Association of Medical Laboratory Scientists of Nigeria (AMLSN) has come out to reaffirm its position on the Teaching Hospitals Reform Bill which is being considered in the legislature. I disclosed its position in response to an article put forth by the Medical and Dental Consultants’ Association of Nigeria.
The circular released by the AMLSN states:
July 01, 2022
BILL FOR AN ACT TO AMEND UNIVERSITY TEACHING HOSPITALS (RECONSTITUTION OF BOARDS ETC) ACT CAP U15 LFN 2004: A REMEDY FOR OUR PAST ERROR
“The attention of the Association of Medical Laboratory Scientists of Nigeria has been drawn to the
malicious piece written by Medical and Dental Consultants’ Association of Nigeria dated 29th June
2022 which ludicrously calls for the “throwing out” of the Bill for the amendment of the University
Teaching Hospital (Reconstitution of Boards etc.) Act CAP U15 LFN 2004 being sponsored by
Honourable Bamidele Salam representing Ede North/Ede South /Egbedore/Ejigbo Federal
Constituency of Osun State.
The Bill, among other things, seeks to reduce interprofessional rivalry among various players in the
healthcare team in the teaching Hospitals by ensuring that all critical stakeholders are involved in the
composition of the boards of Teaching Hospitals, with a view to making them more vibrant and
efficient.
The bill is in tandem with global best practices with special references to the United Kingdom, United
States of America and other countries where medical training has been successfully implemented
through collaborative efforts of all practitioners. One of the most accurate and honest definitions of
“Global Best Practices” is to revere certain methods, techniques, mechanisms and practices that
have been tested and found to be result oriented at a global level. They refer to those practices
that have worked and produced results globally, and as such can serve as examples and
templates and set the pace for others to follow. In tandem with this definition, it could be found that
health institutions, Teaching Hospitals inclusive, in places like the United Kingdom, are headed by
Chief Executive Officers that are not medical doctors. Next to the CEOs are directors of clinical
services, nursing services, etc. That is exactly what the Bill is seeking, and that is in tandem with
Global Best Practices.
It is bewildering how a supposed elite consultants group will compare a section of professionals in
mainstream civil service with a whole arm of government (judiciary)? The Judiciary is never in the
same category with the health sector. Anyone trying to compare the two is simply daft or is just being
mischievous.
Headship of hospitals is purely administrative the world over. Competent hands who are sometimes
non health professionals are appointed as chief executive officers. For example, the National Health
Services (NHS) Providers and the NHS Leadership Academy UK in 2018 issued a report titled
“Clinician to Chief Executive: Supporting Leaders of the Future”. In the report, a survey was
conducted about the professional background of all NHS provider chief executives. The combined
findings established that a third of chief executives (CEOs) hold a clinical qualification. Of these
clinically inclined CEOs, 63% trained as nurses, 19% trained as medical doctors, 4% trained as
pharmacists and 11% other health professionals (Medical Laboratory Scientists, Physiotherapists,
Radiographers, etc).
As a matter of fact, the current CEO of the NHS, being the 9th officer to be so appointed since the post
was established in 1985 in England, Amanda Pritchard, is a Historian.
Some of the Nigeria trained physicians who oppose this positive change in Nigeria will work
harmoniously under CEO when they migrate to the UK! What hypocrisy and self deceit!! Must
Nigeria Health system not move forward?
These people should stop insulting our sensibilities. A Medical Laboratory Scientist just like any other
core health professional is much a professional as a medical doctor; none is superior to the other. It’s
unfortunate how they are reducing the revered medical profession to a mere market association. The
similitude of what we have in health industry is what operates in construction industry where many
professionals like Architect, Builders, Surveyors Engineers and others form a team, of which the
leadership is not an exclusive prerogative of one profession, among equals.
These same consultants would be painting politicians black about medical tourism, yet they’re not
ready to accept global best practices in order to build a robust healthcare system in Nigeria. As far as
we don’t put our differences and sentiments aside and adopt the right method of doing things as
obtainable in developed nations, politicians would show no commitment in revamping our healthcare
sector.
A brief trip down memory lane revealed that the Teaching Hospitals in Nigeria in the 1950s and 1960s
were sites of medical tourism in Nigeria, with particular reference to University College Hospital
(UCH) Ibadan, as it played host to Saudi Arabia royal family and this was at a time when the Colonial
Administrators who were non-doctors and their Nigerian counterparts such as Mr S. A. Ladehinde and
Mr F.G.A. Cole after him held sway. These two gentlemen were administrators and not Doctors and
the Nigeria tertiary institutions were doing fine under their leadership. Hon. Minister of State for
Health, Dr Olorunnibe Mamora attested to this fact as reported by Punch Newspaper on the 3rd of
March, 2020. Another Senator of the Federal republic of Nigeria lamented at a lecture he delivered
that UCH was better managed when Mr S. A. Oladehinde, Mr F. G. A. Cole (non-doctors) were at the
helms of affairs than now when Consultants who are Physicians now run the hospitals.
History revealed the first house governor in UCH was Brigadier N. B. Brading (1957-1958) followed
by Mr. G. Parker (1958-1964), Col. J. B. Robertson (1965-1967) before the first Nigerian house
governor, Mr. S. A. Ladehinde (1967-1973), then Mr. F. G. A. Cole (1975-1984). It was when decree
10 of 1985 paved way for Physicians as CMD that serious deterioration of the tertiary health
institutions in Nigeria began till it reached the present state. It was the decree 10 of 1985 that gave
absolute power to Physicians and we all are witnesses to what damage that has caused the nations.
In the year 2000, under the total control of Physicians, Nigerian health system was ranked 187th out of
190 countries according to WHO (WHO, 2000). This might have informed the then President
Obasanjo’s decision of not using a Physicians as Minister except the brief stint of Dr. Tim Menakaya.
