Shopping for next health minister

Pate

AS President Muhammadu Buhari appoints his Health Minister, one question that has been on the mind of stakeholders in the sector is, ‘must a medical doctor be the health minister or rather must the next minister of health be a medical doctor?’

The answer to this rhetoric or rather the choice of Mr. President for the next Health Minister may go a long way in determining harmony among the various professionals in the sector.

In fact the situation has polarized the health sector, which has culminated in the formation of the Assembly of Healthcare Professional Associations (AHPA), the Joint Health Sector Unions (JOHESU) and the National Union of Allied Health Professionals (NUAHP) by the other health workers besides doctors basically to be strong opposition.

AHPA, JOHESU and NUAHP comprise: medical laboratory scientists, radiographers, pharmacists, dieticians, psychologists, physical therapists, optometrists, health information managers, medical social workers among others.

Besides, the medical doctors who believe they are most suited for the position, all the other professionals including pharmacists, medical laboratory scientists, nurses and midwives, physiotherapists, and so on think the position should be given to anybody with requisite managerial and administrative stills not necessarily a medical doctor or health worker.

Medical doctors under the umbrella of the Nigerian Medical Association (NMA) at the height of the last ministerial nomination and screening had stated that its own must be appointed at the helm of the Federal Ministry of Health (FMOH) because, according to the Association, it is a global practice.

President NMA, Dr. Kayode Obembe, had warned that the next occupant of the office must be a medical doctor. “This is not negotiable,” he said.

Obembe told journalists that other health professionals have the right to clamour for their entitlements, such as increase in salary, but the office of the minister of health was a no-go area for them.

The NMA President warned against the politicisation of the office of the minister of health because, according to him: “We don’t joke with the health of the people.”

Obembe said: “I don’t think the ministry of health should be so politicised. The head of that ministry must be professionalised and must be a medical doctor.

“You cannot say the head of the ministry of justice, for example, should not be a lawyer. It is not possible. The Attorney general of the federation must be a lawyer. So, for people arguing about salary increase and so on, fine, but you don’t go to the extent of saying that the head of that ministry must not be a medical doctor. If he is not a medical doctor, should he be a carpenter or bricklayer? You don’t joke with the health of the country.

“You have to be a high-ranking medical doctor with public health experience before you can talk to the international community and they will listen to you.

“Health workers can talk about increase of their salaries but when you talk about the minister of health, it must be a doctor. That is not negotiable.”

A medical doctor and consultant obstetrician and gynaecologist and Director General of the Nigerian Institute of Medical Research (NIMR), Prof. Innocent Ujah, told The Guardian yesterday: “Nobody says it is a must. It has not always been a doctor as the health minister. It is desirable that a doctor becomes the health minister. I can give example of what happened during the Ebola Virus disease epidemic. Let me tell you if the then health minister, Prof. Onyebuchi Chukwu, were not a medical doctor that disease would have ravaged Nigeria. I am not a soothsayer but because he understood the pathology, he understood the pathogenesis; he understood the likely outcome and of course has the confidence.

“In my opinion and I stand by that, it doesn’t have to but it is desirable that the health minister is a doctor because if you are talking though the third party it is not the same as first hand knowledge. We have had an economist being the health minister. Before then there were many other people. In fact the late Aminu Kano was a health minister, he was not a doctor. You see we are evolving and the truth is that we must understand.

“I just like asking ‘must a lawyer be the Attorney General and Minister of Justice?’ In their own case it is captured that ‘if your are not a practicing lawyer you cannot be Attorney General and Minister of Justice.’ It is also true that in the Arm forces if you are not a combatant you cannot be the Army Chief. If you are not a pilot you cannot be an Air Chief and if you are not a sailor you cannot be Naval Chief. We have every profession everywhere. In this Institute we have accountants, we have administrators and we have other professionals that are here. The issue is that we want to situate things that will move our health forward and that is why I said it is desirable. The word ‘must’, I don’t think anybody has used must.”

But President of the Pharmaceutical Society of Nigeria (PSN), Olumide Akintayo, disagrees. He said: “It is important to state that the headship of the health sector is not vested in medical doctors contrary to the claims of the NMA. A minister of the Federal Republic of Nigeria is a political appointee whose duty is purely administrative.”

Akintayo said Sections 147(1) and (2) of the 1999 constitution of the Federal Republic of Nigeria are very clear as to how ministers are appointed. “Section 42(1) a and b also compels a right to freedom from discrimination on the basis of community, ethnic group, place of origin, sex, religion, political opinion and so on,” the pharmacist said.

However, The Guardian investigation revealed that medical doctors have not always been the health ministers and none medical professionals had fared better.

The tenure of many non-medical doctors at the helm of the federal ministry of health witnessed stability and harmony as epitomized by the leadership of late Aminu Kano, Admiral Patrick Koshoni, Admiral Jubril Ayinla, Prince Julius Adelusi-Adeluyi, Prof. A. B. C. Nwosu and lately Prof. Eyitayo Lambo.

