Are you a health personal working in Nigeria, get ready! This article is for you: Failure of the Nigerian Health Sector: causes, Actors and Solutions
The appointment of MoH as the birthright of doctors in Nigeria has brought us to this stage of poor health care service in Nigeria which led to our ranking of 192 out of 198 by the World Health Organization (WHO). The mistake was enshrined in Section 147 (1) & (2) of the 1999 Constitution of the Federal Republic of Nigeria is very clear as to how Ministers are appointed which is monopolized. Section 42 (1) a & b also compels a right to freedom from discrimination based on community, ethnic groups, place of origin, sex, religion, political opinions, etc.
It is important to state that the headship of the health sector is not vested in medical doctors only contrary to the claims of NMA, and other Medical professional associations. The doctors believe that they are the best qualified and best-endowed to lead the health team. The other health professionals such as Nurses, Pharmacists, Radiographers, physiotherapist, etc argue that they are also well qualified for the position of leadership and as much eligible as the doctors for appointment as health minister which I so much believe that most especially on the Nursing side because of the vast Nursing, Medical, pharmaceutical, investigatory, sociological, administrative and entrepreneurial knowledge and skills obtained from the scratch while in school and their ability to manage an entire ward in the hospital due to the mandatory Nursing care needed for optimal delivery of all patients. The core courses like management and leadership they nurses are subjected to take have qualified them to be leaders in developed countries, unlike Nigeria where they are marginalized.
The fact that if we want to copy standard international practice, having MBBS or MBHCB alone doesn’t qualify for leadership or administrative role. And I also want to remind you guys that, in the United States of America(USA), Kathleen Sebelius was sworn in as the 21st Secretary of the Department of Health and Human Services (equivalent to our own Minister of Health) on April 28th, 2009. She is a former Governor of Kansas State and holds a Bachelor’s Degree in Arts and a Masters’ in Public Administration.
Donna Shalala and Tommy Thompson were health Ministers in Bill Clinton’s and G.W Bush’s administrations’ respectively. They are neither medical doctors nor healthcare professionals. In the United Kingdom (UK), the immediate past secretary of Health was Rt. Hon. Andy Burnham who holds Master of Arts (MA), Degree in the English Language.
In Japan Akira Nagatsuma who was appointed in 2009 as Minister of Health, is not a Medical Doctor and many more. These are countries Nigerians are traveling to in large numbers for medical attention while Nigerian Healthcare Service has been ranked 192 out of 198 countries by WHO under the leadership of Medical doctors which I termed as a failure on their side due to poor leadership style. In India the Minister of Health, Mr. Ghulan Azad is not a Medical doctor, he holds a M.Sc. Degree in Zoology
In Africa, Botswana has been rated by WHO as having the best National Health care service. The current minister of health in Botswana is an accountant and he took over from Nr. Motsumi, a Registered Nurse, who was health minister from 2003-2009. Earlier on, Nr. Phumaphi also a Registered Nurse was the minister of health from 1989-2002. It is noteworthy that since her independence in 1966, no medical doctor has been appointed as health minister in Botswana and this has been moving in standard which rated them the best.
For years, since the enactment of the act in 1999 which was facilitated by Kuti, things have begun to fall apart in the healthcare sector which even lead to the failure of maximizing the achievement of the Millennium Development Goals (MDGs) which now led to the birth of Sustainable Development Goals (SDGs), despite the new development and strategies given by World Health Organization (WHO) on how to easily achieve the SDGs through the inclusion of Nurses and Midwives as decision-makers and frontline in achieving this, less or no effort was made in doing that which is another mark and beginning of failure due to centralized and self-centered leadership as back by the half-baked act of 1999 at the detriment of the nation Health.
In Nigeria, the tenure of many non-medical doctors or Nurses at the helm of the federal ministry of health witnessed stability and harmony as epitomized by the leadership of the late Aminu Kano, Admiral Patrick Koshoni, Admiral Jubril Ayinla, Prince Julius Adelusi-Adeluyi, Prof. A.B.C Nwosu and lately Prof. Eyitayo Lambo. Similarly, doctors have at different times led other ministries that are not health-related. In these capacities, these eminent doctors enjoyed the support of other core professionals in these different none health ministries and reverse in the case Ministry of health for the reason-based known to those selfish and self-centered leaders which resulted in poor health delivery and disharmony in the health sector.
The deficiencies of Decree 10 of 1985 are now Cap 436 LFN 2004. The decree is a source of so many problems in the health sector. The composition of the boards of management of Teaching/Specialist/FMC Hospitals is unjustly titled in favor of medical doctors in broad daylight. Whereas only one person represents more than fifteen other health professions. However, the medical profession is represented on every board. Additionally, the Provost of the college of medicine, the CMD, CMAC, and the reps of the State Ministry of health are also medical doctors. How do we expect equity and equal representation for the development of our health care industry with this composition? The larger workforce (Nurses) and front-liners who managed the wards are not even well represented how do we ensure proper management with this lopsided representation. It is high time we move to the global best practices where the nomenclature will be reformed and qualifications for such positions for a sustainable and better healthcare industry. The causes of failure from the doctors’ side as perceived to be the best to head hospitals are numerous.
Experience has shown clearly that our hospitals and indeed the entire healthcare delivery system fared much better when professional health service administrators were CEO of hospitals in Nigeria and Nurses are also found to be the best administrators. The recent bill is the best to tackle the deteriorating/retrogressive healthcare industry from monopolized and poor leadership skills.
Equal treatment is given to all health students unlike the preferential treatment given to medical practitioners in training institutions to the detriment of other health professionals. The countries are ours, and the care is more of a team, we all need each other and it makes each other’s work easier when we all have high skills as a result of teamwork.
The appointment to the position of CEO of Federal Health Institutions such as TH and Specialist should be open to all qualified healthcare professionals and the office be restructured to CEO as seen in the global best Operating Hospitals instead of CMD.
Unified salary Structure because it’s the same ministry not a different one like other ministries. And the appointment of the head of agencies like NCDC, and NAFDAC be properly done. And the appointment of the health Minister is open to all based on qualifications and experience not only to the doctor’s domain. Putting the patient first before any other thing.
Introduction of Advanced Nurse Practitioner to fill in the health gap and will also minimize the unpatriotic strike which causes many Nigerians’ lives by Medical Doctors. And more awareness on the role of nurses in the healthcare industry and clarification to the medical doctors referring nurses and other healthcare workers as support staff due to ignorance and lack of exposure to the global and international best practice. And also attitudinal and behavioral change be implored to medical doctors from their students, MO up to their consultants and nonacademic professors by mental health Nurses.
To educate the medical doctors the more, I want you to know that, in global best practice, the Chief Executive Officer (CEO) is the highest-level management position in a hospital or hospital system. Hospital CEO’s must possess the qualifications and skills to manage and direct the complexities of a modern patient care facility. CEO positions require long hours, as well as involvement in the community, philanthropy, fundraising, and other organizations related to their work and to be frank if that’s the global best practice, selfishness aside, nurses are the best to suit this position for a better health development and this can be seen in few nurses that were appointed as commissioner of health at state level which resulted to a standard management than ever when it was a medical doctor.
I overrated consultants and provost in Nigerian but their recent circular to stand against the best bill which calls for sanity in the Nigerian healthcare sectors has expose their level of hatred, lack of exposure to what the world entails and the best for our country. It’s better for them to accept the reality for its going to be beneficial to them, their family, community and the nation health which is indirectly or directly related to the wealth of the county.
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By; Nr. Reuben Zirahgi Markus