The Nigeria Optometric Association (NOA) extends our fraternal greetings to your Excellency, and wish you a new year of new  inspiration and further empowerment We express our gratitude to your Excellency for the uncommon commitment and tenacity with which you have worked to propel to world standard the Nigerian Healthcare system. The NOA extend our total solidarity with you in the patriotic task of developing and structuring a harmonious, integrative, and proficient Healthcare delivery system in Nigeria In this light we wish to bring to your esteemed attention the unwholesome and reprehensible representations of the Yayale Ahmed Committee Report on the Inter-Professional Relationships in the Health Sector, something that we believe negates the thinking, perspectives and actions of your Excellency in the Health sector. 

 

EXPECTATIONS OF THE YAYALE COMMTTEE 

The convening of the Yayale Committee was welcomed with so much enthusiasm by all of the stakeholders in the Health sector,  as evidenced in the spirited submissions of practically an of the players in the sector. This intervention was expected to  evolve a framework for the veritable coordination of the inputs of all the Professionals and Stakeholders in the sector. For  so long in Nigeria's Healthcare history, we have witnessed that instead of a collaborative and constructive engagement of all stakeholders, the component professions are operating in disharmony, and sometimes in conflict. Hence, fundamentally, the  Committee was expected to evolve a holistic and clear definition of the targets of the Healthcare system. With a scientific  appreciation of the capacities and inputs of all the component professions, those individual professional groups should be appropriately positioned and factored into a functional framework for efficacious service delivery. Evidently, the challenges and imperatives were not just administrative or of management, but also and fundamentally technical. It was also expected to  derive propulsion from the substratum of the current National Health Act. But tragically, its philosophical underpinnings  contradicted the spirit and letter of the National Health Act.

 

THRUST OF THE NATIONAL HEALTH ACT

The National Health Act represents a revolution in perspective in the Nigerian Healthcare enterprise. The Act made a radical  paradigm shift from an elitist emphasis on Tertiary Health Care to according unmistakable premium on Primary Health Care,  so me thing that would provide operative space to most of the other Healthcare professionals. It went further to provide for  the inclusion of other Healthcare Professionals in the composition of several Committees concerned with coordination and  

management of Health Services. Above all, and most fundamentally, the Act provides opportunities and enablement’s for  Nigerians to challenge their leaders through the judicial process on issues concerning their rights to Healthcare Services. 

 

But the Yayale Report, instead of giving potent value, and possibly evolving the perspectives of the Health Act beyond its  immediate specifications, sought to negate the spirit and letter of the Act. Instead of submissions that would engender a  Federative collaboration of all the Health professionals and stakeholders, it promoted the case for a unitary structure by  creating/empowering a monster/dictator out of one of the professional groups, namely medicine, over others; A structure that  suggests and promotes an executive euthanasia/killing of other healthcare professions. We address in material specifics some  of the objectionable recommendations of the Yayale Report. 

 

INCONSISTENCIES/ILLOGICALITIES OF THE YAYALE COMMITTEE REPORT 

1. That Joint Health Sector Unions (JOHESU) and the Assembly of Healthcare Professional Association (AHPA) which have the  Nigeria Optometric Association (NOA) as an affiliate member had advanced a comprehensive response to most of the  unconscionable submissions of the Yayale Committee Report. (Find Attached in Daily Trust, 7th January, 2015, Pages 40 & 41).  The NOA associates fully with all of the items referenced in the response, and remains in full solidarity with the thinking  

and actions of JOHESU and APHA in these respects. Therefore we narrow our submissions to address the issues that affect  excursively the Optometric profession in the Report. 

