By Francis Okeke
President of National Association of Nigerian Nurses and Midwives Comrade Abdrafiu Alani Adeniji speaks to Daily Trust on the seemingly intractable acrimony in Nigeria's health sector and how to end it. Excerpts:
For long now, there has been acrimony between doctors and other health workers, the problems seem to be intractable, tell us what these problems are and how to get a solution?
The health sector had been moving well until around 1980 when things started changing. It is all about one group of people seeing themselves as the most important sector whereas what makes other countries to succeed is that they believe in team spirit which ensures efficiency.
What group of people see themselves as the most important?
In Nigeria today, the healthcare industry is in bondage; in the bondage of medical and dental practitioners. In the past, merit matters when you are appointing medical practitioners but today it is seen as a birthright, whether somebody is good or not, nobody cares to know. Even on the clinical side, before a doctor can say he is successful in his beat, he needs the cooperation of nurses, laboratory scientists and others.
What particular functions do nurses carry out?
For the nurses, they are the ones that own the patients, they own the wards and they are the custodians of the wards. A doctor is supposed to be a visitor to the ward. How can you then operate without the owner of the premises?
Before a doctor can prescribe a drug, you need the services of a laboratory scientist who is trained and have qualifications as well to go into the nitty-gritty of body chemistry to determine what is wrong.
There is nowhere in the world where you use your naked eye or your brain alone to make diagnoses; you need these people. Today, a radiographer will have to come in and they will also do their job. At a point, a nutritionist is also needed and in some emotional and psychological work, a clinical psychologist will also be needed. So, it is a team approach that is supposed to give us the result.
For example in the nursing profession, the independent role of a nurse is the one that you don't need a doctor to tell you what to do before you make your own diagnoses and go ahead. Nursing diagnoses is universally known and adhered to. Apart from that one, there are some interdependent roles where a nurse will have to perform, a clinical psychologist will have to come in and a doctor will have to be there. In this team, it depends on what job you are doing; if you are talking about comfort for the patient, a nurse is supposed to be the leader of that team and a doctor will make contribution but when you are talking about clinical diagnoses, the doctor will be the person that will lead and other people will contribute.
Why is that arrangement not working in Nigeria?
It was this team spirit that was destroyed and everybody who gets into the medical profession either by hook or crook whether you know how a hospital is ran or not, see themselves as the head. We have followed this thing for almost two decades now and that is why our health indices are falling. That is what the Joint Health Sector Unions (JOHESU) is trying to correct for the benefit of the public; it is not personal at all. That was why I said there was no acrimony but only an attempt to correct the anomalies in the health care industry.
What is the solution to these challenges?
Where there is no harmony, peace, accord or cohesion, there cannot be progress; the solution is in everyone of us sitting down; a professor of medicine, a professor of nursing, a professor of pharmacy, a professor of laboratory science, they are all professors in the field of health sciences and they have their areas of core competence but still have areas of collaboration.
We must realise that every one of us needs to contribute. When the Minister of Health Professor Onyebuchi Chukwu was to be appointed a second time, he was particularly given the assignment of ensuring harmony in the health sector but today, we have not achieved that. That was why there was a committee on harmony that comprised all health workers; they made their contributions but today, the concocted story in the Federal Ministry of Health is that the committee that comprised everybody was lopsided.
Lopsided in whose favour?
They say in favour of other health workers. Sincerely speaking, the chairman of that committee was a retired chief judge of the high court. Such a person cannot do anything that can denigrate his office. But we have faith in the new approach and that is the presidential expert committee on professional interaction in the health sector. We have representatives of the laboratory scientists, nurses, pharmacists and administrators. It is the combination of both health workers and people who are into administration. We believe this committee will do its work very well and use the report of Justice Abdullahi Bello's committee on harmony in the health sector as a working paper.
You said the president charged the Minister of Health to ensure harmony. What are the specific things militating against harmony?
In the health industry we have a professional cabal. They are a very strong mafia. They are the ones impeding the achievement of harmony because they believe health care industry is the right of their profession and it is not done like that anywhere in the world. It is the right of all professionals to make their contributions. When you go through the interviews of some members of the Nigeria Medical Association they call others supporting staff. How can you call a professor of pharmacy, nursing, laboratory science or physiotherapy a supporting staff? It is not done. In countries all over the world, they distribute duties equitably and things work well there. For example Botswana; the past three or four ministers of health in Botswana have been nurses. Botswana is one of the countries with the best healthcare services in Africa. This is adjudged by the World Health Organisation. The situation is that these people who think it is their birthright to lead are not leading well; if they were leading well, it would be another thing, our health industry would not be nose-diving.
How do we arrest the decline?
The solution is to work together in harmony and respect each other as well as give chance for merit to reign.
The leadership of your union has been meeting through the weekend and will close today (Monday), what is your message to the government?
The issue of Nursing and Midwifery Council is long overdue; we need a formidable council to transact the business. When they are doing this, let them follow the norms and the rules. The ideal thing is to have a professional heading a professional council, not board.
This is not a board of parastatal; you cannot choose a carpenter to lead tailors or a welder to lead butchers. However similar our work may be in the healthcare industry, nurses' council must be headed by a professional nurse.
We also have our unified scheme of service that we have been thrashing, whatever is the obstacle, we want the Federal Government and the office of the Head of Civil Service of the Federation to conclude this thing on time. We are also requesting for internship for our graduate nurses. Internship will sharpen the intellect, expertise and practice of professionals as is being done for doctors, pharmacists, laboratory scientists and even nutritionists.
We also call on the Federal Government to as a matter of urgency, empower the Ministry of Health to enter negotiations on our professional allowances as the court injunction directed. On skipping of grade levels, the court has ruled in our favour that skipping is justified for our health workers. As skipping is done in other sectors; they should likewise release a circular in conformity with the court injunction so that there is sanity in the health sector. They should also work to equip the schools of midwifery, collaborate with international agencies to give scholarship and in due course, we shall reap the benefits and the life expectancy of Nigerians will be on the increase and we shall be able to compete, health wise with other developed and developing countries.
Source : Daily Trust
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