Re: Addressing The Crisis In Nigeria's Health Sector ~ A Lab Scientist Speaks

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It is no more news that the Nigerian Health Sector is seriously sick, and urgently needs a Diagnostician to identify the root cause of the lingering crisis that has not been amenable to lasting cure.  

Sahfeeyah Musa as a writer has tried to identify the problems for there to be lasting solution but the big question is, did she really identify the problems? Or was she cosmetically trying to divert our attention from the main issue by taking sides with one of the stakeholders in the lingering crisis? As the aphorism goes ‘the conscience is an open wound only truth can heal it’.   In order to get to the root cause of the crisis in the Health Sector, we must be firm to holistically look at the Health Sector as a functional entity in which there are many stakeholders. It is very important that before one can really write about the Health Sector, there is a need to interact with the different stakeholders in the sector in order to get their side of the story. This is very important so that one doesn’t  have a jaundiced view which can lead to a wrong inference and conclusion. That is the only way we can really understand what is happening. How do the workers in the Health Sector feel? What is the problem that has made the lingering crisis to persist? In the words of late Prof M A Onwuejeogwu “For one to write effectively about a people, one must stay with them, interact with them, get to know about their culture, the way they feel, and the things that motivates them.  One cannot live afar off and tend to write about a people. For doing that you will never get to know the people you are writing of”.   Does Sahfeeyah Musa really know the people of the Health Sector? Did she interact with the stakeholders to have an unbiased view? Or was she just writing just based on the information she merely gathered from the internet? What is the root cause of the problem in the Health sector?

Sahfeeyah Musa, has tried to write about the people of the Nigerian Health Sector but she failed to have followed the socio-anthropological advice of the erudite scholar late Prof M A Onwuejeogwu, so she could not really discuss much; she could not address the issues associated with the crisis in the Health Sector properly.

Even though she had tried to cover much by repeatedly saying, I have read much about the issue, it turned out in my opinion that she wasn’t really conversant about the people she was writing about. I also think she do not have enough in-depth knowledge about the different Professional groups. This can be seen when she was using different nomenclatures to talk about different professional cadres as if they were in the same cadre. She had used Medical Laboratory Technician/Medical Laboratory Technologist, Medical Laboratory Technician/Medical Laboratory Scientist interchangeably as if they were the same. And I think she held brief for doctors of allopathic medicine, when she said that it is not in doubt that doctors are the leaders of the team as a result of the nature of their training.  Waoh! That is the voice of NMA! She had ascribed the leadership of the hospital solely to doctors of allopathic medicine, when the organic law setting the hospital did not say that they are the sole leaders of the health team.

She went further to talk about the role of the Medical laboratory Scientist and the Pathologist and she went on to suggest that it is the pathologist who always, is a medical doctor that is the custodian of the Medical Laboratory. And that for one to be a pathologist the person must be a medical doctor. She sighted Wikipaedia as her authority. It is pertinent to ask ; is she correct?   Sahfeeyah Musa erred in her definitions!  First and foremost,  the science and act of analyzing patients samples for the purpose of diagnosis, treatment , research, and fabrication of equipment which is currently called Medical Laboratory Science is much older than today’s practice of allopathic medicine. Again she tried to ascribe the study of pathology to only doctors of Allopathic medicine.

The big question is what is pathology? And who is a pathologist? The word pathology is derived from two words pathos and logy-pathos meaning disease, logy meaning study, so a pathologist is one who studies disease. The statement that for one to know or practice pathology one has to be a medical doctor is fallacy of hasty generalization.   All medical personnel study pathology in one way or the order, to enable them understand the disease they are handling .A nurse, pharmacist, physiotherapist,  medical doctor, optometrist, radiographer, dietician, a medical laboratory scientist etc all study pathology.

Medical Laboratory Scientist haven been found worthy in character and in learning and are members of Royal College of Pathology UK , American Society of Clinical Pathology etc. They have won international laurels of organizations associated with disease control and management. The study of pathology is an integral part of Medical Laboratory Science.  I make bold to say that all Medical Laboratory Scientists are pathologist but all pathologist are not Medical Laboratory Scientist!

In line with section 29 of Medical Laboratory Science Council of Nigeria, Act 11 2003- Medical Laboratory Science means;

(a) the practice involving the analysis of human or animal tissues, body fluid, excretions, production of biologicals, design and fabrication of equipment for the purpose of medical laboratory diagnosis, treatment and research; and

(b)includes medical microbiology, clinical chemistry, chemical pathology, haematology, blood transfusion science, virology,histopathology,histochemistry,immunology,cytogenetics,exfoliative cytology, parasitology, forensic science, molecular biology, laboratory management etc.  As shown above inter alia,  the study of pathology is a subset of Medical Laboratory Science.

