Prof Rotimi Jaiyesimi
DISHARMONY AMONG HEALTH WORKERS - A HOUSE DIVIDED AGAINST ITSELF WILL FAIL AND HAS FAILED PATIENTS
The headline stories emanating from the health sector is a grave cause for concern and requires an urgent resolution.
Osun State doctors embarked on a three day strike because of unpaid October – December 2015 salaries (February 2016)
The Joint Health Sector Unions (JOHESU) members comprising pharmacists, radiographers, nurses, physiotherapists, medical laboratory scientists, occupational therapists, optometrists, dieticians, medical social workers, clinical psychologists and dental technicians have been on strike since November 12 in a number of hospitals in Nigeria. JOHESU members are kicking against their non-appointments into key positions in hospitals as well as their non-promotion to the position of consultants (February 2016).
Medical laboratory scientists at a teaching hospital embarked on a protest against the management, grounding laboratory services in March 2016. There discontentment is the alleged disrespect for the office of the Director, the Laboratory Scientists. Their request is the call for the recognition and respect for the office of the Director of Medical Laboratory Scientists. Reports have it that the National Industrial Court has given three verdicts supporting the autonomy of the office of the Director of Medical Services as provided for by the Federal government.
Our hospitals have been deserted because of the discord between the doctors, nurses, pharmacists and other health workers. While this goes on, patients who we are called to serve are dying needlessly. Nigerian doctors need to understand that the old hierarchical system that placed doctors at the top of the pyramidal structure is no longer fit for purpose. Health care delivery involves a myriad of professionals, - professionals in their own right. Each health care worker, including information analysts, porters, secretarial staff and others play a significant role in achieving an efficient healthcare system.
The current management structure places too much power in the hands of a few doctors. This is the basis, to a certain extent, for the current agitation within the Nigerian health sector. It is unfortunate that a number of State and Federal medical centres do not have existing management boards as they have not been constituted by the government. This destabilises the reporting structures and the accountability of the professional leadership within hospitals.
Hospitals are complex organisations with a variety of complex processes. Hospitals should be led by personnel who hold degrees and have considerable experience in hospital administration. Most doctors do not have these essential qualifications. Inherent in the name Chief Medical Director is that the occupant is a professional lead for doctors. The same goes for the Director of Nursing and Chief Pharmacist who are the professional Lead for Nurses and Pharmacists respectively.
The Chief Executive of a hospital oversees the running of the hospital, has overall responsibility and is answerable to the Executive Board and to external agencies such as the Federal and State ministries of health. The Executive Board should be made up of the Chief Executive, Chief Medical Director, Director of Nursing, the Chief Operating Officer, Director of Finance, the Director of Integrated Services (representing Laboratory, Imaging, Physiotherapy etc) and the Director of Estates. The Chief Operating Officer is responsible for the operational management of the hospital. These officers must work together as a team for the good of all.
The internal wrangling between other professions and the medical profession does not bode well for team work within the health sector and it leads to unnecessary strikes that paralyses the health system. It requires tact to handle this impasse. The Nigerian Medical Association, Nursing and Midwifery Council of Nigeria, the Pharmaceutical Council of Nigeria, the Medical Laboratory Science Council of Nigeria and other stakeholders must come to the negotiating table.
An area of difference of opinion seems to be who should hold the prominent positions in the health sector. Appointments are made on qualifications for the job. The Chief Executive of the hospital must not be the exclusive rights of doctors. Any professional with the essential qualifications and experience can occupy this position. it may interest our readers that a number of universities have moved away from appointing academics as vice chancellors and have recruited from industry.
There is a need for dialogue between the various warring factions and this may be facilitated by an independent trained mediator. The Federal Government needs to remodel the leadership structure of health institutions to reflect contemporary healthcare delivery. This is fundamental to the attainment of the government's objectives of providing an excellent health service.
Patients are dying and we cannot afford to let our health system grind to a halt. Each Nigerian life is priceless. The government must act urgently to resolve the discord.
(Disclosure of interest - I have been a doctor for over 37 years)