AHAPN backs proposed amendment to University Teaching Hospitals Act

Expresses shock at MDCAN opposition to bill

Says it is time to rejig Nigeria health system

The Association of Hospital and Administrative Pharmacists of Nigeria (AHAPN) has expressed support for the proposed amendment to the University Teaching Hospitals Act.

The body, however, expressed great shocks at the Medical and Dental Consultants’ Association of Nigeria (MDCAN) on its rejection of the proposed amendment.

AHAPN National President, Pharm Olabode Ogunjemiyo

Recall that a lawmaker in the House of Representatives, Bamidele Salam, sponsored a Bill that will project the Nigerian Health System into the trajectory of countries with global best practices like United Kingdom, Canada and United States.

The bill is to amend the University Teaching Hospitals (Reconstruction of boards, etc) Act Cap U15 LFN 2014. The bill among other things seeks to change the nomenclature of the heads of tertiary health institution in Nigeria from Chief Medical Director, redefine the qualifications of the head of tertiary hospitals, and provide a definite tenure of office for the head of the tertiary hospitals.

Another aim of the bill is to restructure the composition of the governing boards of Federal Government tertiary hospitals.

AHAPN in a statement by its President, Pharm Olabode Ogunjemiyo, said from the global perspective and from the principle of International best practices, it is shocking that a body like MDCAN could ever rise up to antagonize such a proposed Bill in this 21st century as the bill is to reposition and revive the country’s already comatose health system, which has placed Nigeria health indices among the worst in the global ranking, 189 position out of 191 countries that were rated.

The group said it is unimaginable for MDCAN to accuse non-physicians of being the brain behind sponsoring of the bill.

AHAPN said it should be of utmost importance for MDCAN to restructure and reposition the national’s health system in line with the international best practices to avert unnecessary and frivolous medical tourism as is being witnessed today due to the country’s faulty health system.

“Contrary to the erroneous claims by the MDCAN that such proposed Bill portends serious present and future risks to the effective running of the Federal Government tertiary hospitals with the consequential poor outcomes on our patients, this proposed Bill intends to do the contrary. It is on record that countries operating such or similar proposed structure have demonstrated an undebatable, conspicuous and incontrovertible evidences of positive health impacts on their citizens.

Countries like US, UK, Canada and many other African countries practicing the proposed system, have unequalled or unparalleled enviable height in terms of far better health indices, more accessibilities to health and better health coverage for their citizens.

“No country or society will continue to fashion or reposition its health system primarily based on history of evolution of various professions but based on the present or future realities. Even judging from the history of the evolution of the various health disciplines, it is undisputable that the origin of health actually emanated from the use of herbs (drugs) which is pharmacognosy as seen in pharmacy. Without dispute, pharmacy as a profession has even existed before the advent of surgery and Medicine and Surgery as a field. No wonder the Ibos call the hospital “Ulo ogwu” (House of Drugs) just like other tribes do.

“Globally, the structure in the hospital is such that most hospitals are headed by those called ‘Hospital Administrators or Hospital President’, which could be anyone who has the requisite skills, knowledge and experience. Such requisite skills, knowledge and experience are far beyond what any group of health professional could lay monopoly of. Such skills, knowledge and trainings are beyond what one can gather solely from any medical, pharmaceutical, nursing or any other school. They are more than the clinical skills, knowledge or training needed to handle patients, drugs and many others.

“To effectively head a hospital, such a person must have possess some administrative, human resources, economic, psychological skills, trainings, knowledge and experience. Knowledge of handling a stethoscope is not and never synonymous to heading a hospital. The insistence by MDCAN that such a post must be its exclusive reserve runs in sharp contrast to the global norms. Again, in most hospitals, the head of pharmacy (Director of Pharmaceutical Services), Director of Nursing Services and other heads of other clinical and non-clinical services directly report to the hospital administrator or hospital president in matters relating to administration and not passing through a physician.

“Again, in the provision of care to the patient, the physician remains the head of the medical team and not the hospital administrator which is always thrown open to relevant professionals with the requisite knowledge, skills/trainings. In fact, most hospital administrators are accountants or lawyers and so on abroad.

“Among the clinicians, more nurses head the hospitals than any other clinician in countries like Canada. The existence of hospital administrators has even allowed the core clinicians to concentrate more attention to providing medical, pharmaceutical, nursing, nutritional and psychological care to patients,” the statement read.

AHAPN noted that it is childish and a mark of immaturity and highest level of ignorance for MDCAN to be comparing the hospital or health system with the judiciary, military and others. The group said the hospital or health system is totally different as it is a multidisciplinary system with diverse professionals.

The group said it is falsehood that only the physicians are appointed as consultants in hospitals. The body pointed out this present administration has debunked the falsehood by approving the status of consultant pharmacists recently, though the heads of government hospitals (CMDS/MDS) have refused implementing it since 2020.

