ASSOCIATION OF MEDICAL LAB SCIENTISTS OF NIGERIA (AMLSN) RE-AFFIRMS STAND ON PROPOSED LEGISLATIVE BILL TO AMEND VARSITY TEACHING HOSPITALS

The Association of Medical Laboratory Scientists of Nigeria (AMLSN), has criticized the call by its fellow professional body, the Medical and Dental Consultant’s Association of Nigeria (MDCAN), that the Bill for the amendment of the University Teaching Hospital (Reconstitution of Boards etc.) Act CAP U15 LFN 2004 which is currently before the National Assembly for deliberation, be thrown out.

The Laboratory Scientist’s body expressed their outrage in a joint statement on Friday, July 1, 2022 by its National President, Professor James Garba Damen and National Secretary, Dr Musa Abidemi Muhibi. The body which described the bill as ‘A Remedy For Our Past Error’, said it is both ‘malicious’ and ‘ludicrous’ to make such call by another medical body which knew the importance of that Bill for an Act for a smooth running of the nation’s health system.

The Bill is being sponsored by a House of Representatives member, Hon. Bamidele Salam, representing Ede North/Ede South /Egbedore/Ejigbo Federal Constituency of Osun State.
The Bill, among other things, seeks to reduce inter-professional rivalry among various players in the healthcare team in the Teaching Hospitals by ensuring that all critical stakeholders are involved in the composition of the boards of Teaching Hospitals, with a view to making them more vibrant and efficient.

The bill, according to the Association of Medical Laboratory Scientists of Nigeria (AMLSN), is in tandem with global best practices with special references to the United Kingdom, United States of America and other countries where, it said, medical training has been successfully implemented through collaborative efforts of all practitioners.
AMLSN stated that one of the most accurate and honest definitions of “Global Best Practices” is to revere certain methods, techniques, mechanisms and practices that have been tested and found to be result oriented at a global level. They refer to those practices that have worked and produced results globally, as those that can serve as examples and templates and set the pace for others to follow.

The Lab Scientists Group said “In tandem with this definition, it could be found that health institutions, Teaching Hospitals inclusive, in places like the United Kingdom, are headed by Chief Executive Officers that are not medical doctors. Next to the CEOs are directors of clinical services, nursing services, etc. That is exactly what the Bill is seeking, and that is in tandem with Global Best Practices.
“It is bewildering how a supposed elite consultants group will compare a section of professionals in mainstream civil service with a whole arm of government (judiciary)? The Judiciary is never in the same category with the health sector. Anyone trying to compare the two is simply daft or is just being mischievous. Headship of hospitals is purely administrative the world over. Competent hands who are sometimes non health professionals are appointed as chief executive officers.
“For example, the National Health Services (NHS) Providers and the NHS Leadership Academy UK in 2018 issued a report titled “Clinician to Chief Executive: Supporting Leaders of the Future”. In the report, a survey was conducted about the professional background of all NHS provider chief executives. The combined findings established that a third of chief executives (CEOs) hold a clinical qualification.

“Of these clinically inclined CEOs, 63% trained as nurses, 19% trained as medical doctors, 4% trained as pharmacists and 11% other health professionals (Medical Laboratory Scientists, Physiotherapists, Radiographers, etc). As a matter of fact, the current CEO of the NHS, being the 9th officer to be so appointed since the post was established in 1985 in England, Amanda Pritchard, is a Historian.

“Some of the Nigeria trained physicians who oppose this positive change in Nigeria will work harmoniously under a CEO when they migrate to the UK! What hypocrisy and self-deceit!! Must Nigeria Health system not move forward? These people should stop insulting our sensibilities. A Medical Laboratory Scientist just like any other core health professional is much a professional as a medical doctor; none is superior to the other. It’s unfortunate how they are reducing the revered medical profession to a mere market association.

