In recent times, the health sector has experienced some stressful events, the latest of which was the nationwide strike called by the allied health workers under the auspices of the Joint Health Sector Union. In this interview with journalists, the National President of the Nigeria Medical Association, Dr. Osahon Enabulele, discusses sundry issues affecting the sector. Solaade Ayo-Aderele was there
There have been numerous complaints by members of the public over cases of negligence and malpractice by doctors, yet not much has been heard in terms of sanction of erring members. Is it a case of cover-up by the NMA?
Let me also inform you that in the last 10 years, the Council has not been in place for more than four years in all. In fact, we are embarrassed and frustrated by the absence of the Council. Nobody is covering anybody, contrary to the general belief out there.
Why was the last Council dissolved?
No explanation was given; and typical of government, they did not give any reason when they announced the dissolution of all boards and councils. The law provides that the MDCN exists in perpetuity, yet government frequently dissolves it alongside other government boards of parastaltals. As we speak now, the medical profession is not being regulated by anyone, and that is not good for the nation. The public should blame the government and not the NMA for protecting doctors or individuals alleged to have misbehaved in their practice.
During the strike embarked upon by the allied health professions under the auspices of the Joint Health Sector Union, your members tried to keep some services running. How were you able to do it in the absence of other workers?
It wasn’t anything really difficult. Our radiologist colleagues and their residents took charge of everything concerning x-ray and scanning. The laboratory medicine physicians and their residents took care of clinical laboratories. Most patients bought their drugs from chemist stores in town, while our colleague anaesthetists were fully on ground for the theatres to function. House officers were on ground in the wards all the time, and patients’ relations assisted in bathing the patients. With all these, we were able to forge ahead; and I am happy to announce that we have yet to hear that a single person lost his/her life as a result of the strike.
This doesn’t mean that other health workers are not important or that we want to take over their jobs as erroneously held in certain quarters. We just looked into our reserve skills and used them to sustain services.
This partly explains why we are calling on government to expedite action towards the outsourcing of other services like pharmacy, laboratory, radiography and other supportive services, through a Public-Private Partnership arrangement. This will markedly improve services in public hospitals, in addition to saving huge sums of money that could be used to fund other critical aspects of hospital services. The already outsourced ones have performed very well and we need to advance the programme. Outsourcing and PPP eliminate waste and engenders commitment, hard work and diligence.
Why is the NMA supporting outsourcing and PPP, contrary to its views some years back?
I am not aware of any time the NMA opposed outsourcing or PPP in the hospitals. From what we have seen from centres where outsourcing and PPP have taken place, we believe strongly that it is the way to go if we must return health care to its past glory. For now, the entire public hospital system is overcrowded, with a lot of wastage. People are just milling around, obstructing duties most of the time. We need to be realistic; we must do what is necessary to get the public health care system working again.
Would this include nursing services?
No, no, no. Nurses are very important in health care. In fact, the burden of patient care mostly rests on doctors and nurses. If any two groups of people must work together in the hospital to change things, it is the doctors and nurses. We have been in the business of health care with them for a long time. So, you cannot outsource nursing or get them involved in a PPP arrangement. Nurses are very important in patient care, the attitude of a few of them notwithstanding.
Is this the views of your colleagues out there?
We have never underplayed the role of nurses in patient care. Everyone who is familiar with processes involved in patient care will attest to the fact that nurses are next to the doctors in importance in patient care. There is no reason why a laboratory scientist or pharmacist should be paid higher allowances than the nurse in a hospital environment. Nurses are quite closer to the patients than all other allied health workers. Nurses ought to be treated better than the other allied health professions. I do not see any of my members disagreeing with this position.
Recently, the NMA gave the government a 21-day ultimatum. What led to it?
