Lagos — In spite of all the efforts by the various state governments towards health sector reform, the sector is still faced with serious challenges. Investigations conducted by Oodua Trust revealed that one of the numerous challenges is shortage of manpower to take care of the teeming population.

This has led to the employment of hundreds of un-qualified and quack nurses and doctors popularly referred to as "auxiliary" staff to take the center stage.

There are indications that the population of Lagos put by government officials at 18 million is being served by less than 50,000 qualified doctors.

In Oyo State, no fewer than 36,000 mothers die annually from avoidable complications before and after birth especially in unorthodox maternity centres. The state government is now set to shut down churches and mission homes being used as maternity centres all over the state.

The ratio of doctor to patients was put at approximately 1:600, an official of the state Ministry of Health informed.

The insufficient number of qualified doctors caused by brain drain had given room to lots of un-qualified nurses and doctors in many private hospitals and clinics in the state.

Also, poverty level of the majority of the populace had allowed the so-called auxiliary nurses-turned-doctors to have field day as more members of the general public cannot even pay their transport fares to general hospitals where minor ailments are being treated for free.

Findings showed that auxiliary nurses are in two categories. The first group is those who learn the science on the job in private clinics. It was gathered that those in this group are mostly secondary school leavers or school drop outs. They seized the opportunity in the wide gap in medical workforce to become medical workers.

After six month or a year in-house training, they graduate and start to work in private clinics or set up mushroom clinics where they at times, perform medical surgery!

The second group are those who, due to the high level of unemployment in the country, decided to take advantage of the dire need for health workers to go for training at the Lagos State School of Health Technology which was upgraded by government in 2004.

It was gathered that the school had its accreditation to train Pharmacy Technicians, Medical Records and Information Management Officers, Environmental Health Technologists and Community Health Extension Workers who in most cases, regard themselves as qualified doctors after completion of their short course at the school.

According to Dr. Simeon Ademiluyi of the Lagos State University of Teaching Hospital (LASUTH), Ikeja, Lagos, the issue of auxiliary nurses operating in the city of Lagos as qualified doctors is worrisome.

He said their operations mostly in the private clinics was not strange nor new adding that the state government was aware of this phenomenon despite various steps taken to frustrate them out of the system.

Ademiluyi noted that the existence of auxiliary nurses is welcome considering the population of Lagos but argued that there must be specific cases they could handle.

"We've seen various cases here from private hospitals and the mushroom clinics that dot the city from where patients, most times pregnant women who are already knocking heaven's door are brought here for deliverance. Such cases are often traced to auxiliary doctors and nurses. So many of such dangerous cases have ended up in untimely death of innocent citizens," he said.

Another doctor, Wonuola Ajayi told Oodua Trust that the existence of auxiliary nurses who operate like a qualified doctors in the sector has more disadvantages than merits.

She identified poor educational background, professional exposure, experience and equipment as factors contributing to dangers posed to the general public.

According to her, "The auxiliary nurses who operate like qualified doctors are criminals whom government should ensure they are sent out of the system. Medically, they are not qualified but what we see is that they take advantage of so many things and go as far as diagnosing ailments and performing surgical operations. This is one issue government should be up and doing about to ensure this group of people do not go on maiming, killing and adding to people's problems."

The doctor stressed that an average auxiliary nurse thinks that they could take care of all kinds of ailment, even without necessary equipment at their disposal. She said they ought to be put where they belong by government and the Nigeria Medical Association.

The state Commissioner for Health, Dr. Jide Idris explained that the state government did not fold its arms and watched quack doctors and the auxiliary nurses to continue to operate.

The commissioner explained that action had been stepped up to closely monitor activities of private hospitals and clinics in the state. In the past one year, he said 119 new private hospitals and clinics were registered while 142 certificates of registration were renewed. He also said that 12 health facilities found to be substandard were forcefully closed down while the quacks and the auxiliary nurses there were arraigned.

Idris admitted that the health sector was still faced with all sorts of challenges which included the issue of quacks and un-qualified auxiliary nurses which he said was due to peculiarity of Lagos.

He said his ministry realised that health was a social service that needed to be managed as an economic commodity in an inter-play of efficiency, cost-effectiveness and equity and a matter of policy, decided to embark on reform process for sustainable development.

He said government was not unaware of the increase in population of Lagos so it had invested heavily in the upgrade of medical infrastructure at all levels, revitalized the primary healthcare system, established and implemented a financing strategy for the sector.

The health sector reform agenda in the state according to the commissioner was a broad-based purposeful and sustainable fundamental change in the function, structure and performance of the health system in order to deliver efficient, qualitative and accessible healthcare to the populace with a view to improving their health indices.

"Hence, it is important that everybody in the health sector in the state, particularly the health workers in government hospitals work to achieve this objective so quacks in the sector are weeded out," he said.

On the un-qualified auxiliary nurses, the commissioner reiterated that government would increase its monitoring of private clinics to curb the menace.

He said government had empanelled a task force comprising of members of the Nigeria Medical Association, State Security Service, Police and the Association of Medical Practitioners to carry out raids on the centres, renowned for using auxiliary nurses and midwives as their personnel. The task force is expected to be inaugurated any moment from now, the state commissioner for Health, Dr. Isaac Owolabi has disclosed in Ibadan.

Expressing shock at the high rate of maternal deaths arising from delivery by some unqualified personnel in mission homes, the commissioner stressed that the state government was disturbed by thousands of lives lost annually in mission homes run by churches across the state.

He said government would no longer fold it hands and allow helpless citizens waste their lives in the hands of quacks who use religious centres as maternity homes. According to the commissioner, the government's taskforce would immediately after its inauguration embarks on raids and unscheduled visits to mission homes where many women attend instead of hospitals for antenatal clinics.

The operation, he however explained, was not intended to witch-haunt anybody or group of people. Rather it should be seen as an intervention to rescue lives of ignorant citizens who die in most of the missions as a result of lack of qualified personnel, he said.

The commissioner stated that the intention of government was to ensure that every practitioner, be they public or private, meet the minimum standards either in facilities or services.

He said government had been planning how best it could improve the quality of primary healthcare delivery to ensure that everybody got best services in the hospitals and clinics in the state.

He explained that 16 new hospitals were under construction in different parts of the state and others undergoing renovations so that quality service delivery could be taken down to the doorsteps of the people as a measure against patronising quacks in some of the mission homes.