able to complete your programme. Someone who has had no training in management throughout his life he has been attending to patients in the clinic and wards, carrying out operation, just one day, its announced that he’s the chief medical officer of an hospital, he takes over a duty where he has no training, experience or background knowledge and begin to administer the hospital as if it is consulting thing. 

 

Administrative or effective leadership is all about the effective coordination of the three elm, manpower, money and material and if you don’t have the training you cannot offer what you don’t have. You see someone who have spent years on training on how to treat diseases and the wounded, how to diagnose ailment and treat and manage patient will go and seat in the office and be pushing file, approving contract seeing to the administration of the hospital. When we talk about it they term it to mean JOHESU wants to be CMD, they believe they have more brain than others, they believe they have divine right to administer the hospital even when they are fumbling and making a mess of the whole thing.

 

Since the Ministry of Health did not issue a bench warrant on MDCAN has your organisation considered doing this?

Yes we have initiated the process at the National Industrial Court last week. We have approached the court with a motion that the judgment that was passed on the 20th of June 2011 in Enugu by the National Industrial Court that the group of Doctors that went on strike has no right under the labor law to go on strike and that the judgment should be invoked and enforce and that nobody is above the law.

 

What is the relationship between that judgment and current strike?

It has bearing because the group Enugu State government dragged to court, NMA were also on strike in Enugu State. We also approached the court that MDCAN appeared before you with an expiate motion, asking for an interlocutory injunction restraining government from implementing agreement they had with JOHESU, and court ordered that no injunction would be given and that all the parties involved should be put on motion to appear before the court and pending the day that would take place no body should go on strike, government should stay action. 

 

Despite all this, MDCAN proceeded on strike, so we expected that government had all the instrument, it was just a question of sending a lawyer from office of Attorney General of Federation, FMOLP and report what was happening and issue a bench warrant, but rather than doing this they looked the other way, because it was there colleagues that was involved, since they have refused to do that, as major stakeholder in the health sector we have decided to do so even at great expense, because it cost you money whenever you engage a lawyer on litigation.