Johesu Response To Call By Nma To Fg Not To Appoint Consultants In Other Fields - Nurses Arena
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Adelani Temiloluwa
School Of Nursing Ondo
Nursing Student
300Level, Nigeria.

The attention of the JOHESU/AHPA has been drawn to a malicious publication credited to the Nigerian Medical Association and addressed to the Honourable Minister of Labour and Employment, and widely circulated in the media. The said letter titled "An Urgent Call for an Intervention to Redress Aberrations in Health Service in Nigeria" was laden with a lot of misconceptions and outright falsehood. We are aware of various rejoinders to the offensive NMA article by several highly respected health professional bodies in Nigeria, and will therefore not bother to join issues with the NMA word to word.

However, we are bound to respond to some very repugnant aspects of the grossly offensive write up, such as that contained in paragraph 3 where the NMA stated "Appointment of other Health Professionals as Consultants/Payment of Specialist Allowance: Having gone through various circulars and court judgments, there is no place it was stated that other professionals should be appointed as consultants in a hospital setting. Every professional with the right qualification can self appoint him/herself as a consultant but NOT in a hospital setting. None of the proposed consultants is useful in patient care as physicians may not need their services. There are consultants in various medical specialties that oversee the work of the allied health workers.

We at the JOHESU/AHPA are amazed that such repulsive and mischievous statement can emanate from a body that styles itself "custodian and leader of healthcare in Nigeria," towards the end of the 21st century. It is common knowledge the world over that healthcare delivery is a collaborative practice, with the patient at the centre of care. The medical doctor uses his expertise and knowledge of diseases to make a diagnosis, the medical laboratory scientist assists the doctor to confirm or establish the diagnosis by making use of laboratory and other diagnostic tests, while the pharmacist makes use of his competences and skills on drug therapy to monitor treatment outcomes. Nurses provide basic patient care to facilitate response. This is the prototype of medical care in developed nations of the world. That way, no health professional is relegated or undermined. Joint clinical ward rounds take place involving physicians and consultant pharmacists, with resultant improved patient outcomes. This explains why the level of medical tourism to such climes is very high. Unfortunately, this is not the case in Nigeria. Ego of practice and internal squabbles commonly formented by medical doctors bent on one man show, has placed patients at their mercy. Unfortunately, most Nigerians are not aware of this, otherwise a lot of doctors would have lost their operating licenses to their penchance and insistence on solo practice.

By way of digression, Medicine started from creation when God gave man every tree of the field, every fish or creature in the sea as well as all the cattle of the field. As the world began to be populated, differentiation of responsibilities, professionalism and more began to happen as well as institutionalization of education which has happened and is still happening to every endeavor of man. And the global world in appreciation of that haven learnt from the Greeks, gives room to the unknown. But not so for our esteemed colleagues, mates, juniors, seniors in the faculty of medicine in Nigeria. They have the rudiments and control of all knowledge in the world of human medicine and its practice. The NMA has become the proverbial Tortoise whose name is ' all of you' . We even heard how they went to former President Goodluck Jonathan to sign an agreement for them on the 1st working day of January, 2014, to get them to vote for him, as if their singular vote will get Jonathan a guaranteed re-election. But, both he and his partners in unrighteousness forgot that we are first human beings regardless of race, ethnicity, creed or whatever else.

There are so many doctors who are so pissed with the madness that Prof Olikoye Ransome Kuti foisted on Nigeria's health care system. Like the proverbial feast of birds in heaven so many good hands have left the system to the ' all of you' and their sponsors (their very own- all the Ministers of Health of Nigeria and the government of the days from Ibrahim Badamosi Babangida to date). What a leader in health sector they really have been!

It is a tragedy that while nations are working out strategies to improve on healthcare delivery by promoting collaboration amongst healthcare providers, the NMA (acting like a slave master) is creating rancor to further plunge healthcare delivery in Nigeria into abyss. It is strange that doctors in Nigeria allocated to themselves, the regulation of their practice, while regulating other professions. A case of control your house and tell another person how to live in his own house or rather they decide their growth and how others should grow also (real slave trade). Doctors dictate their destiny including welfare and also insist on determining welfare package payable to other health workers.

Back in the 70s, you could see consultants who earned more than their heads of departments, even sometimes the head of hospital because it was about professionalism and the health of the people. All professionals trusted each other and worked together then as a team. People came from all over the world to patronize our healthcare system. The minister of Health then was a Minister of the Health of Nigeria and Nigerians, not that of NMA, as it has been since the time of Prof. Olikoye. And that was why they had the effrontery to threaten and go on strike when Prince Julius Adeluyi was made the Secretary of Health during the interim government of Chief Ernest Shonekan. One would have thought that by now, NMA will be boasting about the technological knowhow they have brought to bear in our healthcare industry and the positive impact on the precious lives of our people here in Nigeria.