 

2. The NOA noted the most ridiculous, bothering on illegality and criminality, one of the recommendations of the Yayale  Report for the withdrawal of the approval for the Doctor of Optometry degree in Nigerian Universities. In advancing the  position, the Report (Section 5.4.16) referenced the verbal advice/announcement of an unnamed representative of the National  University Commission (NUC) to the effect that 'the NUC does not recognize the Doctor of Optometry (0D) programmes in the  Nigerian educational system; even though the same NUC set the Bench Mark Minimum Academic Standard (BMAS) for Optometry (in  line with international best practice) since 1981 as 6yrs leading to the award of the Doctor of Optometry (OD) degree.  Relying on mere hearsay and/or speculation in taking such an important decision that touches the nerve center of any  profession is an apparent invitation to anarchy and chaos. It is an apparent conspiracy to achieve through the back door what our greatest detractors failed to achieve since 1981. This recommendation is most atrocious and an attempt to set the World  Council of Optometry (WCO) and the NOA on collision course with the Nigerian Government starting with the NUC. Nigeria can  iII-afford these distractions now just because Yayale Ahmed appeared to have compromised to his friends. Most farcically, the Yayale Report had peremptorily commenced to address the 00 degree (awarded wor1dwide after an intensive 6-Academic years of  study in a University) as "Diploma'! What a bias? We highlight a few incontrovertible facts about the training and practice  of Optometry.

 

a. The Doctor of Optometry (00) degree programme commenced in 1981 at the former lmo State University now Abia State  University, Uturu with NUC approval, concurrence and resource support. 

 

b. In this day and age, five Universities are offering Optometry (OD) programme: 

   (i) University of Benin, Benin City, Edo State 

   (ii) Abia State University, Uturu ,Abia Sate 

   (iii) Imo State University, Owerri, lmo State 

   (iv) Madonna University, Elele, Rivers State

   (v) Federal University of Technology, Owerri.

 

c. Over the years, these institutions have graduated over 3000 Doctors of Optometry (ODs) into the Nigerian Healthcare  system. A good numbers of them are also practicing and lecturing abroad.

 

d. Over these same period, in concurrence with the NUC position, the Joint Admission and Matriculation Board (JAMB) has been  advertising the OD Programme as an option of study for qualified candidates, and likewise conducts examinations and admits  successful candidates for study in the mentioned institutions. 

 

e. The practice of the profession in Nigeria is regulated by law, ie, Decree No. 34 of 1989, now cap 09 law of the Federal  Republic of Nigeria. This law recognizes the OD degree. The law also established the Optometrists and Dispensing Opticians  Registration Board of Nigeria (OOORBN). This board regulates the practice of optometry in Nigeria. 

 

f. In NUC publications and Brochures that lists courses offered in Nigerian Universities, Optometry (OD) programme is clearly and legibly listed. 

 

g. The NUC has published Brochure titled Benchmark Minimum Academic Standards for Undergraduate Programmes in Nigerian  Universities. For the Basic Medical Sciences, the 00 Optometry programme is exhaustively listed, stating the Philosophy,  Aims, Objectives, Admission and Graduation requirements and Course Contents up to the 600 level. (Brochure Attached). Etc.

 

h. In the light of these, the question for the Yayale Committee is; can a verbal advice annul the de facto state of affairs  as itemized above, including disenfranchising the over 3.000 OD practitioners? Could such an action of withdrawal of approval be contemplated without interaction and engagement with the training institutions (Universities where 00 programmes are  administered), members of the profession, Federal Civil Service Commission, Federal Ministry of Health, Office of Head of  

Service, the Incomes, Wages and Salaries Commission, Attomey General of the Federation, the OROOBN which is the Optometry  Regulation Body and JAMB? Such perfidious action bordering on perjury by the Yayale Committee should be investigated at  appropriate judicial level. 

 

3. Also bordering on the most nonsensical was the proposition of the Yayale Committee for the creation of a National Healthcare Commission to replace Professional Regulatory Agencies and regulate Tertiary Health Facilities. The JOHESU response to this proposition captures exhaustively the position of the NOA in all of the respects identified. But we go further to unmask the hidden agenda of the Yayale Committee.