Medical doctors had also held sway as health ministers including: Prof. Olikoye Ransome-Kuti, Dr. Tim Menakaya, Prof. Adenike Grange (the first female), Prof. Babatunde Osotimehin, Prof. Onyebuchi Chukwu, and Dr. Khaliru Alhassan.
The situation in other countries

The Guardian‘s investigation revealed that other countries where the health ministers are not doctors include: Ghana, Sierra Leone, Canada, Italy, Spain, Portugal, Jamaica, Sri-Lanka, Germany, Ireland, Holland, Zimbabwe, United States (US), United Kingdom (UK), Japan, Botswana, India, among others.

It was gathered that in the US, Kathleen Sebelius was sworn in as the 21st Secretary of Department of Health and Human Services, equivalent to Nigeria’s health minister, on April 28, 2009. She was a former Governor of Kansass, holds a Bachelor Degree of Arts and Masters in Public Administration. Donna Shalala and Tommy Thompson were health ministers in Bill Clinton and George W. Bush’s administrations respectively. They were neither medical doctors nor healthcare professionals.

In the UK, the immediate past Secretary of Health was Rt. Honourable Andy Burnham holds a Master of Arts (MA) Decree in English language.

In Japan, Akira Nagatsuma who was appointed in 2009 as health minister is not a medical doctor. In India, the health minister, Mr. Ghulan Azad is not a medical doctor and holds a M.Sc. degree in Zoology.

Akintayo said: “These are countries Nigerians travel to, in large numbers, for medical attention while the Nigerian healthcare services has been ranked 187 out of 191 countries by the World Health Organisation (WHO) under the leadership of medical doctors. A 2013 report showed that Nigeria was placed by the United Nation Survey at 85th out of 91 countries for medical treatment to elderly. Indeed Nigeria was on the bottom 10 of the rankings with countries like Malawi, Pakistan, Afghanistan, Tanzania and Rwanda. This rating cannot be too different from the quality of healthcare to the general populace in Nigeria.

“In Africa, Botsawana has been rated by the WHO as having the best national healthcare service. The current health minister in Botswana is an accountant, and he took over from Mrs. Motsumi, a nurse, who was health minister from 2003 to 2009. Earlier on, Mrs. Phumaphi, a nurse, was the health minister from 1989 to 2002. It is noteworthy that since he independence in 1966, no medical doctor has been appointed health minister in Botswana.”

The PSN President said doctors have at different times led other ministries that are not related to health. Akintayo explained: “Prof. Jubril Aminu was at different times Education and Petroleum minister. Only recently, incumbent Ondo State Governor, Dr. Segun Mimiko, was Housing Minister in the Obasanjo Government. In these capacities, these eminent doctors enjoyed the support of other core professionals in these different non-health ministries. Is worthy of note that Nigerian medical doctors were the only group that protested the appointment of Prince Julius Adelusi, a pharmacist, as Secretary of Health in interim administration of Chief Ernest Shonekan.

“Recall that out of the eight year tenure of President Obasanjo it was only Dr. Tim Menakaya, who featured for six months, that was a medical doctor who was health minister. For seven and half years we did not have any doctor and we made tremendous progress especially with Prof. Eyitayo Lambo, the Health Economist.

“Under the Jonathan administration the two ministers in charge of the federal ministry of health were medical doctors in a multi-disciplinary set up such as health, the first in the history of this nation and yet there was no threat from the other stakeholders in the health sector.

“The general perception on why doctors want to continue to be health minister is to maintain the hegemony of an unjust entry level in the civil service, discriminatory salary scales and continue to intimidate the Nigerian public with their frequent and selfish strike action.”

Medical Laboratory Scientist, Adetoro Taofik, said: “Since 2005, neighboring Ghana has had five health ministers and only one is trained in a health profession, and that minister was a pharmacist. The Health Minister of India is a politician, and he is not a medical doctor. This is same India where every rich Nigerian runs to for treatment now. Germany which is the country our former First Lady went for her numerous treatments and surgery has a trained banker as its Health Minister. Our colonial masters, the United Kingdom has a Management Consultant as her Secretary of State for Health. It is same in United States where the Secretary of State for Health is a Political Scientist and an Administrative Consultant. In France, it is a Lawyer.

“These individuals were chosen based on their track record in management positions and not based on their profession. They would have shown exemplary character in management positions with little or no history of mismanagement before chosen to handle the health ministry. Why can’t Nigeria emulate that? UK and US have always been our reference in national development issues, what then is wrong with issues of health sector? Why can’t we emulate them in that too? Why can’t Nigeria select a Health Minister based on good management history?

“Medical doctors are so obsessed with positions such that they are now heading medical records department in many hospitals. Yet, we have trained and qualified medical record officers.

“There are pharmacists, nurses, medical laboratory scientists, and physiotherapists who have controlled institutions and are still controlling institutions. Prof. Dora Akunyili was a living example. Then why must the heads of all health agencies, hospitals and related institutions be reserved for medical doctors alone? Are they the only professionals in the health sector?

