Last Wednesday, Nigerians rolled out their drums and clicked their glasses to mark the nation’s 54th Independence.  National   president of the Pharmaceutical Society of Nigeria (PSN), Olumide Akintayo,  took a swipe at the health sector during a media chat with journalists. CHIOMA UMEHA (HEALTH EDITOR ) was there.

 

Welfare of Nigeria health workers

About seven months ago, I addressed the nation alongside the chairmen of Joint Health Sector Unions (JOHESU) and Assembly of Healthcare Professionals (AHPA) on crucial matters pertaining to the welfare of health workers and inter-professional relationships. Together with these key platforms of trade unions and professional associations, we issued an ultimatum for a strike which eventually began on January 22. What followed was a total shut-down of health facilities across the nation including primary, secondary and tertiary facilities. Government and public appeals forced us on that occasion to temporarily suspend the strike in the hope that government will be more responsive by identifying with the minimum demands of these templates which we continually remind all who care to listen to embrace. Over 95 per cent of the entire health workforce in Nigeria.

It is worthy to note that seven months after we commenced a robust attempt to redress the unfortunate status quo in healthcare in Nigeria, we are still left in the cold. Government, as a matter of fact, has traded off the salient memorandum of understanding (MoU) it signed with us in a bid to placate doctors when they embarked on their unlawful and illegal strike for seven weeks between July and August.

Since the chain of events began, government has continued to be elusive by tactically classifying majority of our demands as subject matters that have been referred to the Yayale Ahmed-led Presidential Committee of Experts which is seeking harmony in the health sector.

 

While the PSN appreciates that Mallam Ahmed, a seasoned bureaucrat and the crop of distinguished health professionals who work with him may mean well in charting an agenda that will move the health sector forward, the fact remains that it is still largely an advisory/administrative panel which logically implies that if it comes up with some recommendations not acceptable to groups or some dramatis personae, the recommendations might not be binding. Government’s reliance on the Ahmed panel to right all wrongs in the sector may epitomise a grandeur of delusion or an unrealisable utopia as we remain witnesses to how the Federal Ministry of Health in alliance with some doctors sabotaged the noble recommendations of the Justice Gusau panel a few years ago. That development was hinged on the reality that the Gusau panel report touched without fear specific measures to correct the aberrations and distortions in health care, especially those entrenched by the obnoxious decree 10 of 1985 which remains the albatross we contend with in the health sector since the inglorious days of late Prof. Olikoye Kuti. Prof. Olikoye Kuti, was the one who disrupted the harmony in the health sector by legalising the headship of hospitals which he vested in his doctor colleagues as well as introduced discriminatory salary wages in favour of his colleagues, a development which is responsible for the industrial disharmony we have experienced in the labour sector for over 23 years now.

 

The PSN wants to put it on   record that government has failed to come up with circulars in tandem with MoUs it has signed with the labour unions (JOHESU) in many fundamental areas.

First, is on promotion of our members from salary CONHESS 14 to 15 as directors who have stayed for between four and 15 years on the same salary level without promotion in most Federal tertiary hospitals.

The next is the immediate release of a circular on the adjustment of salary since January, 2014 and the immediate payment of at least two months’ arrears, while the remaining is paid after being accomodated in the 2015 budget.

You also have the problem of immediate release of the circular on extension of retirement age to be back-dated to February 2014 when the issue was presented to National Council on establishment; immediate and full payment of arrears of salaries of CONHESS 10, skipping outstandings.

 

Others are: immediate amendment of the circular on consultancy status as pronounced by National Industrial Court on July 22, 2013, and agreed upon at a meeting of August 12, 2014, with the Federal Government; payment of arrears of specialist allowance to qualified hospital-based professionals with effect from January 1, 2010 in line with the National Industrial Court of Nigeria (NICN) ruling; minimizing the lopsidedness in the membership of boards of management of tertiary hospitals and the need to define the functions and power of honourary consultants in teaching hospitals and the need to appoint more hospital-based consultants instead of honourary consultants.

The rest are:   the need for residency programme for all health professionals; issuance of guidelines on appointment of the chairman, Medical Advisory Committee and the committee’s composition; need for complete autonomy for the teaching hospitals by removing university lecturers as heads in some of the clinical departments and restoration of working days as annual leave.

Implication of broken promises by government

 

The direct fall-out is that a whole generation of pharmacists and health workers are stagnated on the same salary scale for upwards of 10 years in many instances. In some other dimensions pharmacists and health workers who have invested personal resources on professional and manpower development are denied reward for labour as government which showed initial interest in remunerating the fellowship programme has succumbed to the blackmail of Nigerian doctors who insist through the proclamation of the Prof. Chukwu Onyebuchi-led Federal Ministry of Health that it is only doctors who can be designated consultants, contrary to international best practice and a 1976 public service circular that recognises consultancy status for eligible health professionals.

 

The experience of pharmacists appear worse because as far back as 1997 the West Africa Postgraduate College of Pharmacists (WAPCP) produced the first set of Fellows.

The fellowship of the WAPCP was formally recognised as a condition precedent for a consultancy status in Nigeria since 2009, yet the Federal Government has failed to remunerate these consultant pharmacists because another group of employees said it is unacceptable.