 

In the thinking of the Yayale Committee, harmony in the operations of the diverse professional groups translates directly  into a dictatorship of one group over the rest. A dictatorship that permits even the right to kill any profession perceived as a threat irrespective of the cost to members of the public. The concept of harmony in the operations of the Health sector is nothing of the sort. Harmony implies collaborative and constructive engagement, a form of synergy, with mutually reinforcing relationship between the players. The National Health Act in section 1(1) envisages a relative autonomy of the professions, with their individual regulatory bodies. It recognizes that the individual professions have their unique history of evolution, hence deserves its own space for further evolution in knowledge, know-how and practice. 

 

Further, the Regulation Agencies and Training institutions are aligned to the best practices globally, with diverse  international affiliations. Of note here is our neighbor Ghana. They run the 00 pragramme but somebody in Nigeria is routing  for a return to the Stone Age. It is of notes that, much of the Health professional practices in Nigeria are in the race to  attain world standards. Therefore, the attempt to institute unitarism in form of the National Health Commission in place of a Federative collaboration and to instantly dissolve the Regulatory Agencies is not only illegal, but an anachronism that seeks to take Nigerian Healthcare backwards by centuries. 

 

4. Unbelievably, the Yayale Committee failed entirely to address the issue of management of the conflict of roles between the Optometrist and the Ophthalmologist, despite the exhaustive representation to the Committee in that respect by the NOA,  including the justification for the creation of a separate Department of Optometry in our Health Institutions and Teaching  Hospitals. 

 

The non-delineation of roles and functions has emasculated in near totality the enterprise of the Optometrist, and this has  undermined dangerously the efficient delivery of Eye Care service to the Nigerian people. The inability of the Health  Management Authorities in Nigeria to appreciate and enable a clear job description and adherence to those portfolios in  respect of the Optometrist and the Ophthalmologist has resulted in a dysfunctional and conflict-engendering order in the  sector. A summary of the difference in their respective portfolios is here highlighted. 

 

By training and certification, the Ophthalmologist is an Eye surgeon, trained to provide Tertiary eye care Service, while the Optometrist, by Training and Certification passes through Undergraduate and Graduate tuition, with the option of proceeding  on Post-Graduate training In that respect, the Optometrist is most positioned to provide Primary Eye care service, as the  first point of call. By implication, it is upon the exhaustion of the intervention of the Optometrist, and perhaps, a  subsequent referral by the Optometrist that the intervention of the Ophthalmologist is necessitated. In the developed worlds, this harmonious role delineation is clearly resolved, and hence the inputs of the two sets of professionals are mutually  reinforcing and functionally synergized. The absence of this feature of multidisciplinary approach to health management in  the Nigeria Health system is one of the major cause of disharmony in the health sector and also the result of several  anomalies. 

 

The proposition for a Department of Optometry well detached from the Department of Ophthalmology by the NOA as a one-way  solution to the anomaly was totally ignored by the Yayale Committee. Hence, we are reiterating this position in our prayer to you.

 

It is evident from all of the foregoing that the Yayale Committee failed in His assignment. Because its perspectives on the  issue at hand were fundamentally flawed its recommendations crashed like a pack of cards; instead of being harmony-  engendering they are in the main conflict-engendering. In due consideration of the very fatal flaws in the Report and the  still existing anomalies in the Nigerian Healthcare System deriving impetus from the National Health Act and conscious of  the Professional Rights of Optometry Service providers in Nigeria and our national responsibility to discharge this mandate  to our nation, the Nigerian Optometric Association (NOA) patriotically advance the following Prayers: 

 

PRAYERS: 

(1) That the Yayale Committee Report be jettisoned in its entirety and any move to generate a White Paper based on the  Report be discontinued. 

(2) That it is needless, unproductive unprofitable and wild-goose chase constructing another Committee for purpose of  addressing the same issue or any other Health related matter. 