We expected that going by NMA's rhetorics, we would have had a Nobel laureate of medicine from Nigeria to celebrate or a new drug or a breakthrough that will impact on Nigeria and the global village. But alas! The achievement is that in the last 30 years or so that this uncurtailed madness started, they are earning much more (in some cases thrice) than any of their counterparts in the healthcare team . That's the 30 year unrivalled achievement of our colleagues in NMA, without a moment's thought for how to add even a penny to the treasury to ensure sustainability of their own scheme. Rather, they fleece the system further by manipulating patients to go on medical tourism to not only India, but any so called Island as long as it is not Nigeria, so that they can make money from the government as well as the patient, making unreasonable demands that are out of this world. Yet, they are leaders in healthcare!

It is noteworthy that the biggest legacy of the leadership of doctors in healthcare remains the negative indices which characterize our health system once rated 187 outof 191 health systems.

Still on the issue of consultancy, research from various parts of the world has shown that teamwork, communication and collaboration between health professionals are important for the safe and effective delivery of healthcare.

For instance a Literature review by the National Prescribing Service in far away Australia "identified significant problems associated with medication misadventure." According to them, "approximately 6% of hospital admissions are associated with adverse drug reactions and high error rates during transfer of care. They concluded that increased interprofessional collaboration between care providers could therefore reduce the considerable medication —related morbidity and mortality."

In the United Kingdom, a project in 2001 where elderly patients received multidisciplinary medication reviews on admission, revealed enhanced clinical outcomes, reduced costs associated with inappropriate prescribing and improved communication with general practitioners. Quite unlike what the NMA would have the nation believe, in the United Kingdom, within the context of expanding practice and service changes driven by the modernization agenda, non medical consultant posts have been introduced into a number of other professions (in 1999 for nursing and in 2000 for Allied Health Professions).

Fundamental changes to service delivery and design are leading to wide-ranging opportunities for all health professionals, and pharmacists are already fulfilling some of these new and innovative roles. Pharmacists have been successful in developing clinical and specialist roles in hospitals and primary care for a number of years. No wonder many Nigerians, including very highly placed ones are trooping to the UKfor medical attention.

In UK, there exists consultant pharmacists for such specialized care as anticoagulation therapy, antiasthma care, older people's care and so on, with resultant improved patient outcomes. Consultancy status is also reality in nursing, physiotherapy and radiography. The real benefit of the consultant role is in the combination of skills the consultant brings to the post, providing not just the professional expertise but the skills to utilize this expertise to best effect by researching, educating and encouraging others to develop their roles.

The four main functions of consultants include expert practice, research and evaluation, practice and service development, education mentorship and > overview of practice and professional leadership. In the United States of America, while the concept of consultant pharmacy originated about three decades ago, today more than 10,000 consultant pharmacists provide a broad spectrum of administrative, distributive and clinical services to several million in a wide variety of care environments.

A consultant pharmacist is a provider of pharmacy systems, an educator, a drug information resource, a clinical practitioner, a patient care advocate, and a member of the health care team. This advancement is same in nursing where over 20 specialist cadres exist and in physiotherapy where practitioners continue to excel in vital areas like cardiology and orthopaedics.

The West African Post Graduate College of Pharmacists (WAPCP) and West African Postgraduate College of Nurses are professional bodies that are involved in post graduate training of pharmacists and nurses in the West African sub region that qualifies them to become consultants by increasing and polishing the skills and competencies of these practitioners. This equips them to tackle greater challenges as is obtainable in developed nations.

A similar body, the West African College of Physicians is responsible for awarding fellowships to doctors in the West African sub region that entitles them to be called medical consultants. It is therefore ridiculous and contemptuous for the NMA to allege that "other professionals can self appoint him/herself as a consultant." We make bold to state here that the post graduate fellowship of these colleges is equivalent to that of the medical consultants. The programme has become modernized with the recent introduction of residency training in various specialty areas similar to those obtainable in various post graduate training institutions across the world.

To date, the post graduate college in pharmacy has trained well over 2,000 consultant pharmacists, with many of them majoring in clinical pharmacy, the branch of pharmacy where pharmacists provide patient care that optimizes the use of medication, promotes health, wellness and disease prevention. It is instructive that it is only in Nigeria that government sponsors residency training for medical doctors. Other professionals including pharmacists, nurses and laboratory scientists pay through their nose to sponsor themselves for the fellowship programme and other post graduate training like Masters and PhD. The additional knowledge and skills they acquire is ploughed back to improve on patient care services.