“Qualified medical doctors are not supposed to involve themselves or be concerned with all these non-clinical issues. Their sole task is making an ill patient well in collaboration with other health professionals. This task is very enormous on its own without adding other non-clinical issues to it. Their colleagues in other countries majorly stick to their primary assignment. And in other to effectively carry their assignment out, they work hand in gloves with other health professionals reasonably and professionally.”

Also, NUAHP has said the next health minister must not be a doctor.

The Union has appealed to the Federal Government to ensure that a non-medical practitioner is appointed as a substantive Minister of Health.

This, the group said, is one of the factors that can help resolve chains of challenges, including professional rivalries, militating against the nation’s health sector.

President of the group, Mr. Kayode Faniran, told journalists that it would be unfair to non-medical professionals should a doctor is once again appointment to head the Federal Ministry of Health.

Faniran said: “Our position is very clear on the appointment of Minister of Health. We are advising Mr. President to be careful. The former Minister was a medical practitioner, a member of NMA. Any attempt by the presidency to appoint another person from NMA, it means that he does not want peace in the health sector.

“We advise him strongly that there should be no two persons from NMA as Minister of health henceforth. History of Nigeria has shown that whenever a member of NMA is made to be Minister of Health, usually, industry crisis usually appreciates. Go and look at history from 1985, Prof Olukoye Ransome Kuti, Oshotimehin, and then Chukwu. They are selfish; they don’t want other professionals to rise. And, they make people believe that NMA member is superior to anybody. That is not correct. We are all professionals; it is not like that in other countries. Why should it be like that in this country?”

However, the Medical Consultant Association of Nigeria (MDCAN) had drawn out the criteria that the next minister of health must possess if he is to succeed in confronting the myriad challenges in the Nigeria’s health sector.

The group had also advised the Presidency to “ignore the cacophony of self-serving calls to make political rather professional judgment in the appointment of the next Minister of Health.”

MDCAN President, Dr. Steven Oluwole, linked the lack of rapid development of the Nigeria’s health sector to the unhealthy rivalry among practitioners in the health sector.

“The unhealthy rivalry and quests for ascendancy by multitude of professional groups in the health team have eroded and fractionated a system that should work in harmony. The primary functions of the health team is now secondary to who controls or head departments, who takes custody of equipment and other needless ventures,” Oluwole stressed.

He suggested that: “For now that the next Minister should possess the requisite skills to perform the combined roles, as Professor Chukwu did, until such a time that the understanding of the need to split roles extend beyond the medical profession.

“But should the Minister of Health be merely a medical doctor? No! He must minimally possess basic degree in medicine and surgery; Postgraduate qualification, not necessarily in public health; skills in public and international health; evidence of administration and leadership skills and at the personal level, he must not be ethnocentric towards the medical profession, but able to lead the health team dispassionately.”

While reiterating the need for a Surgeon General in the country, the MDCAN President said: “The position of the MDCAN is that appointments to leadership positions in the health team should not be politicised to please any group, but must be competency based to achieve clearly stated objectives.

“Had the Minister of Health been incompetent to understand basic public health processes, the situation would have been different. The country was saved enormous resources that would have been wasted on committees, monitoring groups, and other irrelevant agencies that were not needed to control the Ebola disease epidemic.”
Going forward

Sources from the Presidency suggest that the former Governor of Anambra State and Nigerian Senate, Dr. Chris Ngige, who is also a medical doctor, is favoured to be the next health minister. But stakeholders are unanimous that the appointment of a competent Nigerian with experience in result-based budgeting as Minister of Health will boost the chances of success in the implementation of health policies and foster judicious use of available resources.

Despite the inter-professional rivalry in the health sector, there is a medical doctor with requisite administrative and managerial skills that most stakeholders would want to be the next health minister. The former Minister of State for Health in Nigeria, Dr. Muhammad Ali Pate (Born 6 September 1968). His appointment in July 2011 follows his success as the Executive Director of the National Primary Health Care Development Agency (NPHCDA), in Abuja. He resigned as Nigeria’s Minister of State for Health effective July 24, 2013 to take up the position of Professor in Duke University’s Global Health Institute, US. He also serves on the agenda committee of the World Economic Forum.

According to Wikipedia, “Pate is an American Board-Certified MD in both Internal Medicine and Infectious Diseases, with an MBA (Health Sector Concentration) from Duke University US. Prior to this he studied at the University College London, the 7th in the country. He also has a Masters in Health System Management from the London School of Hygiene & Tropical Medicine, UK. He is currently an Adjunct Professor of Global Health of the Duke University Global Health Institute. He is also a member of the Strategic Advisory Group of Experts.”

Stakeholders including Head, Corporate Communication Department, Nigerian Export-Import Bank, Chinedu Moghalu, agree that there is need for such a professional to have exposure to the international health policy community and global funding agencies cannot be overemphasized, considering the significant international resources to be mobilized for healthcare under the Sustainable Development Goals which will replace the Millennium Development Goals in 2015.