(3) That a National Health Summit the equivalent of the National Confab be convened soonest to reflect on our Healthcare  goals and the modus operandi for its actualization. The Summit shall, like the Confab provide a forum for direct one-to-one  interaction of all stakeholders in the Health Sector. This enterprise is far superior to the actions of Panels/Committees of  select individuals who may not have had the time to even read let alone evaluate the inputs of the players in the sector, as  

evidently was the case with the Yayale Committee. Resource support expectedly shall be sought for Mediators, both technical  and administrative, and both national and international including the Nigerian Diaspora. The Mediators shall be enabled to  critique, evaluate and arbitrate on the submissions by the stakeholders. 

(4) That the Yayale Committee members be queried indicted and prosecuted; likewise any identified NUC blackleg for raising  false alarm over a non-existent withdrawal of approval for undergraduate training for O.D. 

(5) Likewise. no consideration whatsoever should be given to the Committee's egregious proposition for a National Health  Commission. 

(6) With the painstaking submission of the Nigerian Optometric Profession substantially not captured in the Yayale Report,  some of those prayers are here restated. We insist that a very comprehensive structure be put on the ground for  Rural/Public/Commonly Health Optometry to take Optometry Primary Eye Care Service as a first line of action to the grassroots communities in the nooks and crannies of Nigeria where the need has reached emergency proportions. 

(7) That the Optometry Department be structured and put in place finally and irrevocably in all Public Health Institutions.  including Public Hospitals, Teaching/Specialist Hospitals, Federal Medical Centres, etc. This Department shall be physically  and administratively detached, though in complementary collaboration with other allied Health UnHs such as the Ophthalmology  Department. 

(8) That a sharp and clear demarcation of roles be enunciated concretized and enforced between the Optometry Units and the  Ophthalmology Units in those institutions. 

(9) Flowing from the above that it be enunciated and enforced as National Health Policy that Optometry Service be the first  line of call for the Eye Patient, as the Primary Eye Care provider; and that it is upon the full exhaustion of the  intervention of the Optometrist, and a subsequent referral shall the intervention of other Health Specialists including the Ophthalmologist be necessitated. 

(10) Further that the Administrative and Professional Management of the Optometry Department/Unit in Public Health  institutions and likewise, the Academic /Professional Management in Tertiary Health institutions be undertaken by the  Optometrist. 

(11) Hence that Training of the Optometry Candidate from Undergraduate through Graduate and Post Graduate including  Internship Training and other forms of Continuing Education be co-coordinated by the Head of the Optometry Units/Departments. 

(12) In consequence. that the laws regulating the operations of Teaching Hospitals (Cap 463lFN) be reviewed to capture the  Services and Portfolio of the Optometrist. 

(13) Further. that the office of Chief Medical Director/Medical Director of Health institutions be re-designated as Chief  Executive Officer (CEO), and made open to all Health Professionals with proven competence and managerial expertise. 

(14) In respect of Scheme of Service. that the Graduate Optometrist with OD Certification be positioned at par with the  Medical Graduate (with MS. 8S). and likewise the Post-Doctoral Residency of the Optometrist as the academic and professional equivalent of the Fellowship Certification of the Medical Doctor. 

(15) Flowing from this plank, that the entry point for the Doctor of Optometry (OD) be Gl 12 or CONHESS 10 after  Internship Youth Service, instead of the current Gl10 or CONHESS 9; and further a GL 15 or CONHESS 13 for the Consultant  Optometrist. 

(16) That all other Incentives/Conditions of Service Honoraria accruable to the Medical Practitioner apply universally to the Practicing Optometric, such as: Rent Subsidy for Optometrists working in the Public Sector. Call-Duty Allowance for  Optometrists in Federal Hospitals and Clinics in MDAs, Non-clinical Duty Allowance to Optometrists in MDAs, and Clinical Duty Allowance to Honorary Optometry Consultants who are employed as Academic Staff in Universities. but render clinical services to Tertiary Health Institutions.

 

We thank you for this opportunity of making once again our humble contribution for your consideration and timely action.

 

Dr. Damian Echendu OD., LL.B., FNOA

National President

 

Dr. Adesuwa Agbontaen, OD

National Secretary