Elsewhere in the world, medical doctors pay for their residency training from their pockets. This information can be readily verified. Notwithstanding the sponsorship of medical doctors' residency training by government, what does the government get in return from them? Rather than settle down and give back to government and the nation for sponsoring them, they resort to blackmail and endless strike actions, to cajole government to increase their salaries, while at the same time trying to belittle and undermine the integrity of other hard working healthcare professionals.

i. It is very obvious that this trend can no longer continue. We hereby call on the federal government to include other duly qualified healthcare professionals in the residency programme, or abrogate the programme completely and let everybody fend for himself as is obtainable elsewhere in the world. The money so saved can be ploughed back to the health sector to improve on service delivery.

ii. We wish to inform the Honourable Minister of Labour and Employment that Nigerians who have trained to be consultants in various healthcare callings apart from medicine are already working in hospitals, where they are using the additional skills acquired to improve on service delivery in their various practice locations. What is needed now is for government to formally give backing to the enabling programme with the necessary circulars, to enable these consultants in other fields receive appropriate remuneration for services rendered to patients.

The JOHESU/AHPA is using this medium to call on the Federal Executive Council, through the Office of the Honourable Minister of Labour and Employment, to as a matter of urgency, give approval to the fellowship programme of professions which already have approvals of the National Council of Establishment with enabling circular to enable patients benefit maximally from the additional skills and competencies of these consultants.

iii. The JOHESU/AHPA is also calling on the NMA to realize that she cannot single handedly ensure or guarantee optimal healthcare delivery in the country. She must learn to respect other healthcare professionals and carry them along. She should stop using 18th century tactics to solve problems of the 21st century. She keeps making reference to international best practice when it suits her whims and caprices but suffice it to say that in the US and elsewhere in the world; there is mutual interprofessional respect and trust as well as multidisciplinary approach to healthcare, which in turn has engendered maximum healthcare delivery. This explains why medical tourism thrives in those climes.

In some medical centers in US, some specialist pharmacists earn as much as medical doctors, while nurses earn more than medical doctors. They are paid on hourly basis, depending on their internally generated revenue and individual input. On the issue of leadership of the healthcare sector, the NMA had this to say "The NMA wishes to advice both government and those that may be seeking autonomy that it is the life of Nigerians including all health workers, their family members and others resident in the country. This fight for professional ego should not be extended to this area as it impacts on patient survival. There cannot > be two captains in a ship." We beg to disagree with the NMA on this issue. The captain of the ship in this case, must not necessarily come from one profession. It is all about leadership roles.
While we concede that medical doctors are more in number than some equally top rated professionals in healthcare, that does not give the NMA the right to intimidate or oppress the other professionals. Any professional that has undertaken basic courses in the medical sciences, is medically qualified to head hospitals and other healthcare institutions. The World Health Professions Alliance (WHPA) which brings together the International Pharmaceutical Federation (FIP) International Council of Nurses, World Confederation of Physical Therapy, World Dental Federation and World Medical Association (WMA) is the flagship organ of all healthcare professionals funded on the basis of equality of professions.

Based on the collaboration Cecil Wilson, President of World Medical Association insists that "high quality patient care is most likely to be achieved when professionals work together". Tragically for NMA it is only about self aggrandisement and pecuniary gains for its members.

In 2013 the ICN, FIP and WMA sent a joint proposal to the 56th session of the United Nations High Commission on Human Rights seeking the appointment of a UN Special Rapporteur on the integrity of independence of health professionals. This is the beauty of teamwork.

In conclusion, we make bold to state that there is need for government to call the NMA to order and to curb their excesses. The Healthcare Sector in Nigeria cannot afford to continue like this. This bitter rivalry in the sector engineered by the NMA must stop. The day society realizes that most patient deaths that occur in hospitals actually arise from internal squabbles engineered by the NMA and they litigate in court; the doctor as an individual, the hospital, overindulging the Federal Ministry of Health and by extension, the Federal Government, that will be the day when we shall have some sanity, peace and advancement in our healthcare sector.

That day surely beckons.

Please accept assurances of our esteemed regards.

Com. Biobelemoye Joy Josiah National Chairman JOHESU
Ekpebor Florence National Secretary, JOHESU

His Excellency President Muhammadu Buhari, GCFR
Aso Rock Villa Abuja.

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