Doctors, pharmacists differ on headship of hospitals
By Ben Ukwuoma
Asst. Health Editor
A SHARP division has emerged between medical doctors and the other professionals in the health sector over the headship of the nation's teaching hospitals, The Guardian has learnt.
And, if the Federal Government accedes to the recommendations currently with the Federal Ministry of Health, the helmsmen of the hospitals may no longer be an exclusive preserve of medical doctors, but be simply thrown open to "competent administrators," who could be pharmacists or any other suitable professional.
Also, the hospitals may soon be under the supervision of a special commission to be set up by the Federal government.
These are some of the recommendations of a committee on health sector reform, recently constituted by the ministry.
While the proposed commission is to monitor, supervise and set guidelines as well as minimum standards, the headship of the hospitals, which will be semi-autonomous, will ensure effective administration of the hospitals.
The committee submitted its report to the Health Minister, Prof. Eyitayo Lambo, last week. The members were unanimous on their recommendation for the enactment of a law to be called National Tertiary Commission. They, however, differed sharply along professional lines on the headship of the hospitals.
The Guardian learnt that the government may adopt a middle-of-the-road approach by throwing the position open to every healthcare professional with administrative background.
The enabling law for the teaching hospitals; Cap 467 Laws of the Federal Republic of Nigeria, which was formerly Decree 10 of 1985 as amended, stipulates that the position of a chief medical director and chief executive of the hospital must be a medical doctor with considerable administrative experience. Before the law, the administration of hospitals in the country was in the hands of hospital governors whose designation was later changed to Directors of Administration.
While medical doctors in the committee recommended to the minister the retention of medical doctors as the chief medical directors, other health professionals such as the pharmacists, nurses, and medical laboratory scientists maintained that it should be for trained administrators or managers with cognate experience.
The chairman, Lagos State branch of the Pharmaceutical Society of Nigeria (PSN), Mr. Olumide Akintayo, said: "We declare without ambiguity that if reforms lead to retaining an already flawed management, then it is not worthwhile contemplating the endeavour. Management emanates from cultural background totally different from and diametrically opposed to that of health professionals including pharmacists, doctors, laboratory scientists and others who are trained usually in their core callings in a particular approach to decision making and organisation, which is different from more corporate and consensual approach."
He continued: "It is a known fact that the chief executive officers of our health institutions often display glaring biases in the management of these institutions and these have led to serious imbroglio and dislocations. The current disgrace if not an outright tragedy that has enveloped operations and activities at LUTH, Idi-Araba aptly captures the scenario".
To Akintayo, retaining doctors as chief executive officers of tertiary hospitals will "never produce just as it has never achieved the desired result." We call on the Minister of Health to adopt the spirit of the recommendations, which prescribes seasoned administrators or managers as chief executive officers of tertiary health institutions to promote responsiveness, effectiveness and proper management, which borders on adequacy of capacity to deliver service."
A former vice president of the Association of Medical Laboratory Scientists and chief medical laboratory scientist at the Department of Haematology, College of Medicine, University of Ibadan, Mr. Idris Aliyu, argued in the same vein. To him, the team that makes up the health care is heterogeneous and varied, requiring somebody with the right skill and core competence in management to manage crises, inter-personal and inter-professional relationships.
He added: "The core professionals in the health sector are well trained in their core competence areas, what we need is somebody who can be a good co-ordinator to enable the patients benefit from our services. Take a surgeon who is a hospital administrator. He has to attend a series of meetings as the chief medical director even when a patient is waiting in the theatre. Invariably, he has to either postpone the operation or forget the meetings. Both ways, we are actually losing by putting a highly skilled person as an administrator."
Aliyu continued: "I think this country has a good opportunity to look at things very broadly. Take any teaching hospital that has existed before the enactment of Decree 10 and count the number of strikes we have witnessed. You will readily come to the conclusion that the right people are simply not in charge".
But doctors, under the umbrella of the Nigeria Medical Association (NMA), argued that facts are being mixed with sentiments. NMA's Secretary-General, Dr. Kayode Akinlade, said: "People should not pretend as if healthcare is a Nigeria phenomenon. It is an international endeavour. We can not come to Nigeria and practice what is not practised anywhere else in the world. Everywhere in the world, it is a common practice that doctors are the heads of hospital facilities. The reason is quite obvious, their training involves every aspect of healthcare."
He continued: "Imagine a pharmacist as chief medical director of a hospital or a doctor as managing director of a pharmaceutical industry! It is very odd. So, we should not talk as if medicine has a Nigerian variant. In countries where they have tried what they have suggested, they failed and are going back to what we have now. In the National Hospital Abuja where they brought some administrators from Britain, they messed up the whole place and they have been sacked by government."
The problem, according to Akinlade, is that the government has not been doing well in the appointment of chief medical directors. "We have pointed it out to the Minister of Health. When you appoint the right people, they do well. Take the beautiful work Prof. Rogers Makanjuola did at the Obafemi Awolowo University Teaching Hospital, when he was the chief medical director (CMD)."
The NMA scribe stressed that the government had not been following the law setting up teaching hospitals, which stipulates that a medical doctor with considerable administrative experience should be appointed to the office.
But Prof. Makanjuola does not seem to share the sentiments of his professional colleagues. At the conference of doctors last week in Osogbo, Osun State, Makanjuola who is now vice chancellor of the Obafemi Awolowo University, Ile-Ife, confessed that doctors had not performed well in the administration of hospitals and advised that they concentrate on how to improve their skills.
He said: "We have not done well as we should. If we want to continue as chief medical directors, we need to ensure that we have the knowledge and the skills to allow us do the job efficiently.
"When I was CMD, I realised that there were some knowledge and skills that I did not have. It was only when I went on training that I really understood that there were aspects to our skills that we do not have, which we need to have in healthcare administration," he added.
Akintayo advised the government to strengthen the skills of health administrators in the country by enacting a law that will set standards to be fulfilled to be recognised as health administrators.