The decision to issue the ultimatum was taken at the National Executive Council meeting of the NMA held in Sokoto on August 31, 2013. The ultimatum was meant to draw the attention of the government to a series of matters that our association had previously brought before them for which no attention had been given. We felt there was need to take a more resolute stand this time around. The issues concerned the absence of a governing council for the MDCN, persistent gross irregularities of the Integrated Personnel and Payroll Information System policy of the government, difficult work environment, inadequate working tools, gross underfunding of research and training of doctors, erosion of best practices and professional hierarchy in the public hospitals buoyed by the seeming determination of allied health workers to collapse the health care system through various inordinate demands, actions and inactions, welfare issues and a few other related issues.
Budgetary provisions for training and retraining of staff have continued to diminish at an alarming rate, while the dynamics of medical sciences continue to evolve at a jet speed. It is only through training that we can catch up with changes and give quality care to our people. Only recently, government introduced the IPPIS as a means of payment of workers in the public sector. We very much welcomed the IPPIS policy, but the gross inefficiency exhibited by the operators has left many doctors and some other health workers without salaries for more than three months. Some of these doctors are just new in the system, and some are about to leave the system for their national youth service assignment. All our complaints have yielded no positive results so far.
Many people seem to believe that the ultimatum was as a result of the decision of the government to accede to the demands of JOHESU…?
The truth is that whatever the government gives to those acting under the aegis of JOHESU will invariably impact on doctors on account of the universally held principle of pay relativity. So, the government is bound to give to us as well. If, by granting JOHESU’s requests, the balance in wages tilts further against doctors, it behoves the government to take measures to correct it.
In the same vein, if government decides to make every nurse, radiographer, lab scientist, physiotherapist, etc., directors, then doctors will also be appointed directors and super directors. However, issues will arise when you appoint any of these health care workers as directors and leave out the doctors on the same scale. We cannot accept to be left out.
We have had people being appointed assistant directors and deputy directors, even when there was no directorate; and we consider this to be very abnormal. Do you create a directorate through a promotional process? Do you create a directorate within a department? Why would you want to appoint someone as director when his/her boss is not a director; where does that leave the boss? We must be very careful not to create anarchy within the system.
Similar to this is the demand by every person in the hospital to be appointed Consultant. The cleaners, clerks, accountants, administrators, nurses, lab scientists, pharmacists all want to be appointed Consultants. What this implies is that every doctor, right from the house officer, will be a Consultant and those who are Consultants now will probably become super consultants or extra-consultants. What we are witnessing in the health sector does not happen anywhere else. Decisions are taken and policies are made without any regard to the impact on the system and the patient we all claim to care for.
What is your advice?
Government should thread with caution on matters concerning the health of citizens. It must not compromise on the enthronement of professionalism and international best practices.
What about the perception that doctors don’t want other workers to be promoted from level 10 to 12?
The Udoji salary review introduced the grade level system, which terminated on grade level 17. Under this system, there was no grade level 11. Everybody that was promoted from GL 10 moved to GL 12. This was not restricted to health workers. It was the same across the entire civil service, both at the state and federal levels. Subsequent salary system reviews abolished the gap between 10 and 12 by creating level 11 and reducing the terminal level to 15, such that HATISS 15, CONTISS 15 and now CONHESS 15 were all the equivalent of GL17. At the emergence of each new salary scale, the National Salaries Income and Wages Commission always provided a conversion table, which was binding and applicable across the federation. What went wrong was that while the rest of the state and federal workers were complying with the conversions, non-medical workers in the federal hospitals were still skipping level 11. It therefore implies that a staff moving from CONHESS 10 to CONHESS 12 is actually moving from GL 12 to GL 14. The question is, why should this be allowed for only non-doctors in the hospitals? If it was right to skip, why were doctors excluded from such skipping in the system where they work? Why is it that other workers in the civil service of the federation are not skipping? Our position is that this skipping is abnormal; but if it must go on, then every civil servant, including doctors, teachers, engineers, and lawyers must skip one level from where they are today and those above moved up. Those at the terminal levels who did not skip before getting there must be compensated properly for it. This is the only way to enthrone equity and justice.