Olumide Akintayo is the immediate past President of
Pharmaceutical Society of Nigeria (PSN). In this interview with CHIOMA UMEHA,
he speaks on the challenges of leadership, inter-professional crises in the
health sector and the way forward for effective healthcare management in
Nigeria. Excerpts:
The original aim of the National Health Insurance Scheme
(NHIS) is to bring quality healthcare to the doorsteps of every Nigerian and
above all, streamline the role and responsibilities of all healthcare
providers. At the point of commencement, the medical doctors introduced
in-house laboratory and pharmacy facilities and smuggled into the scheme global
capitation where a doctor can carry out laboratory test and stock and dispense
drugs without the intervention of the experts in that field.
Doctors also issue and dispense same prescription
especially, in the private health facilities. The only reason why NHIS has not
met its goals almost after 12 years is because the doctors hijacked the scheme
and sidelined other healthcare givers. Today, we have a lofty scheme being
driven by only doctors at the detriment of the patients.
Non–implementation of job evaluation of Federal Ministry of
Health/Head of Service document for health workers
A job evaluation committee of the Federal Ministry of Health
and Head of Service of the Federation (HOSF) was set up in 2007, under
Professor (Mrs.) Adenike Grange as Minister of Health, primarily to assess and
evaluate how each health professional adds value to patients care. The report
brought out a lot of salient things that would have addressed issues of
professional wrangling and wages of healthcare workers once and for all, but
the medical doctors worked very hard for the non-implementation of the report
because it did not favour them.
Nominations and appointment of Minister for Health,
conditions of service, salaries, promotions, among other issues have remained
controversial ones among professional players in the sector. What is the way
forward?
On each event of ministerial nominations and screenings in
the country, the Nigeria Medical Association (NMA) has often taken a narrow and
discourteous position that one of its own must be appointed at the helm of the
Federal Ministry of Health (FMOH) claiming that this was a global practice.
The NMA in a particular dispensation under the President
Goodluck Jonathan’s administration threatened that it would ground the health
sector if its position was not adhered to. This conceited stance has
perennially polarised the health sector, which has culminated in the formation
of the Assembly of Healthcare Professional Associations (AHPA), and the Joint
Health Sector Unions (JOHESU) to agitate for the rights of other health workers
in Nigeria.
Sections 147(1) & (2) of the 1999 constitution of the
Federal Republic of Nigeria are very clear as to how Ministers are appointed.
Section 42 (1) a & b also compels a right to freedom from discrimination on
the basis of Community, Ethnic Group, Place of Origin, Sex, Religion, Political
Opinion etc.
This is contrary to what obtains in other countries – United
States of America (USA); Kingdom (UK), Japan, Botswana, among others.
It is important to state that the headship of the Health
Sector is not vested in medical doctors contrary to the claims of the NMA. A
Minister of the Federal Republic of Nigeria is a political appointee whose duty
is purely administrative.
There is also discrimination in the salaries and wages in
the health sector as well as illegal and unlawful strikes by doctors which have
sent many patients to early grave.
The issue of imbalances in the directorate structure of the
Federal Ministry of Health (FMOH) is also worrisome.
Others are unprofessional and hostile disposition of doctors
to the team approach; poor implementation of National Health Insurance Scheme;
non-implementation of job evaluation document of Head of Service of the
federation/federal ministry of health; unlawful appointments in regulatory
agencies of government; poor implementation of interventionist health agencies;
establishment of the post of Surgeon-General of the Federation, among others.
Agitations over what the activists have described as
unlawful appointments in regulatory agencies have been rife in the sector. What
is the true position?
The National Agency for Food Drug Administration and Control
(NAFDAC) was established by Decree 15 of 1993 and the establishing statute
provides for the appointment of a Director General/Chief Executive Officer.
Section 9 (1) of Decree 15 of 1993 gives a condition precedent for the
appointment of the D.G. of NAFDAC which states to wit, “There shall be
appointed for the agency by the President Commander in Chief of the Armed
Forces on the recommendation of the Minister, a Director-General (DG) who shall
be a person with good knowledge of Pharmacy, Food and Drugs.”
The immediate past DG of NAFDAC is a doctor who specialises
in Neuro-pharmacology. It is a matter of commonsense that the DG failed to meet
the condition precedent in Section 9(1) as he does not have the requisite
training to have a good knowledge of Pharmacy – a recognised profession in
healthcare.
Since the major areas of regulation cut across pharmacy,
food and drugs at NAFDAC how can the DG who is not lawfully qualified to
regulate these core areas be conversant with day to day running of the agency?
Again, Nigerians are denied the expertise of the pharmacists
in drug assay and quality assurance.
What about poor implementation of interventionist agencies
and effective healthcare management in the country.
Most of the interventionist health agencies like National
Programme on Immunisation (NPI), National Agency for the Control of AIDS
(NACA), Roll Back Malaria (RBM) etc. are populated by medical doctors and they
have very poor drug procurement and management systems because of
non-involvement of pharmacists.