“The similitude of what we have in health industry is what operates in construction industry where many professionals like Architect, Builders, Surveyors Engineers and others form a team, of which the leadership is not an exclusive prerogative of one profession, among equals. These same consultants would be painting politicians black about medical tourism, yet they’re not ready to accept global best practices in order to build a robust healthcare system in Nigeria.
“As far as we don’t put our differences and sentiments aside and adopt the right method of doing things as obtainable in developed nations, politicians would show no commitment in revamping our healthcare sector.

“A brief trip down memory lane revealed that the Teaching Hospitals in Nigeria in the 1950s and 1960s were sites of medical tourism in Nigeria, with particular reference to University College Hospital (UCH) Ibadan, as it played host to Saudi Arabia royal family, and this was at a time when the Colonial Administrators who were non-doctors and their Nigerian counterparts such as Mr S. A. Ladehinde and Mr F.G.A. Cole after him held sway. These two gentlemen were administrators and not Doctors, and the Nigeria tertiary institutions were doing fine under their leadership.

“Hon. Minister of State for Health, Dr Olorunnibe Mamora, attested to this fact as reported by Punch Newspaper on the 3rd of March, 2020. Another Senator of the Federal republic of Nigeria, lamented at a lecture he delivered that UCH was better managed when Mr S. A. Oladehinde, Mr F. G. A. Cole (non-doctors) were at the helms of affairs than now when Consultants who are Physicians now run the hospitals.

“History revealed the first house governor in UCH was Brigadier N. B. Brading (1957-1958) followed by Mr. G. Parker (1958-1964), Col. J. B. Robertson (1965-1967) before the first Nigerian house governor, Mr. S. A. Ladehinde (1967-1973), then Mr. F. G. A. Cole (1975-1984). It was when decree 10 of 1985 paved way for Physicians as CMD that serious deterioration of the tertiary health institutions in Nigeria began, till it reached the present state. It was the decree 10 of 1985 that gave absolute power to Physicians and we all are witnesses to what damage that has caused the nations.

“In the year 2000, under the total control of Physicians, Nigerian health system was ranked 187th out of 190 countries according to WHO (WHO, 2000). This might have informed the then President Obasanjo’s decision of not using a Physicians as Minister except the brief stint of Dr. Tim Menakaya. It is pertinent to say that since the return to democracy, the best Health Minister we have had was Professor Eyitayo Lambo, an Health Economist under whom the Teaching Hospitals in Nigeria were equipped with the VAMED project.

“Also, there was less acrimony culminating into strikes and industrial disharmony in the nation’s health sector. It is pertinent to reiterate that the relationship between the University and the Teaching Hospital that was supposed to be symbiotic is rather a parasitic one at the expense of the Teaching Hospitals. It is very wrong for Honorary Consultants who are primarily staff of the University under the Ministry of Education to be CMD, CMAC and now with the expansionist agenda created offices of Deputy CMACs (which is alien to law) as many as they want for compensation and patronage of their cronies, feeding fat on the hospitals’ resources.
“Honorary Consultants are HODs in the hospital in departments where the core professional staff with better competence are made to be subservient to these honorary consultants. This highly de-motivating culture imparts negatively on service delivery”.

However, the Association of Medical Laboratory Scientists of Nigeria (AMLSN) pointed out that the Bill seeks to correct, among other discrepancies: the Diversion of public fund to private pockets; Obnoxious PPP arrangement where the CMDs use their cronies as fronts to defraud the hospital by entering into PPP arrangement that will be parasitic to the hospital’s internally generated revenue. Some concessionary arrangements even led to litigation that the hospital has to pay heavy in damages; the Diversion of patients from public facilities to private clinics by Physicians.