“The same falsehood has also been propagated in the area of ‘Surgeon General’. The Nigerian physicians have always claimed that only physicians could be appointed as ‘Surgeon General’. In a country like USA, nurses and pharmacists have also been appointed into such a post. Nurses, pharmacists and others are also appointed as consultants in countries like US, UK and Ghana among others.

“It is very disheartening that presently, most hospitals are running without adequate drugs as most physicians as medical directors and chief medical directors have mismanaged the Drug Revolving Fund (DRF). It is now no news that these physicians have created a pseudo-drug scarcity, all in the name of pushing for the privatisation and out-sourcing of pharmaceutical services under Public Private Partnership (PPP) without knowing the consequences on the patients.

“Also, most physicians as CMDS or MDS are fond of refusing to implement any circular that favours non-physicians. The current arrangement empowers and favours the physicians to stagnate non-physicians during promotions, refuse employing non-physicians while they continuously employ their colleagues as well as re-engage only their colleagues who retired as contract staffs, create more post which are not gazzeted for physicians to enable them dominate the hospital top management team.

“The issue of health involve multi-disciplinary team that collaborate and provide holistic care to the patient. What we see in Nigeria is where the physicians only create enabling environment and policies that disfavour the patient from accessing total care from multidisciplinary team. No wonder do we continue to experience continuous decline in our healthcare indices and no wonder do our privileged ones continue to engage in ‘Medical Tourism’, so as to access quality care and as the only way to preserve their lives in spite of the enormous amount of money being budgeted into our health sector annually.The MDCAN, Association of provosts of Colleges of Medicine in Nigeria (APCOM) and other affiliate bodies of physicians should realise that, in line with the International best practices, the nomenclature used for the heads of tertiary health institutions in almost all climes is such that allows both physicians and non-physicians to use. For instance in US, the name used is Hospital Administrator or Hospital President.

“The continued usage of the terminology, “Chief Medical Director or Medical Director has skewed out non-physicians from applying for the post and this has deprived competent hands among non -physicians from applying.

“Also, the proposed bill is aimed at redefining the qualifications of anyone who wants to apply for the post. The current pre-requite qualifications of being only a member of Nigerian Medical or Dental Association that is registered by Nigeria Medical and Dental Council, being a medical consultant, and others, only favours the physicians and are not in tandem with the international best practices. The pre-requisite qualifications require that one should have certifications and qualifications in Hospital/ health Administration, Health Management and possession of other qualifications that will enable such a head for accounting and budgeting, knowledge in hospital bye- laws, human resource management, overseeing hiring of staff and salaries, among others. The truth is that the claim by the Nigerian body of physicians that possession of MBBS is sufficient to head the hospital is a fallacy. Anyone with the basic qualification in medicine and surgery, pharmacy, nursing or any other health related field has just an added advantage as they are not an absolute and sole requirement.

“This is will go a long way in imbibing and fostering the spirit of team work, collaborative practices, etc among the students. In countries like the USA, others like students in the Nursing and Pharmacy schools also enjoy the collegiate status. This is very important as modern health system is multidisciplinary in providing various types of care like Nursing, Pharmaceutical and others aside from Medical Care. Provision of only medical care is grossly inadequate for the general wellbeing of our patients.

“The World Health Assembly, the highest health-decision making body, has even acknowledged that the patient is at the centre and non-physicians should be allowed to make their inputs.

“This is absolutely necessary and in tandem with the global best practices. The Governing Boards should have members of the other Health professionals like the Pharmacy, Nursing and others as statutory members of the Governing Board.

“For instance, the inclusion of pharmacists are undisputable as the usage, availability, accessibility, rational use of drugs, drug administration, training of pharmacy students (even now the pharmacists have been granted the status of consultant cadre), the operation of Clinical Pharmacy and Doctor of Pharmacy (PharmD) require the supervision by pharmacists since drug is the bedrock of most treatments in the hospital. It is very pathetic that the issues pertaining to drugs and pharmacy are sidelined and handled by persons who do not have any training in the pharmacy school. Pharmacist presence is essential in the Governing Board as Drugs are even in the exclusive list of the Federal Republic of Nigeria.

“It is also unbelievable and shocking to listen to the argument by the physicians that this purposed bill, which is targeted to uplift the health standards of most Nigerians by guaranteeing full care (medical, nursing, pharmaceutical, nutritional, etc), is being jettisoned by the body of Nigerian physicians. It also very insulting and a mark of highest level of ignorance for a body of Nigerian physicians to project the highly noble efforts of members of the National Assembly as an attempt to strangulate and suffocate the already comatose Nigerian state of health. Why must our physicians continue to enjoy the current lopsided structure of health system which bleed most of our patients financially and deprive them of most collaborative care from other core clinicians?

“Let it be known and re-iterated that Nigeria is bigger than any group of people, hence the country must not be left behind in the current wind of positive change blowing in our health system. MDCAN, APCOM etc should even be the ones who should have initiated this wonderful Bill which is meant to bring life into the comatose nature of our present Health system,” the statement further read.

AHAPN called on the National Assembly to pass the bill for the improvement of healthcare in the country.