Sahfeeyah Musa fell short of the principle of fair hearing when she called the Joint Health Sector Unions (JOHESU) an amorphous body, a term that has always been used in the Corridors of NMA. What made JOHESU amorphous, when she is a body of all registered Unions in the Health Sector? She is also registered with the registrar of labour. According to the labour laws/trade union laws for a body to be legal to operate as a trade union it must be registered. NMA/NARD is always going on strike but Sahfeeyah Musa never bothered to ask if these bodies are legal bodies? Are they registered by law to operate as trade Unions? The big answer is they are not. So what it means is that NMA, NARD, MDCAN, ASSOPON, etc which are all medical doctors Associations are not trade Unions. Where Sahfeeyah Musa showed that she is an NMA script writer is, when she accused JOHESU for going on strike solely because of the appointment of the office of the Surgeon- general and that all the people appointed as Surgeon General in the USA since 1871 till date have all been Medical Doctors. She even went on to sight the reason given by the Nigerian Health Minister why the need for the office without stating JOHESUS’S side of the story.

In a ceremony at Joint Base Myer-Henderson hall Va in December 7, 2011, Lt Gen Patricia D Horoho, a Nurse was appointed as Army Surgeon-general. On July 19, 2013 Pharmacist and Rear Admiral Scott Gibberson was named and also appointed Deputy Surgeon-general. In a letter dated January 6, 2014, addressed to His Excellency Dr. Goodluck Jonathan GCFR , the Assembly of Healthcare Professionals and Joint Health Sector Unions , had articulated 11 cardinal issues that needed urgent attention. The caption of the letter is “girding our loins for professional survival.” In a press briefing granted by JOHESU to the public that same day, JOHESU had enumerated the cause of the lingering crisis but Sahfeeyah Musa in her bid to promote brazen lawlessness in the health sector did not mention any of these. Is it that Mgbeke the Barber does not know how to barb or her scissors is not sharp? 

In her write up she had told us that the problems in the Health Sector, needs urgent attention, which is a fact but what did she identify as the problems?

(a)Poor funding

(b)Poor equipment

(c)Lack of specialist Personnel

(d) Brain Drain

(e ) lack of industrial harmony which she called struggle for supremacy.

Having read critically her essay it was glaring that the writer was fishing on shallow waters. A –D were not really the major problems of the Health Sector. It is on record that if there is any sector that the Nigerian Government has paid so much attention it is the Health Sector. The Health Sector has been well funded from within and outside Nigeria by the Nigerian Government and donor agencies but the major problem is accountability and mismanagement by some of the Chief executives/agents of these Government Institutions. So much money is yearly budgeted for buying of hospital consumables/ equipment and some are also donated. Sometimes these allocations are mismanaged and diverted and the primary users don’t get them. Sahfeeyah Musa was correct when she said that lack of industrial harmony is one of the problems of the Health Sector but she was incorrect when she tagged the cause of this disharmony to struggle of supremacy by the stake holders. In my opinion, she missed the mark the more when she tried to justify medical doctor’s claim to supremacy without recourse to the law and established code of conduct as exemplified in the Public Service of the Federation.

What really is the Problem in the Nigerian Health Sector?

•             (1)  Structural injustice and favouritism. This is one of the major problems of the Nigerian health Sector; the Ministry of Health in her policy statement does not have uniform policy and principle when she is relating to the different stakeholders in the health sector. Members of NIGERIAN MEDICAL ASSOCIATION are favored in governmental policy  against  other Healthcare Personnel. They get more sponsorship for training on the job, better pay packages, while the other healthcare professional most of the times are the ones sponsoring themselves in their training. The Government is not quick to implement welfare packages for healthcare personnel who are not doctors of allopathic medicine even when there is a court order/judgment in favour of the Healthcare Workers.   Agreements based on the principle of Collective Bargaining are never obeyed/implemented by the Government in favour of members of JOHESU.