In fact, at a point some doctors styled themselves ARV
doctors at National Agency for the Control of AIDS (NACA) because doctors were
dispensing ARV drugs after diagnosing and prescribing the ARV drugs.
What is the way forward?
Instances abound of glaring misinterpretations of provisions
of Decree 10 of 1985 now Cap 463 LFN 2004 and the need arises for these lapses
to be redressed. For instance, that the law specifies only the Clinical and
Administrative Departments cannot be enough reason to subsume all health
professionals under the head of the clinical department, especially when the
existing Civil Service Regulations recognise university graduates as persons
who can reach the apex of the civil service via GL 17 or equivalent.
In view of the difficulties envisaged in the promulgation of
another law, we suggest appropriate interpretation of this law within three
months, while within one year Cap 463 LFN 2004 should be reviewed and
subsequently repealed.
You are an advocate of limitation to professional calling.
Can you give further explanations on this?
Every provider must be reoriented to limit his output to
only areas of core competence.
The propensity of doctors to feel they can annex the professional
and statutory duties of some other health workers, while others cannot encroach
into medical practice is the foundation of mutual mistrust displayed by care
providers.
Specifically, government must obey court judgments
compelling it to respect the autonomy of Medical Laboratory Science as a
professional calling.
In this regard, pathologists cannot head laboratories,
optometrists cannot be subservient to ophthalmologists, radiographers must be
made to paddle their canoes independent of radiologists to fulfil their
destinies.
How can private sector potentials be harnessed to address
healthcare needs of Nigerians?
In 2001, the various Heads of Government of different
African states met in Abuja and resolved under what is now popularly dubbed the
Abuja Declaration that National Governments should dedicate 15 per cent of
their budgets to healthcare.
Despite being a signatory to this declaration, the highest
that has ever been dedicated to health since 2001 by the Federal Government is
a meagre six per cent of National budget in 2012.
We as healthcare provides must continue to critically
evaluate healthcare expenditure as a percentage of Gross Domestic Product and
the analysis paints a very dangerous picture.
I have observed that over 88 per cent of health budgets are
dedicated to only recurrent expenditure. Out of this huge cost a whopping 82.5
per cent is dedicated to only personnel expenditure.
Of the total cost reserved for healthcare, staff emoluments
of about 61 per cent is gulped by salaries of sometimes an over-bloated core
medical staff in Federal Health Institutions. Unfortunately, what has played
out in recent years is that over 50 per cent of total health budget is
dedicated to paying only one cadre of personnel in healthcare – doctors.
The unfortunate scenario depicted above is one of the
reasons why healthcare infrastructure remains in limbo and endeavours which
facilitate research and development are completely comatose in an ever dynamic
health sector in the global arena. One is compelled to call on the Federal
Government and indeed government at all levels to see an urgent need to
drastically reduce the unproductive recurrent expenditure invested in personnel
emolument of some clinical staff which can be diverted to fruitful capital
projects as well as research and development initiatives.
Specifically, this forum must adopt a call for a
privatisation of some level of clinical services especially at Out-Patient
Department at all levels of care (primary, secondary and tertiary) in Nigeria.
This approach will entail bringing in tested private sector players (private
hospitals) to take over the running of some services in public sector hospitals
in Nigeria. In some areas where service might be in higher demand, doctors
might be hired on locum basis as we have seen been successfully implemented by
some state governments.
The advantages inherent in this model are numerous as it
checkmates the obvious propensity to embark on strikes perennially by those who
should provide services, but do otherwise.
The age-long strength of the private sector in the area of
service delivery would be felt maximally in the health sector which continues
to misfire at the detriment of the consuming public.
Government can dedicate more funds to revamp infrastructure
and equipment of secondary and tertiary levels in particular. The Nigeria
Institute of Pharmaceutical Research and Development (NIPRD) as well as Nigeria
Institute of Medical Research (NIMR) would also be beneficiaries of this
process as substantial votes to these institutions would ultimately re-position
healthcare in Nigeria.
For our sector – pharmacy, the process offers Nigeria the
unique opportunity to join the League of Nations which are self-sufficient in
the manufacturing of consumables, essentials drugs as well as exporters of
Active Pharmaceutical Ingredients (APIs) and Pharmaceutical grade raw
materials. This becomes imperative when we reckon that the global
pharmaceutical market is now an impressive $1 trillion dollar business which is
growing at an annual rate of seven per cent.
With Nigeria currently providing about $1 billion dollars of
this global market at an annual growth rate of 10 per cent even when we do not
do much of primary production of drugs and consumables in Nigeria, a wisely
discerning health administrator should look at the immense potentials new
investment in the pharmaceutical sector offers an economy already overburdened
by avoidable and excessive personnel overheads in clinical services.