It is pertinent to say that since the return to democracy, the best Health Minister we have had was
Professor Eyitayo Lambo, an Health Economist under whom the Teaching Hospitals in Nigeria were
equipped with the VAMED project. Also, there was less acrimony culminating into strikes and
industrial disharmony in the nation’s health sector.
It is pertinent to reiterate that the relationship between the University and the Teaching Hospital that
was supposed to be symbiotic is rather a parasitic one at the expense of the Teaching Hospitals. It is
very wrong for Honorary Consultants who are primarily staff of the University under the Ministry of
Education to be CMD, CMAC and now with the expansionist agenda created offices of Deputy
CMACs (which is alien to law) as many as they want for compensation and patronage of their cronies,
feeding fat on the hospitals’ resources. Honorary Consultants are HODs in the hospital in departments
where the core professional staff with better competence are made to be subservient to these honorary
consultants. This highly de-motivating culture imparts negatively on service delivery.
The bill seeks to correct, among other discrepancies:
- Diversion of public fund to private pockets.
- Obnoxious PPP arrangement where the CMDs use their cronies as fronts to defraud the
hospital by entering into PPP arrangement that will be parasitic to the hospital’s internally
generated revenue. Some concessionary arrangements even led to litigation that the hospital
has to pay heavy in damages.
- Diversion of patients from public facilities to private clinics by Physicians.
- Divided loyalty, the interest of the CMDs and honorary consultants has never been that of the
hospital but that of the College of Medicine, where they hold sway.
- Monopoly – we have seen the best the physicians can give in terms of administrative prowess
and it has led the health sector in Nigeria to the lowest of low; it will be very fitting to give
other health professionals chance to change the narrative, after all nobody is more Nigerian
than the others by mere choice of profession.
- Exclusion of critical stakeholders leading to policy somersault. It has been observed over the
years that these honorary consultants legislate based on what catches their fancy and this has
eventually led to failure of many government policies. The boards of tertiary hospitals as
presently designed, is just an NMA general meeting in disguise with few observers and the
policies of the board had in many cases not translated into tangible development. No
professional group must be given power to solely determine the fate of the health sector as we
have seen played out in Nigeria. No serious country of the world would allow that.
- Criminal Negligence – there are many unethical practices allegedly perpetuated by these
honorary consultants as we have seen over the years. Many cases of criminal negligence have
been swept under the carpet by the doctors in our teaching hospitals because the physicians
with pathologists know how to swing the pendulum to exonerate themselves where a patient or
his/her relative muster the strength to challenge their unwholesome practices. These have
promoted criminal negligence over years.
It has been observed over the years that whenever some honorary consultants become professors,
they do virtually nothing and receive the fattest pays for doing virtually nothing. What an irony!
They will come to work whenever it pleases them and can travel as it pleases them without any
check while their salaries are being paid as and when due.
Many consultants will abandon their clinics in the teaching hospitals without consequences but
will always be found at their private clinics almost all the time, while they send Residents (Trainee
Doctors) to review the patients unsupervised. Sometimes when they are available, they will attend
to few cases and give others long appointment dates so that patients can negotiate private
appointment with them at their private facilities where patients are treated like gods, while they
treat same patients without dignity in public facilities. These Honorary Consultants cannot justify
the budgetary allocation to the teaching hospitals over the years.
These and many more are the main causes of collapse of the Health sector.
It is understandable for MDCAN to call the bill obnoxious because the bill will expose
malfeasance and unwholesome practices, and as well take away their perceived right which indeed
is an abuse of privileges.
The bill is a step in the right direction and will give all critical stakeholders opportunity to
contribute meaningfully to the growth of health sector in Nigeria.
It is laughable when MDCAN talked about international best practices but failed to remember that
WHO is not headed by a doctor. In the UK and US, many hospitals are not headed by doctors.
Leadership of health institution in advance countries is based on competence and not on a degree
in Medicine and Surgery. In the US, the “big Pharma” is a force in the health sector. They have
forgotten that in the Universities where they are primary staff, doctors compete with scholars from
others fields for the post of Vice Chancellor and in many cases, they fall short.
The MDCAN insulted the sensibilities of the legislative Arm by referring to parliamentary
business as a backdoor process. The law that gives power to the CMD was a military decree which
was a product of selfish agenda of doctors to mislead the military government in 1985 to
promulgate the decree without due reference to all critical stakeholders and the result of that decree
is evident to all.
Anyone with financial wherewithal does not trust Nigerian Doctors with his/her health and this is
palpable as many Nigerians now travel abroad for procedures like kidney transplant among others.
This is an indictment on these Physicians who have held sway at the ministry and the tertiary
health institutions.
The Physician; Professor Pondei, NDDC acting MD who “fainted” while he was being quizzed by
a panel before the full glare of the world is a typical example of a Nigerian Doctor and how they
want to be head of all agencies with the aim of fleecing our common patrimony, The video went
viral all over the social media. That is an example and does not paint a good picture of the country.
It is our considered view that this bill, when passed, will revolutionize our health system in Nigeria
and health will be assessable to all Nigerians. It will make a good attempt at the Universal health
coverage and bring quality health care service to the reach of common man as well as stem the tide
of medical tourism.
Incidentally, it was the military administration of General Muhammadu Buhari that enacted the
decree: It will be a credit to his Excellency’s administration to correct the error of thirty-seven
years ago.
It is pertinent that MDCAN understands that their claim of having a Medical and Dental
professional as the best fit for management of hospitals is flawed contextually. The narrative is not
accurate and it is a very poor attempt at rewriting history.
God bless Nigeria”
Signed:
Professor James Garba Damen
National President
Dr Musa Abidemi Muhibi National Secretary
