How to create a truly healthy health sector has the issue over the years. So no year has really passed without some disagreement between the ovemment and those working in Nigeria's health sector. Of recent, those issues have resurfaced again with a warning strike that lasted for about one week. Yes, the much touted mother-of-all-strike by workers in the health sector is yet to be declared, but some state governments are already at logger heads 

with Nigerian Medical Association (NMA).

Interestingly; one issue that has become the game changer for the NMA is the proposal it made to the federal government recently to consider the creation of the Office of Surgeon-General of the Federation as part of measures to rescue the sector from total collapse for its incessant strikes to cease. Yes, President Goodluck Jonathan acceded to that request, with search for the best man for job now his major pre-occupation. 

The idea of a Surgeon-General was first conceived by the United States in 1798. Basically; it is an American conscription with the main objective as an advisory office for public health. 

In most instances, the Surgeon-General act as the Chief Spokesperson on health related issues nationwide. The office assists in various fronts in disease prevention and outbreak of epidemics. Constitutionally; though, it is domicile in the office of the president, the office acts in conjunction with the Health Department, reporting to the Assistant Secretary of Health. 

In the US, the functions are so explicitly stated that conflict is avoided. The quest for Nigeria to adopt the US pattern, by appointing a Surgeon-General has been around for decades. Though the executive is yet to initiate the bill for onward transfer to the National Assembly; a bill of its kind was first initiated by the former Senator from Lagos State, Senator Olurunnimbe Mamora in the fourth senate. At the forefront canvassing for the establishment of the office are the medical doctors under the auspices of Nigerian Medical Association (NMA). Since then, the creation of the office has become one of the top demands put forward by doctors during strikes and negotiations. The Federal Government through President Coodluck Jonathan early this month gave a nod to the demand for the establishment of the office. 

The government during negotiations with the NMA was believed to have heeded to the call for the appointment of a Surgeon-General based on information at its disposal that it ensure required progress for the health sector in the country. The negotiations led by the Delta State Governor, Dr Emmanuel Uduaghan, who himself is a medical doctor might have pacified the crisis between the government and doctors A source in the Presidency had told lHISDAY that "the government has taken a decision to appoint a Surgeon-General of the Federation who will be a medical doctor and will be responsible for public health. That appointment will be announced soon." And though, the decision to create the Office of the Swgeon-Genera1 of the Federation appears germane in many respects, but those opposed to it argued that there is need to do necessary reality checks, if the office must achieve its purpose. 

For instance, many argued that the haste with which government and the NMA are pushing for the Office of the Surgeon-General is without recourse to several impending loopholes in the process. A few days ago, the Joint Health Union (JEHU) said during a press conference of Lagos that government decision to consent to the demands by NMA for the setting up of the office amounts to disregard for the extant laws in the sector. They further urged government to heed to "an unconditional halt to the appointment of a Surgeon-General for the Federation as the concept remains both And though, the decision to create the Office of the. Surgeon-General of the Federation appears germane in many respects, but those opposed to it argued that there is need to do necessary reality checks, if the office must achieve its purpose unconstitutional and outright unlawful." 

But the Minister of Health, Prof. Onyebuchi Chukwu thinks otherwise. In an elaborate interview with journalists on the issue in Abuja, Chukwu gave reasons while the Office of the Surgeon-General has become sacrosanct and indispensable, if Nigeria is to tackle her many health challenges. According to him, "the president has in principle accepted that there is a need for a Surgeon-General. But you know some distance exists between principle and practice. Obviously now that the president has accepted that there is indeed the need for the position, it means we need to begin to go to work and at the end of the work, I believe that an appointment is going to be made. What is that work? We need to draw up the core responsibilities of the Surgeon- General having accepted that in principle. This is what the NMA has been asking for in decades, it is not a new thing." 

