Posted on: Thu 31-07-2014

The President, Pharmaceutical Society of Nigeria (PSN) has faulted the position of the Health Minister, Prof. Onyebuchi Chukwu, on the ongoing strike by medical doctors under the aegis of the Nigerian Medical Association (NMA).Akintayo in this interview with The Guardian spoke about the many reasons for professional rivalry between medical doctors and other health workers and how to tackle them. CHUKWUMA MUANYA writes. Excerpts:

AT last the Minister of Health appears to be on the same page now with other health workers and has openly condemned the strike action embarked upon by the NMA. I think he needs some thumbs up?

I think it depends on what individuals decide to see. It is a matter of conjecture and perception, but at any rate we must tolerate libertinism of inferences. In an attempt to appreciate the various issues, it will always be necessary to even evaluate how we got to this stress junction. The very first of the fundamentals to appraise is whether the NMA should legitimately speaking contemplate a strike and go-ahead to negotiate the conditions of service of doctors. 

The answer is a no and so logically you need to find out from government why it has refused to be government. This is not farfetched, every level of senior government official right to the apex contends with these guys as sacred cows who must be treated with kid gloves. 

The Hon. Minister of Health did say they have successfully handled 23 out of the 24 commandments of the NMA including coming up with two different Memoranda of Understanding (MOU) and enabling circulars. Do recall some of those demands to the extent of about 80 per cent bothers on clinical governance in that it relates directly with the welfare and destiny of my members and of course the cognoscenti  of other health workers. 

Nigerian doctors have amongst other issues that amount to outright absurdity and irrational logic demanded that government should not appoint health professionals other than doctors as consultants in their professions, health professionals and workers must not get to the apogee in public service even if relevant schemes of service dictate so, government must continue to appoint only doctors as Chief Executive Officers  (CEOs) of hospitals even in the face of obvious systemic failure, that government must continue to appoint doctors as Deputy Chairman Medical Advisory Committee (Dep-CMACs) even when there is no law that backs such appointments through the relevant enabling Act of Parliament, Government must through fiat appoint a Surgeon-General notwithstanding the reality of a constitutional imperative towards same because they are used to a dispensation in the dark days of military dictatorship when their godfathers imposed all sorts of balderdash that we are still grappling with and then the garbage stuff of an enduring relativity advantage in pay which must be documented through circulars. 

Even when you insinuate that there appears to be a crack in Prof. Chukwu and NMA relations, I won’t be deceived because all that is on display is a duplicitous politics of expediency. In a recent media interview, Nigeria’s Hon. Minister of Health found it necessary to share with the world how skipping became part of our lexicon in the Health Sector by giving the impression that it was an unlawful concept or privilege granted some health professionals. This is far from the truth because Nigerian doctors are the biggest beneficiaries of skipping in the public service. You try to find out what the norm was up to about 1992 when the Medical Salary Scale was introduced. 

Pharmacists and doctors were on Grade Level (GL) 08 during internship/housemanship after graduation and proceeded to GL 09 after National Youth Service Corps (NYSC). That was the system i passed through as a young practitioner in the eighties. Today a house doctor starts on GL 10 and moves to GL 12 after youth service. If you are conversant with Public Service Rules (PSR) it takes an average of three years for anybody to move from one GL to another. It will therefore take any average University graduate who starts on GL08 after NYSC at least 10 years to get to GL 12 where a doctor takes off after NYSC. So what other relativity supercedes that type of advantage?

A serious Medical Doctor who passes his consultancy exams in 5 years would certainly make GL 17 which is the peak in public service well under 10 years after youth service, while it takes other University graduates over 30 years to achieve same. Through luciferian energy the NMA and its appendages continue to plot to suppress citizens of Nigeria like some conquered species with overwhelming support of state machinery. 

The Federal Ministry of Health is the catalyst for the many years of recklessness in our sector through its biased personnel who have reduced it to a ministry of doctors. Can you imagine Prof. Chukwu publicly declaring that his Federal Ministry of Health is challenging the National Industrial Court of Nigeria (NICN) judgment on skipping of Consolidated Health Salary Structure (CONHESS) 10 in the Appeal Court. We have also joined issues with them at the Supreme Court because it was surprising that the Appeal Court granted a relief to the Federal Ministry of Health to challenge a National Industrial Court of Nigeria (NICN) judgment. It was unprecedented in labour struggles. 

There is a particular official of the legal department of the FMOH that I had cause to challenge openly at one of our numerous consultations with the FMOH. She has never disguised her bias against professional ranks outside medicine from the first time i met her at a Public Hearing at the Senate about 10 years ago. These are legal experts who dictate the pace in the Federal Ministry of Health (FMOH). The same dramatis personae once told us at another parley that the FMOH would sustain the relief declaration at the Appeal Court, but we shall push this through at whatever cost through legitimate means. Does it mean anything to you and indeed Nigerians who observe this scenario, that the Federal Government negotiates and placates an unlawful template in labour statutes (NMA), while it activity spends taxpayers funds to engage legitimate Health Sector Unions (JOHESU) whenever they obtain court judgment against NMA, Medical and Dental Council of Nigeria (MDCAN) and the other medical interests? For as long as this methodology suffices the circadian rhythm of failure in the Health Sector will prevail albeit tragically. 

Let me however remind government that we are waiting and once there are violations of our right and MOUs our people who constitute over 95 per cent of the health workforce will do the needful. 

In all these what do you think is the way out because we cannot afford to go on like this? 

