In this interview, President of Medical and Health Workers Union (MHWUN) Comrade Ayuba Wabba speaks on the challenges facing Nigeria’s medical sector, disharmony among stakeholders and how to improve the system.

 

Why has there been unending disharmony amongst the different professional bodies in Nigeria’s health sector?

From the community health workers who work in the villages to the secondary healthcare where you have the nurses, doctors, pharmacists and medical laboratory scientists; all of us are supposed to complement each other’s efforts in making sure that we have quality health care services.

But I think in Nigeria we have not been able to achieve that and strictly speaking it is because, those at the helm of affairs and specifically I would say the medical doctors are self centred. Basically they have not encouraged team play and that has been the bone of our contention.

For instance, in most developed countries, the administrative aspect of the hospitals is left in the hands of administrators. We have people that are trained basically to administer both the services and also manage the entire health professionals. We call them the hospital administrators.

But what we have in the country is basically people trying to take up responsibilities of others. If you have a hospital administrator like we have in many cases, you have an executive secretary as being head of the hospital, basically, he is going to make sure there is equity and everybody will be carried along.

If you are medical doctors, concern yourselves with clinical duties. Leave the administrative aspect to a hospital administrator, if you are a pharmacist, concentrate on your drugs, if you are a nurse, concentrate on your patients and discharge your responsibilities effectively and so also medical laboratory scientists.

It seems there is a battle for superiority amongst health sector professionals

All this bickering is about who occupies which position. For instance, in the National Health Bill, there is supposed to be a National Hospital Commission and our bone of contention is that why must government insist that the headship of that particular agency be a medical doctor? Globally, it is supposed to be headed by an executive secretary just as we have the National Health Insurance Scheme headed by an executive secretary and other agencies of government.

The only way to address the issue of disharmony in the health sector is to make sure that every health professional concentrates on his primary area of responsibility and leave diagnosis aspects to hospital administrators who will better manage the system and also manage the human and material resources.

What concrete steps can be taken to achieve that?

The only time we had an improvement in the health sector was when Professor Eyitayo Lambo, a health economist was appointed minister. He initiated the National Health Policy of 2004 where he brought all professionals and unions to the table to forge ahead and look at how we can work as a team. If you look at the improvement in our indices, it was during his tenure we recorded all the achievements that we are seeing now because when you put policies on ground you don’t expect the effects immediately. So, all the effects of his policies are what we have recorded between 2004 and now.

As I am speaking to you now, no health professional was consulted in drafting or in putting some proposals into the new bill. What we hear now is that it is already before the National Assembly; we are also putting our acts together to go and sort it out at the National Assembly.

What parts of the bill do you not accept?

Most of the controversial issues have to do with statutes in the bill; the composition of the technical committee on the National Council on Health, our earlier proposal which was through a stakeholders forum during Eyitayo Lambo’s tenure was replaced to put essentially only medical doctors at the headship of very important institutions like the Primary Health Care Development Agency which presently is being headed by an executive secretary.

They want to replace it and make it mandatorily for medical doctors which we are also opposing and other provisions which contravene the existing laws that are regulating all these professions.

And principally I told you about the National Hospital Commission, why must it be a medical doctor that will head that commission? Let it be an executive secretary where everybody can fit in. if at any given time the best person to fit into that position is a pharmacist, let the pharmacist take the position. What we are saying is that don’t make certain position the sole right of a particular profession. All over the world, nowhere is that done. What we are saying is that, there must be a stakeholders forum to really look at these issues.

There is a rampant case of Nigerians going abroad for medical tourism, what can be done to make them patronise the local medical facilities?

The only way we can stop this is if we can make our medical system work and the first step is to bring harmony into the system because where there is disharmony in the system, the system cannot work effectively.

The basic thing is to make sure that first, there is harmony, people that are responsible for the provision of healthcare services must be working in harmony and therefore the next issue is to make sure that there is conducive environment, i.e., equipment, facilities, budgetary provisions that will be able to drive the process.

Second is the issue of training and retraining; the issue of training and retraining currently is only restricted to doctors and we are saying it should not be so. All other cadres are entitled to training and retraining if we are to make best use of the system. If we are to address that issue, we have to holistically restructure our structures in the federal ministry of health and also our tertiary health institutions, ditto in the states and local governments to make sure that competent persons are put in place to drive health administration and we must ensure that there is harmony at all levels. Let me tell you this fact, in most states, there is harmony, it is only at the federal level that there is disharmony.

As money goes out, personnel also go out; there is the issue of brain drain.

I will look at this issue from two angles. The first angle is that this is something that permeates the entire system not only the health sector. People go out first in search of greener pastures. If you compare the remuneration here in the country, you know people go out for greener pasture. For instance, if I can get a better deal elsewhere, naturally I will move and that’s why you have mobility across the country and the globe.

Basically it has to do with first, the issue of remuneration; when you compare what is being paid in other parts of the world, especially the developed world and what is being paid to health professionals and even other sectors; you find out that there is a very large gap.

You also look at other aspects which have to do with job satisfaction, most people are frustrated out of the system because there is no platform in place for them to have job satisfaction; some people have truncated the system.

The third issue is also about our health facilities. Certainly, most of our equipment  are obsolete. Even where we have the opportunity to replace these equipment, we don’t bring the best; people compromise and in the process of compromising, we don’t have the best. So, those best that we have certainly will not tarry behind and begin to work with those obsolete equipment.

Recently, you went on a strike, you suspended the strike, you issued an ultimatum, you met government. What is the position now?

The entire health sector, joint health sector unions including all professionals went on strike. We went on strike because we had an agreement with the federal ministry of health which was not honoured; we had a collective bargaining agreement which was not honoured and we thought that basically, we are persons that represent the interests of our members and we also have to drive the process to ensure that those agreements are not just thrown to the dustbin and that was why we went on that strike after issuing all the necessary warnings and also following laid down legal procedures. We gave notices; those notices expired; no one responded to our demands and that was why we proceeded on that strike action.

It was on the intervention of the National Industrial Court and we wanted to respect the law of the land and all those issues that we have hitherto not agreed upon are now before the industrial court.

There are three issues; the issue of review of professional allowances, issue of the skipping of CONHESS 10 which has been a contentious issue and the issue of appointment to be a consultant. Those issues are already before the court of competence.

What is your relationship with the Nigeria Medical Association?

I want to respond to a statement that was credited to the Nigeria Medical Association recently where they said we are a collection of nonentities. Basically, I think that statement is one of ignorance because the health sector is made up of a team of health professionals. Nowhere in the world can a particular profession on its own drive the process of delivering quality health care service. Let them go through the National Health Policy, all of us are listed there; nonentities cannot be listed in the National Health Policy.