The health minister did not overlook issues being raised by those arguing that there are critical issues regarding the proposed Office of the Surgeon-General. He acknowledged that there are grey areas in setting up such office, but rather added that the advantage far outweighs the disadvantages. '1 think there are areas where we actually have some lacuna;' Chukwu said. But, he provided the impetus and rationale for such an office. 'Take for instance, we have been talking about government sponsoring public servants for treatment abroad. Presently we have a mechanism in the public service, it is either the ultimate approval is given by the head of service or is given by the Secretary to the Government of the Federation depending on whether you are a core civil servant or a political appointee like a minister. But government is beginning to feel that there is the need for an office that is removed from politics that may even require the senate for instance, approving or maybe the whole of the national assembly to which everybody will know we can direct such request and such. office should be able to say 'why can't this be treated in Nigeria?' why must it go outside, there are places where 

this can be treated so that is possibly one of . the function of the Surgeon-General, if it is eventually field as a position." 

Critically, Nigeria has been caught up in instances, where the services of a Surgeon- General would have been helpful. For instance, the health challenge that led to the death of the former President Musa Urnaru Yar'Adua and subsequent squabble in the presidency by powerful interests on who takes decisions in his absence ( while dealing with his health challenge) 

remains in the annals of the country's history. Even the case in Taraba State between Govemor Danbaba Suntai and his deputy are all reasons, proponents for the office of Stugeon-General are urging President Jonathan to do the needful. 

Analysts observed that if Nigeria has had a Surgeon-General, Nigeria would have been saved the troubles. Chukwu also took time to explain the situation by saying that, "When the constitution says that either the president or governor could be relieved of his position, if indeed he is no more in sound health, the question here is: Who decides that a governor is in sound health? There may be the need for such an independent office established by the constitution or by law that should be able to handle that. So these are some of the reasons why we feel that there is a gap to be field but how it is going to be filled has been the debate over the years and also remember the question as to whether the minister of health ought to be a medical doctor or not, why can't he be someone who read English or who read mass communication or who read history. For you to have such, then you must be like other countries that have an office that is independent that handles some specific issues and mattersof public health professionally so that the minister concentrations are purely political and administrative decisions." 

Speaking on the fears expressed by some section of health care providers concerning the office, Chukwu said there is no course for alarm. He debunked claims that that the office of Surgeon-General will duplicate functions perform by the Minister of Health He explained that, "like in the United States of America, where there is a Surgeon-General, the person 

responsible actually reports to the assistant secretary for health which is the equivalent of minister of state." "So if you are going to report to the minister of state how is that gOing to conflict with the job? I don't think so. Even today, the people that advised that someone A few days ago, the Joint Health Union OEHU) said during a press conference in Lagos 

that goovernment deciSIon to consent to the demands by NMA for the setting up of the office amounts to disregard for the extant laws in the sector should go abroad or sponsor for treatments are doctors. When you go to hospitals, the person that refers you for treatment is a doctor, so I don't see how that conflicts with other professions to be honest. But let's not jump the gun, let us not preempt the matter, the President has accepted in principle, we are to await further directives." 

Speaking to THlSDAY on the issue, NMA President Dr Osahon Enabulele said the Office of the Surgeon-General will save Nigeria a lot of crisis, induding promoting accountability and transparency in government. Enabulele opined that the essence of the office should be Seen in the light of ,creating "access to constitutional issues or lacuna, whereby the office is independent of political maneuvers. To fill that gap you need an independent office to access the state of health of both politicians and 

nation's public health system. If you appoint politician, any public officer will just be there playing to the whims and caprices of his or her boss," he stressed. The NMA president further stated that the creation of the office will curtail fraud in the system, adding that, "it will stop most public officers from going abroad for fraud in the name of foreignmedical trips." As the NMA and government speak in unison, perhaps thought should also be given to opposing views. This will avert future crisis and prevent other health workers from hOlding government hostage and the masses to ransom over prejudice against the creation of the office. One critical aspect with the office according to those familiar with the system elsewhere though is that, it will at least be separated from the politics and hanky-panky common to the Office of most Minister of Health. Now, Nigerians are waiting to see where the pendulum Swings in the end.