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[The Concourse] PACIFICATION OF NIGERIA’S HEALTH SECTOR: New Lessons From Borno

In 2012, one Mr. A.A Obi (a Medical Laboratory Scientist) with Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi, went against ‘popular convention’ to vie for the office of Chief Medical Director (CMD) of the hospital, and the whole heaven was let loose! Physicians protested against how a paramedical health worker could have the balls to challenge them in a position that was ‘exclusively’ reserved for them — holders of MBBS certificates. They forgot it is called Ministry of Health not Ministry of Medicine and Surgery!

And that was eight years, after then President Olusegun Obasanjo had broken another known ‘tradition’ to appoint a non physician, and non-healthcare professional, Eyitayo Lambo, Minister of Health in July 2003. He was a renowned Economist.

Direful number of Nigerian physicians under the aegis of NIgerian Medical Association (NMA) went haywire! They protested the appointment. How could someone who is not a medical doctor man the Health ministry? What does he know about medicine and health administration?

They didn’t bother to appraise his other credentials. Lambo was the Regional Adviser for health sector reforms, health care financing and health in socioeconomic development in WHO’s regional office for Africa from 1990 to 1999.

He was the first economist to be employed by the WHO’s Regional Office for Africa. During his tenure as Minister of Health, the first Health Sector Reform Program for Nigeria was developed and implemented; the National Health Insurance Scheme was launched after being on the drawing board for forty years. Many health policies and legislations were formulated during his tenure, including the hotly debated National Health Bill.

He was one of the few politically neutral technocrats to serve under the administration. He had a strong focus on long term health sector reform and good governance. Lambo was eminently qualified! But it doesn’t matter to avowed naysayers.

It is noteworthy that the most vocal opponents against appointment of other health-care professionals (non-physicians) to administrative offices like CMD or health minister/commissioner were majorly from southern part of the country. They cherish innovation, but not in tapping from the geniuses of colleagues from sister professions in health administrative offices. They dread new ideas from people of other health-care professions, otherwise they would not be so obstinate to suffocate all efforts at giving paramedical personnel or even non healthcare professionals, opportunity to offer their administrative expertise by taking the front seat in our health sector.

Some analysts of the time tried to school them through the reality of the office and the imperativity of its specifics, in line with what obtains in other parts of the world, but none of the frontline protesters listened. It was a blasphemy and the doctors were declaring fatwa and setting anathema seat against government and against the candidate(s) being projected. Chief Obasanjo was on marble to have asked one of the antagonists who confronted him “who are you?” And the fellow answered “I’m a Medical doctor” and Baba comically told him “then go back to your hospital and allow me run this country.”

Today, the Director General (DG) of World Health Organization (WHO) Tedros Adhanom Ghebreyesus Ph.D is not a Medical Doctor. He studied Biology. But he was Minister of Health in his home country Ethiopia from 2005 to 2012. His exploits earned him high reputation and gave him advantage over other contestants for the World Health DG position. He was elected by WHO Member States at the Seventieth World Health Assembly in May 2017.

The problem with most Nigerian professionals is that they tend to be emotional where they ought to be rational. And by so doing, close their minds against sound reasons. They inadvertently become professional bigots; and myopically patronize simpletons’ theory while demarketing cosmopolites. All in the name of protecting professional solidarity and brotherhood of parochial interests.

Even though former President Jonathan, in his days succumbed to the whims and caprices of these obdurate doctors, and appointed Prof. Onyebuchi Chukwu minister of health, he made a touching remark on 27th April 2010 during his swearing-in. He told the minister: “Your first assignment should be to put your house in order. Physicians are fighting other healthcare professionals and vice versa. Ensure you fix the issues and re-build a united and amicable health sector for Nigerians.”

Prof. Chukwu was a great man. He performed creditably well. During his stint, Nigeria got certifications as a guinea worm and Ebola-free country respectively. But did he comply with that primordial presidential advisory? No. The dichotomy in the sector widened the more. It was in the time of his penultimate predecessor, Lambo that the sector witnessed the best improvement in terms of making every subsector of the ministry count and be harmoniously unified.

Ever since then, Physicians in private practice had been fighting against Nursing and Midwifery council of Nigeria regulating against use of quack nurses in their clinics. They also resist the move by Medical Laboratory Science Council of Nigeria (MLSCN) to exercise its constitutional mandate of supervising their sidelabs to rid them of quacks and ensure compliance with extant laws. Same fate is metted to Pharmaceutical society of Nigeria (PSN). Radiologists who are physicians are in constant fight against radiographers (Imaging Scientists) over supremacy. Pathologists who are physicians are in perpetual battle with Histopathologists who are Medical Laboratory Scientists over who owns the histopathology Labs etc.

Thousands of Court cases have been filed and won/lost in this regard. Yet the rancour kept the gap widening. And it is the patients (who can be me and you, or our loved ones) who bear the brunt.

But while this was raging, many Nigerians, like Chief Obasanjo were not comfortable with it. And so on May 25, this year (barely a week ago) Borno state governor, Prof. Babagana Zulum made another ‘unusual’ move and appointed a nurse, Mrs. Bitrus Juliana, the commissioner for health!

Interestingly, no squabble has risen from any quarters. It has been congratulatory messages after another. Their state branch of NMA has not raised eyebrow. Just imagine if such appointment was made in any of the states down south.

In fact a veteran journalist, Fajiero Oliver observed: “…you see that that the Borno State Governor has appointed a Nurse, Juliana Bitrus as the Commissioner for Health in the state.

This has been my stand for years that any clinician (healthcare professional) can man the health sector in administrative manner and heavens will not fall

The Borno State Governor, Zulum is a professor and knows better. Nobody coughed when he made the announcement. If its Southern Nigeria, there would have been shouts and even protests that only Physicians have right to be appointed health commissioner.
We are getting there.”

The evil of parochialism need to be jettisoned in this most sensitive of all sectors. Administrative competence and versatile leadership charisma should be yardstick for appointment into key positions and not necessarily acquisition of MBBS degree certificates. This alone can reduce to appreciable percentage, the subterfluent disaffection bedeviling our health care professionals and service delivery.

May daylight spare us.

✍Eze Jude O.
A Medical Laboratory Scientist, Columnist and public affairs analyst.

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