•         (2) Brazen lawlessness and arbitrariness.  The Health Sector is given to impunity because the Government has not had the will to bring sanity. The Ministry of Health has not been firm to encourage the rule of law. A situation the ministry allows Institutions and agencies under her, to undermine the rule of law by creating posts and responsibilities which are not in her power to do so, and are not backed by law, and when such posts are created  tax payers money are used to fund them. Among all the 54 Health Institutions in Nigeria there are the offices of the CMAC, which is not backed by law. The establishment uses this to undermine the various schemes of service of other professionals. A circular was written to call the various chief executives to order about this illegality, by the Permanent Secretary Ministry of Health but in a National network the incumbent Minister of Health said the letter has been withdrawn.

·•       (3) Disregard of Government Scheme of Service/Career Path.

The various chief executives, who are members of Nigerian Medical Association, are part of the problem when they undermine the criteria for appointment as exemplified in the scheme of service as stated in the Public Service Rule.  A  level 16-17 officers who is a deputy director or a director is made to be answerable to a doctor who is on level 15 when they are not in the same cadre and career path.   This is gross violation of the Public Service Rule on Criteria for appointment .There is non-implementation and Selective implementation of Scheme of Service. People are told that it is only two directorates that are allowed in the Hospital, the directorate of Clinical Services and Administration all in the bid to make sure that members of JOHESU don’t reach the zenith of their career.

•        (4)Composition of Boards- Members of JOHESU are not well represented in the Boards of Health Institutions even when the law provides such representation.

•        (5)Disparity in Remuneration between Federal and State Medical Personnel. There is disparity and discriminatory relativity among Medical Personnel represented in the CONMESS for medical doctors and CONHESS for Members of JOHESU. The pay package of a baby doctor,  a house officer who is just entering the service is more than that of an ASSISTANT CHIEF in the CONHESS scale. How can two people working in the same sector have such disparity in pay package?

•       (6) The Health Sector wears the face of Janus. The Ministry of Health wrongfully accuses JOHESU members of skipping, when there is nothing like that .  Even with a court judgment , many chief executives of Health Institutions still refused to pay JOHESU members what rightly belongs to them. The same ministry that accuses JOHESU members of skipping is the same that has approved skipping for doctors thus introducing segregation in the Health Sector and disharmony.

•       (7) Discriminatory Definitions and application of certain terminologies in the Health Sector. The chief executives of Health Institutions and members of NMA have wrongfully arrogated to themselves only such terms as being medically qualified with the support of the Ministry of Health which they have used to make sure that they only are made consultants and appointed chief executives of health Institutions. This is not in line with the dictates of the organic law setting the Hospital.

•       (8) Non-compliance with laws of Regulatory Agencies under the Federal Ministry of Health

Members of NMA with the support of the hospital chief executives undermine the laws of Regulatory Agencies. Many of them employ unqualified personnel to work in their Institution, which is contrary to the laws setting up the practice e.g. a Medical doctor who is licensed to practice medicine in the posture of jack of all trade, wants to do the work of everybody, even when they do not have the license and training to do so.

In a land mark judgment delivered in favour of Medical laboratory Scientist by the National Industrial Court, it was clearly stated that Medical Laboratory Scientists  are distinct professional that deserve respect and are to work as stipulated in their scheme of service and that there is a nexus between their scheme of service and career path. And it will be a misnomer to have a directorate system without a director and a department.  Yet, NMA and many Hospital Chief Executives don’t see it that way. Rather, NMA is more comfortable for members of JOHESU not to reach the zenith of their career. Pathologists, who are not licensed to practice medical laboratory science wants to take over the job function of the medical laboratory scientist. The major problem is not professional supremacy but brazen lawlessness championed by NMA and her members.

•        (9) Non implementation of the Presidential Committee Report on Harmonious Working Relationship Amongst Health Workers and Professional Groups in the Health Sector.0n the 9th of August 2010 the federal Government set up a Committee to look into the disharmony in the Health Sector headed by Justice Bello Gusau. The Committee did a very good job.   Another Committee was set up to look into their recommendations, headed by the then Head of Service Alhaji Yayale Ahmed. The Chairman had to resign because they were not provided the means to carry out their job.   And today the disharmony is worse than as at 2010.

The Health Sector is in a heavy mess and the Government must have the will to do what is right because it is at the brink of collapse. It needs an urgent restructuring and reformation based on the rule of law.  NMA and her members must be made to respect the laws setting other professions.

I think the writer must do more home work to help the Nigerian populace and the world to know the real truth. 

Benjamin Chukwunonso Ajufo is a medical laboratory scientist. He writes in from Federal Medical Centre (FMC), Asaba, Delta State.

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