I am not sure i want to continue to posit on this. It has proved on a perennial basis to be a dialogue of the deaf. It is interesting that people mouth dialogue but in reality walk in the spirit of monologues because they expect to give directives to the other party they should relate with in a supposed rule of engagement. 

If you want to solve a problem, perhaps you need to appraise the foundational defects or root causes and in some scenarios both key elements. The madness that industrial disharmony epitomes in Nigeria today is directly traceable to the implementation of discriminatory salary wages vis the introduction of Medical Salary Wages in 1992 specifically. 

Today NMA even tells ignorant people that it has sacrificed about N250 billion which its members should have earned to government. Prior to MSS in 1992 to purportedly curb brain drain which is still a reality in all the health professions employees in the public service were on one Uniform Salary Scale (USS) which provided for entry levels based on training, specialisation and expertise. Once government approved Medical Salary Scale (MSS), which has now metamorphosed to CONMESS in contemporary times, other sectors began active agitations for what suited their interest. 

I am well informed through reports from the budget office that public sector wages which stood at less than N850 billion in 2009 now exceeds N1.8 trillion in 2014, in just five years you can see a drift that amounts to a staggering 105 per cent increase. These are some of the reasons why development is stifled as all the resources are spent on recurrent expenditures. Incidentally, the percentage that benefits from these wages trancends to less than one per cent of our population. The danger that apparently lies ahead is that the economy may crash ultimately like we have seen in some other climes because no fiscal system has in-built absorbers to continue to neutralise the many excesses the unending pressure wage increases compel. 

In the Health Sector, I have insight into analysis which confirm that well over 85 per cent of total budgets in the Health Sector is dedicated to only payment of emoluments. Today over 59 per cent of our total health budget at federal level is utilised to defray wages of the medical doctor cadre alone. This type of output, which cannot be sustainable makes it impossible to replace obsolete equipment or dabble into research and development (R&D) and so logically our ailing sector will continue to sink deeper into doldrums of unproductivity. The biggest two Federal Health institutions (FHIs) gulp over N14 billion in overhead expenses, so you imagine what it will cost government to maintain 55 FHIs. Again we advise government to stop this drift by appointing seasoned administrators or managers of cognate experience to head the 55 FHIs. In the ranks of administrators and managers, you will also find some competent health workers who can add value and so are appointable. The point here is that a CEO of today’s health institution may not excel only on the basis of professional qualifications in the health sciences. 

Beyond this government must drastically reduce cost by working out a privatisation of some of the clinical services especially at the level of out-patient department. If the National Health Insurance Scheme (NHIS) will be genuinely re-engineered more of the Out Patient Department (OPD) services should be diverted to private care providers provided the NHIS secretariat will handle this in tandem with lawful payment mechanisms. 

Opinion molders in larger society need to intervene to help our doctor friends to drop their philosophy of McCarthyism which is the basis to relate with other healthworkers across board. Those who pray well need to uphold the NMA lords in prayers so that the professed nobility associated with medical practice will be restored within the ambits of normative civility in Nigeria.      

You have been quoted as telling the NMA to stop trespassing on the privacy of some prominent Pharmacists. What is the crux of the matter? What is your advice to NMA?

The Pharmaceutical Society of Nigeria notes once again the distasteful reference to Late Prof. Dora Akunyili - a notable pharmacist in one of the press statements of the NMA. It is a widely accepted principle to respect the departed in this part of the world. One therefore wonders the need for vein glory the NMA was seeking by claiming its correct diagnosis on Akunyili was a mark of competence on the part of its members. Without attempting to meet this negative disposition of members of a profession that espouses patient confidentiality at the same level, what happened when members of NMA misdiagnose the clinical conditions of numerous Nigerians including some civil rights activists and others who eventually passed away based on ailments that were never detected by Nigeria practitioners? Any average care-provider knows that early detection of cancers though desirable and important, does not eventually guarantee remissions. For a fact evidence based data shows that remissions in cancers occur in just about five per cent of cases. 

In the immediate past leadership dispensation of NMA, calls were made by the NMA for it to assess the mental and physical fitness of His Excellency, the Governor of Taraba State, Pharm. Danbaba Suntai after his return to the country when legal protocols did not provide for such. This assault on the sensibilities of our members and their families through unrestrained political scheming for cheap gains must stop forthwith. NMA has a way of misinforming a gullible public. 

I have also read accounts bothering on doctors teaching pharmacists and other healthworkers in the University. The fact is there are few areas of common ground in training, so just like a few doctors might handle courses in pharmacy, academics in pharmacy teach medical students at both undergraduate and postgraduate levels. Other scientists and non-scientists alike definitely teach doctors, so there is no big deal about this. I once posited and i am restating this to the new leadership at NMA, you will have the President of the Pharmaceutical Society of Nigeria to contend with once you clandestinely contend with Nigerian pharmacists.

Finally, I wish to admonish the NMA and its hierarchy to familiarise with global best practices especially as preached in the World Medical Association ethics manuals, which has many salient and relevant reflections to the Nigerian experience. In a particular appropriate context I leave the NMA oligarchy with these submissions that state as follows: ‘The weakening of medical paternalism has been accompanied by disappearance of the belief that physicians “owe” their patients. The traditional right of patients to ask for a second opinion has been expanded to include access to other healthcare providers who may be better able to meets their needs. According to the World Health Assembly (WHA) declaration of the Rights of Patients, “The physician has an obligation to cooperate in the coordination of medically indicated care with other healthcare providers treating the patient’. It went further to justify this on the basis of sharing a basic human equality and a similar concern for the wellbeing of patients.

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