By Daniel Dauda, Jos


The age-long rivalry between the Medical and Dental Consultants' Association of Nigeria (MDCAN) and other health Professionals could be said to have reached its crescendo A's the Professional bodies have recently engaged in a war of words.

The current upheaval is triggered by a Bill currently before the House of Representatives, sponsored by Hon. Bamidele Salam, representing Ede North/Ede South/Egbedore Ejigbo Federal Constituency of Osun State, South-West Nigeria.

The Bill, entitled, "Bill for an Act to amend the University Teaching Hospitals (Reconstruction of Boards etc) Act Cap U15 LFN 2004, seeks among other things, to 
1. Change the nomenclature of the Head of Tertiary Health Institutions in Nigeria from Chief Medical Director 
2. Redefine the qualification of the Head of Tertiary Hospitals 
3.  Provide a definite tenure of office for the Heads of Tertiary Hospitals 
4. Include students of Health Sciences in the training programmes of Tertiary Hospitals 
5. Include hospitals established post-enactment of the extant legal framework in the schedule and for other related matters 
6. Restructure the composition of the Governing Boards of the Federal Government Tertiary Hospitals. 

However, the MDCAN described the Bill as obnoxious sponsored by alleged group of workers within the Federal Tertiary Hospitals in the country who MDCAN said  were hell-bent on destroying these Hospitals due to their perennial, insatiable quest to take over the Federal Tertiary Hospitals from the back door. 

In a statement by Dr. Victor  Makanjoula and Dr. Yemi R. Raji, President and Secretary of MDCAN respectively, MDCAN however, expressed its conviction that the National Assembly, relying on global best practices, would not align with what it called, forces of anarchy to destroy the country’s already beleaguered health sector.

"We would like to put it on record that passing this Bill portends serious present and future risks to the effective running of the Federal Tertiary Hospitals with consequential poor outcomes for the Nigerian patients who go to these hospitals with the hope of getting the best of care. 

"A bit of the history of the Medical and Dental profession and how the allied health care professionals were established would explain the rationale behind the age-long tradition of having the Medical and Dental Professionals as the best fit for the management of our hospitals".

MDCAN posited that the training of the Medical and Dental Professional gives him/her a holistic view of all aspects of patient management, as well as the administration of the hospital towards achieving that priority, which is the patient care. 

It also reminded the sponsor of the Bill that running a tertiary hospital, anywhere in the world, has never been a popularity contest, just as no military establishment has ever left its commands (like the Chief of Army Staff, Chief of Air Staff, Chief of Naval Staff or Chief of Defence Staff) in the hands of non-combatant support staff because of their possible numerical advantage. 

According to MDCAN, due to their holistic training and exposure, military personnel will always lead a military mission, just as the judiciary is always led by a trained lawyer and not any non-lawyer, warning that the passage of the Bill remained a recipe for disaster in the running of Federal Tertiary Hospitals.

"Based on what we know, we will blame ourselves if we stay by and watch the Nigerian health sector retrogress as a result of insatiable quests by an amorphous amalgam of power-seeking health care workers. 

"There is a growing body of evidence, the world over, to show that Physician-led hospitals are better managed with measurable advancement in all aspects (patient care, infrastructure development and economy of the hospitals) compared to non-Physician-led hospitals. 

"Furthermore, analyses from those studies show that hospital quality scores are at least 25% higher in physician-led hospitals than in non-Physician-led hospitals (Stoller et al 2016, Rotar 2016, Goodall 2011, Clay-Williams 2017, and Gupta 2019). 

"As a matter of fact, the findings from these studies are within reach. Physicians, by virtue of their training, orientation, and experience, place their focus on the primary users of services in the hospital: the patient – whose care, as a matter of fact, is registered in the hospital in the Physician’s name. 

"For this reason, they apply patient-focused strategy to hospital administration. It therefore calls to question why a Bill of this nature is being introduced in the House of Representatives at this time".

In the light of the above, MDCAN stated that Bills that will promote drivers of sustainable growth and development of our Tertiary Hospitals are what Nigeria needs at this time, not the ones that will add to volatility of the sector arising from using legislation to remove professionalism and expertise from thee leadership structure of Tertiary Hospitals. 

"Incidentally, one continues to wonder how a change in the nomenclature of the Chief Medical Director and reconstitution of the Boards of the Federal Tertiary Hospitals would benefit the average Nigerian patient who does not benefit from any financial risk protection while accessing health care but mostly pays out-of-pocket.

"At the risk of sounding repetitive, how would this Bill improve the poor infrastructure that currently 
defines our Tertiary Hospitals? 

"And how will it improve skilled manpower shortage and the avalanche of redundant personnel that contribute little to nothing to patient care, or the fiscal deficits that constrain the Government from meeting its obligations to the Tertiary Hospitals? 

"The questions are endless. It is about time we all start addressing the essential enablers of improved health system performance in Nigeria".

Consequently, the MDCAN urged the National Assembly to throw out the Bill and engage the critical stakeholders in instituting Bills that would bring quality, efficient, and affordable healthcare services to all Nigerians. 

However, in their  reactions, the other health Professional bodies condemned in the strongest terms the decision of MDCAN saying that no professional group must be given power to solely determine the fate of the health sector as  have seen being played out in Nigeria. The other health Professional Associations in support of the Bill are;
Pharmaceutical society of Nigeria, Nigeria society of Physiotherapists, Association of Radiographers of Nigeria, National Association of Nigeria Nurses and Midwifery and the Association of Medical Laboratory Scientists Association of Nigeria AMLSN.

 Of particular consideration is the position of AMLSN who described MDCAN's suggestion to the National Assembly to throw away the Bill as unfortunate, stressing that the intention was to reduced the revered medical profession to a mere market association. AMLSN stated that it was 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", the statement stated.

The Bill, among other things, AMLSN said seeks to reduce interprofessional 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. 

It further submitted that the Bill is in tandem with global best practices and made special references to the United Kingdom, United States of America and other countries where medical training have been successfully implemented through collaborative efforts of all practitioners. 

AMLSN said that the Bill equally seeks to correct, among other discrepancies: 
1. Diversion of public fund to private pockets. 
2. 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. 
3. Diversion of patients from public facilities to private clinics by Physicians. 
4. 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. 
5. 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. 
6. 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. 

AMLSN also said that there were many unethical practices allegedly perpetuated by these honorary consultants as noticed 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". 

The Association further revealed that 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. 

It further held that 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. 

AMLSN added that the Honorary Consultants cannot justify the budgetary allocation to the teaching hospitals over the years, noting that the above and many more were the causes of collapse of the Health Sector.

AMLSN further said it understood why MDCAN called the Bill obnoxious because, according to the association, will expose malfeasance and unwholesome practices, and as well take away their perceived right which indeed is an abuse of privileges. Consequently, AMLSN said that the Bill was a step in the right direction stressing that it 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 other fields for the post of Vice Chancellor and in many cases, they fall short". 

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. 

In addition, AMLSN said that those practices have worked and produced results globally, and as such can serve as examples and templates and set the pace for others to follow. 

"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". 

AMLSN said it was 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 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 officer", the statement added.

AMLSN posited that 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".

Taking the above into cognizance, AMLSN said it was 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, saying that the narrative was not accurate and a very poor attempt at rewriting history.