12 January 2013

Nigeria: Health Sector Embroiled in Multifaceted Rivalry

In spite of their recent calls and protests for the removal of Health Minister, Oyebuchi Chukwu, the Joint Health Sector Union (JOHESU) is set for yet another protest on January 23.

Across all federal teaching hospitals and states, the rally will be replicated. After that, we are coming back to Abuja for the mother of all rallies," said Dr. Ayuba Wabba, chairperson of JOHESU and president of Medical and Health Workers Union of Nigeria, one of four unions that comprise JOHESU.

"We are going to continue except changes are made to address such issues," Wabba told Weekly Trust. "You don't expect the problems to just vanish. The conflicts boil down to superiority, who controls what. Meanwhile, the substantive issue of providing quality healthcare has been relegated to the background."

The incessant rivalry has brought about untold hardship to persons seeking medical attention in mostly government hospitals. Patients are caught in the middle - in a background lacking in team work and team spirit, but choked by vaulting ambition and rivalry amongst professionals.

Doctors are on one side; on the other side are nurses, midwives, pharmacists, laboratory scientists, technologists, among others. These individuals are no more working as a team. "In the present circumstance, the team work and spirit have totally collapsed. Everybody is aware of that," Wabba said.

There is no doubt that this feud has apparently affected the health care system in the country.

Statistics of 2012 by the World Health Organisation (WHO) indicate Nigeria is just halfway toward cutting the rate of children dying before age five.

Nigeria also ranks among the bottom 20 countries far from achieving measles immunisation coverage for children under age one - below countries as Congo, Sierra Leone, Ethiopia, Rwanda, Zimbabwe. The number of women dying at childbirth exceeds regional average on the continent. Nigeria - along with Ethiopia, Chad and Sierra Leone - comprise four bottom countries with the lowest number of births attended by skilled personnel.

Reacting to the incessant crisis in the Health sector, Nigerian Medical Association (NMA) President, Dr. Osahon Enabulele said the sector needed "constructive and transparent support" by all stakeholders.

The leadership of the NMA felt the "strong conviction that we could no longer afford to lament the ills and uninspiring statistics of the healthy or the Nigerian system for that matter, but constructively organize to make our honest contribution towards engendering greater improvements in medical practice, health care and governance."

Dr. Wabba said "there have been elements of rivalry in the past, but it has not been pronounced. It came to light precisely before Chukwu was appointed minister when the NMA made a statement that the Minister of Health must be a medical doctor. By constitution and general best practice, apart from the Attorney General of the federation whose appointment is clearly stated in the constitution, the president has the right to appoint any qualified Nigerian as minister.

"The health ministry in particular has been headed by ministers who were not medical doctors. Take Eyitayo Lambo, a health economist credited with initiating the National Health Bill," he said.

The JOHESU president said it didn't protest Chukwu's appointment as a person but against a statement by the NMA calling for restricting the position to doctors. It was the first confrontation between the minister and health workers.

When JOHESU accused Chukwu of turning the Federal Ministry of Health into a ministry of doctors, a statement issued by the Ministry reads:"The MOH is "astonished" by the protest by a "handful of health workers" and called the protest "orchestrated."

"It is surprising that they would call for the removal of the minister under whose watch, Nigeria's score rose from 47.5 per cent in 2009 to 50.7 per cent in 2011 in the Mo Ibrahim Human Development Index (Health Category), which they referred to so copiously in their protests."

However, Dr. Wabba said the minister was supposed to water down the rivalry - "to build confidence and bring people to a roundtable so they can work as a team, instead he went ahead making sure that he makes life difficult.

"He has come in with that mindset that is why things have never been the same. In fact, things have degenerated, that it has been difficult even at hospital level for people to work as a team. The disposition of the minister has polluted the minds of many healthcare providers - the issue of superiority, who controls what, has taken centre stage."

Reacting to the issues, Dr. Enabulele said "even if there is an error, the doctor takes responsibility. When you go to court to witness a case, it is the doctors that are often called upon. That is why we say you cannot do anything about the doctor's leadership role. This situation has demanded it."

Meanwhile, Mr. Maigari Nuhu, Pharmacists in private practice said this is part of the frustrations that have driven many of his colleagues out of the hospital setting.

"I feel better in private practice. When you go to the hospitals you cannot bear the frustration inflicted on pharmacists by doctors. It is not that they are better professionally. Every unit plays an important role in health care delivery.

"From the laboratory, the pharmacy, the nursing unit etc, everybody is important, but why the special treatment to doctors?

"It is mostly political, because most heads of hospitals are doctors, so they have this feeling of superiority which is false in reality."

However, there are indications that different health groups are meeting one another halfway to resolve crises that have kept them divided for long.

The NMA wants long-time rivals in other health professions to attend its summit in Asaba, where it is hoped experts and professionals could help unravel contradictions.

The JOHESU has begun "reaching out to other professionals to see how we can address the issue so the public does not unnecessarily suffer," says Dr. Wabba, adding that the "responsibility is essentially that of the Federal Government."

Separate groups of professionals in the health sector have been pitted against one another over leadership roles and duties ascribed to them - a major problem that has stalled the National Health Bill for more than a decade, sparked protests by coalitions of health workers, and prompted series of strikes.

The JOHESU consists of nearly every professional groups except that of doctors; Association of Nigerian Nurses and Midwives, National Union of Pharmacists, Medical Technologists and Professional Allied to Medicine, Senior Staff Association of Nigerian Universities, Teaching Hospitals, Research Institutes and Associate Institutions amongst others. All these have been in running battle with doctors in the country.

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