“The Divided loyalty, the interest of the CMDs and honorary consultants has never been that of the hospital but that of the College of Medicine, where they hold sway; Monopoly – we have seen the best the physicians can give in terms of administrative prowess and it has led the health sector in Nigeria to the lowest of low; it will be very fitting to give other health professionals chance to change the narrative, after all nobody is more Nigerian than the others by mere choice of profession.
“The Exclusion of critical stakeholders leading to policy somersault. It has been observed over the years that these honorary consultants legislate based on what catches their fancy and this has eventually led to failure of many government policies. The boards of tertiary hospitals as presently designed, is just an NMA general meeting in disguise with few observers and the policies of the board had in many cases not translated into tangible development. No professional group must be given power to solely determine the fate of the health sector as we have seen played out in Nigeria. No serious country of the world would allow that.
“Criminal Negligence – there are many unethical practices allegedly perpetuated by these honorary consultants as we have seen over the years. Many cases of criminal negligence have been swept under the carpet by the doctors in our teaching hospitals because the physicians with pathologists know how to swing the pendulum to exonerate themselves where a patient or his/her relative muster the strength to challenge their unwholesome practices.

“These have promoted criminal negligence over years. It has been observed over the years that whenever some honorary consultants become professors, they do virtually nothing and receive the fattest pays for doing virtually nothing. What an irony! They will come to work whenever it pleases them and can travel as it pleases them without any check while their salaries are being paid as and when due.
“Many consultants will abandon their clinics in the teaching hospitals without consequences but will always be found at their private clinics almost all the time, while they send Residents (Trainee Doctors) to review the patients unsupervised. Sometimes when they are available, they will attend to few cases and give others long appointment dates so that patients can negotiate private appointment with them at their private facilities where patients are treated like gods, while they treat same patients without dignity in public facilities.

“These Honorary Consultants cannot justify the budgetary allocation to the teaching hospitals over the years. These and many more are the main causes of collapse of the Health sector. It is understandable for MDCAN to call the bill obnoxious because the bill will expose malfeasance and unwholesome practices, and as well take away their perceived right which indeed is an abuse of privileges.
“The bill is a step in the right direction and will give all critical stakeholders opportunity to contribute meaningfully to the growth of health sector in Nigeria. It is laughable when MDCAN talked about international best practices but failed to remember that WHO is not headed by a doctor. In the UK and US, many hospitals are not headed by doctors.

“Leadership of health institution in advance countries is based on competence and not on a degree in Medicine and Surgery. In the US, the “big Pharma” is a force in the health sector. They have forgotten that in the Universities where they are primary staff, doctors compete with scholars from others fields for the post of Vice Chancellor and in many cases, they fall short.

“The MDCAN insulted the sensibilities of the legislative Arm by referring to parliamentary business as a backdoor process. The law that gives power to the CMD was a military decree which was a product of selfish agenda of doctors to mislead the military government in 1985 to promulgate the decree without due reference to all critical stakeholders and the result of that decree is evident to all.

“Anyone with financial wherewithal does not trust Nigerian Doctors with his/her health and this is palpable as many Nigerians now travel abroad for procedures like kidney transplant among others. This is an indictment on these Physicians who have held sway at the ministry and the tertiary health institutions.
“The Physician; Professor Pondei, NDDC acting MD who “fainted” while he was being quizzed by a panel before the full glare of the world is a typical example of a Nigerian Doctor and how they want to be head of all agencies with the aim of fleecing our common patrimony. The video went viral all over the social media. That is an example and does not paint a good picture of the country.

“It is our considered view that this bill, when passed, will revolutionize our health system in Nigeria and health will be assessable to all Nigerians. It will make a good attempt at the Universal health coverage and bring quality health care service to the reach of common man as well as stem the tide of medical tourism. Incidentally, it was the military administration of General Muhammadu Buhari that enacted the decree: It will be a credit to his Excellency’s administration to correct the error of thirty-seven years ago.

“It is pertinent that MDCAN understands that their claim of having a Medical and Dental professional as the best fit for management of hospitals is flawed contextually. The narrative is not accurate and it is a very poor attempt at rewriting history”, the Medical Laboratory Scientists stated.