 

While pharmacists pay with their own resources for post-graduate training, government often pays for the training of doctors through provision of scholarships and subsidies.   One is forced to wonder why government must wait for the threat of a strike before it concedes to legitimate privileges to its workers. The reality of a strike is not unlikely despite the maturity of JOHESU and AHPA as it is apparent that government will not bulge until another round of disruption in health services becomes a reality.

Beyond strikes which pose severe economic consequences, morbidity and outright fatalities, government must realise that its recent strategies to impose a master-servant relationship in the health sector is beginning to generate ripple effects at the detriment of national development.

New generations of Nigerians are shunning science-based programmes other than medicine in the health care discipline. A recent survey in one of the first generation universities confirmed that 53.8 per cent of applications for the sciences was for only medicine, while the other science-based professional courses including pharmacy, engineering, architecture, estate management and others shared 46.2 per cent. The result was that the cut of mark for medicine at the post-JAMB examination was put at over 80 per cent, at a time other courses could not meet their quota. This is the reality we shall confront in a nation where ego propensities count so much.

The PSN, therefore admonishes government to be dispassionate in redressing matters of equitable distribution of resources and privileges in healthcare or to seriously consider scrapping other professional programmes it has treated with contempt in the last couple of years.

 

Privatisation of pharmacy facilities

The attention of the PSN has been drawn to recent public notices emanating from the registry of the Pharmacists Council of Nigeria (PCN) with regards to a public-private partnership (PPP) philosophy. We at the PSN believe very much in the spirit of a private sector-driven economy and logically support the concept of legitimate models of a PPP.

Pharmacy practice is a regulated one with a myriad of regulatory agencies having substantial latitudes of influence. These agencies include the PCN, National Agency for Food and Drug Administration and Control (NAFDAC), National Drug Law Enforcement Agency (NDLEA), federal and state task forces as well as other statutory agencies of government.

The PSN is worried at attempts by some state governments to reduce pharmacy practice into a purely commercial venture of buying and selling with absolutely no standards in the guise of a PPP. There are patients who visit public hospitals only because they assume drugs in such facilities will be genuine in the reality of an existing fake drug syndrome which continues to ravage the health sector. This is why the PSN continues to caution on the consequences of diverting a guaranteed public sector market in pharmacy facilities to private profiteers. Some of the fundamental fall-outs remains who takes responsibility when anything goes wrong with respect to drugs dispensed in such public facilities concessioned to profiteers. The profiteer or government? Presently the Lagos State government which blazed this trail has been able to adapt its privatisation model to the PPP guidelines prescribed by the PCN. There can be no compromise on this demand in both the public and professional interest.

 

Some of the federal health institutions which experimented with privatisation in pharmacy facilities are still in huge mess even after such contracts have been terminated because the profiteers who utilised the goodwill of the federal health institutions to source drugs from the pharmaceutical industry simply sold the drugs and pocketed the accruing revenue. Many of the pharmaceutical companies refuse to do business with public health facilities up till now and   this poses serious consequences for consumers of health products in such institutions.

The PSN therefore issues a clarion call on pharmacists, pharmaceutical companies and stakeholders to familiarise with the tenets of the PPP guidelines of the PCN before formalising contracts with public pharmacy facilities. Violations of existing provisions of the PPA Cap 535 LFN 1990, Cap P. 17 LFN 2004, gazettes 79 and 81 of August 2005 and the Code of Ethics for Pharmacists in Nigeria will attract sanctions from the PSN as erring pharmacists will be placed on the roll of dishonour of the PSN.

 

Finally, the PSN appeals to affected state governments and other stakeholders to dialogue immediately with the PCN to facilitate lawful models of PPP in their domains in public interest.

Annual National Conference of the PSN – “Ibom 2014”

The 87th Annual National Conference of the PSN will hold in Uyo, Akwa Ibom State from Monday, November 3 to Saturday, November 8. For us at the PSN this will be the ultimate in conferences as it has been well planned and its execution will bring excellent delivery.

 

This conference comes with new packages, including the maiden Deans Forum, Directors of Pharmaceutical Services Forum, and Head of Pharma and Federal Health Institutions Forum as part of our agenda to boost human relationship management. As part of arrangements with the PCN to revolutionalise the Mandatory Continuing Professional Development (MCPD) credit point earnings, the continuing education segment of the conference will hold at the ultra-modern e-library facility of the Akwa Ibom State government in Uyo.

There will be a technical/interest group and other sectoral consultations.

The Board of Fellows and Young Pharmacists Group will be energised through new processes to optimise their potentials. An official social nite will be hosted at some stages, while the VIP forum which debuted in Ilorin, last year will be consolidated.

 

The major highlight of the opening ceremony will be the awards of Ambassadors of the Health Sector to four distinguished Nigerians which include: Chief Martin Elechi, Executive Governor of Ebonyi State; Comrade (Dr.) Ayuba Wabba; Dr. Godswill Okara, chairman, AHPA; and Prof. Temitope Alonge, Chief Medical Director (UCH), Ibadan.