Making the Nigerian Health System Work Part 2

I was moved to write this update by a story posted recently on one of the social media by a very young colleague who is currently undergoing his Residency training in one of the Centers of Excellence in the country. I beg to use an except from that post quoted below:

"Today is a great day...I was on the round with the Consultant Plastic,Aesthetics and Burn Surgeon.He requested that an N.O.II should please help him open the wound for inspection.

She,the N.O.II nurse asked him to either ask me (incubating Senior Register) to open the wound for him or if he wants to see the wound he should open it himself.LOL.Nonplussed,he asked the N.O.II nurse to ask the Chief Nursing Officer whether what she did was wrong.The Chief Nursing Officer(CNO) retorted that if the Consultant wants to see the wound he should open it himself.
We need to remind some people that their degree is not the equivalent of OND. I am doing a postgraduate training for Christ's sake!
This is where the Nigerian health system stands........."

This story represents a typical picture of the relationship dilemma that exists within the healthcare environment in Nigeria. Day by day, the relationship between the various cadre of healthcare professionals continues to deteriorate. The struggle within the health system has become so unhealthy for the various professional groups to be able to work together for common goals. The struggle for leadership positions in our health institutions, between the doctors ( who believe it is their natural right to lead) and other healthcare professionals (especially, Pharmacists, Nurses, Medical Laboratory Scientist) has become a major drag in the wheel of progress in these institutions. Aside from the doctors, the other cadres are laying claim to leadership positions in these institutions insisting (rightly or wrongly) that leadership positions should be by merit and seniority, and not merely reserved for doctors alone. These group probably are making valid argument, especially when you consider the situation where in a general hospital, a recently qualified medical doctor, with little or no work experience, could be trusted with the management of the institution ahead of other more experienced  health professionals in the institution, just for the mere fact that he is a doctor. I once benefited from this faulty arrangement, when I was made to serve as the Medical Director and Chief Executive in charge of a rural hospital in a northern Nigerian state, where there were equally Nurses, Pharmacies and Medical laboratory scientist of many years work experience, from who I basically learnt the principles of healthcare management relevant at that level during this period. Now, I have often wondered what qualified me to become a Medical Director with barely few years work experience, ahead of these more qualified personnel. I could not see any aspect of my training in the medical school that contained the requisite component of management principles required for such position. 

My recent exposures in public health management have made me realize that to manage a health institution, one do not necessarily have to be a medical doctor. All that is needed in my view, is requisite knowledge of healthcare management principles that is now a major curriculum in healthcare administration and management training courses. Many nations have addressed these issues by establishing specialized trainings for management cadre in health institutions. Trainings in healthcare management and administration is being emphasized as a criteria for attaining leadership positions in healthcare institutions irrespective of the professional backgrounds of the personnel. What that means is that, any medical doctor who aspires to head a medical institution, should endeavor to acquire an advanced qualification in healthcare administration and management. This also applies to other health professionals. In this way,these nations and organizations have been able to minimize the practice of mediocre in healthcare management in their environment. Little wonder, health care development in these nations have continued to grow.

Addressing the issues of continued struggle within the professional bodies in Nigeria, it is my opinion that the medical institution on its own is not doing enough in addressing these issues. It is said that charity begins at home, hence the medical profession should as a matter of necessity, clean up its system. You cannot give what you do not have. I am obliged to argue that, the system that allows a medical doctor in training to be so abused and disrespected by his seniors in the course of the training can only produce more hatred down the line. As a medical doctor in training, I was always appalled by the condescending attitudes of our senior doctors towards those of us under going trainings. Some of my colleagues were made to repeat classes, not necessarily due to the fact that they were not academically sound, but due to blatant dislike by these senior colleagues. The training system as currently being operated is essentially demeaning and has continued to create a gap for abuse and derision by other health professions. 

It is a known fact, that doctors are enemies to themselves. It is on record that when a doctor is a commissioner in a state ministry of health, more industrial action by medical doctors tends to occur. It is the same doctors that would work against their colleagues enjoying the requisite privileges that they truly deserves. For many years doctor have been at the helm of affair as ministers in the ministry of health in the country, yet the health sector has remained the same. Not long ago a serving minister of health in Nigeria was disgraced in office for corruption allegations. It is a common knowledge also, that one of the most corrupt departments and agencies in Nigeria, are in the health sector. Severally, Global Funds and other donor agencies had discontinued funding of healthcare programs in Nigeria, due to incessant corruption allegations linked to the sector. During an international conference in one US city in 2009, I queried one of the presenters of one of the donor agencies on their criteria for choosing a smaller country in West Africa for a major malaria intervention program, when it was evident from their presentation that the malaria burden in Nigeria, out ways all of West African countries combined. The answer I got was, that accountability and corruption in the Nigerian health system was the issue. I was then made to understand that donor countries would prefer to go to areas where they would be able to obtain credible evidence of success or otherwise of their program commitments.

The question now would be, what is Nigeria doing to clean up the system and once again make the health system work?

Watch out for solutions in my upcoming posts!

God bless Nigeria!

...Osita