Leveraging on his expertise and experience in the apex global and national health systems, former Minister of Health, at a Scientific Conference in Abuja, has called for an urgent end to the disharmony and unhealthy rivalry among the various professional groups in the nation’s health sector.
The age-long issue of inter-professional disharmony in the Nigerian health sector resonated in the ornate Africa Hall of the International Conference Centre, Abuja recently as hundreds of health professionals and other stakeholders assembled for the 55th Annual Scientific Conference and Workshop of the Association of Medical Laboratory Scientists of Nigeria whose theme was “Global Health Security: the Medical Laboratory Agenda for sub-Saharan Africa”. Agenda (GHSA). The aim was to focus on how the lofty goals of GHSA could be advanced through an interconnected network of medical laboratories in both public and private clinical settings that are capacitated to rapidly detect and report disease outbreaks in Nigeria and other sub-Saharan African countries.
Renowned Health Economist and former Minister of Health, Professor Eyitayo Lambo, had accepted the Association’s invitation to be the Chairman of the Opening Session of the Conference and the Guest Speaker at one of the plenary sessions on the topic: “Managing Inter-Professional Disharmony in Nigeria’s Health Sector for Health Security.” Lambo, who superintended over the nation’s health sector for four years of momentous developments, was on familiar terrain. For the four years he was on the saddle, not a single industrial action was witnessed in a sector that had built a reputation for being patently unstable.
Prior to his appointment, debilitating industrial actions by workers were a regular fare in the sector, caused often by issues arising from disharmony and needless unhealthy rivalry among the professionals.
Guided by a robust career as a University teacher, Health Economist with the World Health Organization and the peculiar advantage of not being a health professional who had to coordinate the activities of the various professional groups in the sector, Lambo, with no worries about who might take offence, tackled the subject with clinical detachment and spoke truth to those engaged in what he calls unnecessary “beauty contest” in the health sector as very few could do.
Stressing that the process of providing healthcare was interdisciplinary and requiring many health professionals to work as a team or in teams, Lambo noted that effective team work among health professionals was an essential tool for patient-centred health service delivery system. He observed with regret that disharmony and unhealthy rivalry among professionals in the health sector was an age-long problem in Nigeria that had hitherto not been adequately and effectively dealt with by policy makers and the various governments.
Such disharmony and unhealthy rivalry, he added, had become so pronounced that it had negatively impacted on: the quality and continuity of patient care; the confidence of patients and the general public in the nation’s healthcare delivery system; and even job satisfaction among some of the feuding groups of health professionals. He lamented that the ugly trend had also led to a further weakening of the national health system and poor health outcomes.
Lambo, therefore, called on stakeholders, led by the government, to boldly confront the monster of disharmony and unhealthy rivalry among health professionals, and restore harmony, stop unnecessary conflicts among the various groups of health professionals and promote inter-professional collaboration rather than competition and confrontation. A united health workforce, he noted, was necessary for strengthening the national health system, which in itself is a prerequisite to achieving universal health coverage (UHC) and the goals of the Global Health Security Agenda (GHSA).
He examined the dimensions and drivers of disharmony and unhealthy rivalry among health professionals in Nigeria and identified some of them as the rivalry between the Joint Health Sector Union (JOHESU) and medical doctors/dentists. Issues in contention, he said, include: the supremacy and the alleged arrogance of doctors towards other health professionals; leadership of the health team; and the headship of health agencies and federal tertiary health institutions. Others are the appointment of Health Ministers, the structure of the Federal Ministry of Health/other health institutions, and the appointment of Directors of the Ministry.
The groups, he said also bicker over salary structure and emoluments, especially as it pertains to the adjustment and harmonization of emoluments; special training programmes and expanded roles for allied health workers; the appointment of non-medical professionals as consultants in hospital settings; professional autonomy; membership of Boards of Federal Health Institutions; conditions of service as well as the advocacy for the creation of Office of Surgeon-General.
According to Lambo, the disregard for existing regulatory laws of the health professions, non-implementation and selective implementation of the scheme of service for health sector personnel, non-adherence to job definitions and descriptions and selfishness in the pursuit of health workers’ welfare are also among the alleged causes of bitter disagreements.
The former Health Minister further identified other dimensions of clashes as between pharmacists and doctors, nurses and doctors, medical laboratory scientists and pathologists, radiographers/radiology technicians and radiologists, physiotherapists and doctors as well as optometrists and ophthalmologists.
The needless dishonoring and unhealthy rivalry among the professionals, he said, was a major contributor to the incessant strikes by health workers with serious effects on patients, the health system and health outcomes. For patients, the negative effects he listed included increased deaths and worsening health conditions due to moving patients from one health facility to the other; discharge of patients from public health facilities without completion of care; treatment/recovery delays; prolonged suffering and irreversible damage to health.
The unhealthy rivalry among the professions, according to him, also: promotes inequality in access to quality health care because most of the poor cannot afford to pay for private health care; increases morbidity and mortality, especially among the poor; leads to sub-optimal contribution by the various professional groups to the care of patients; encourages outbound medical tourism by those who can afford it; and contributes to job dissatisfaction and emigration of qualified health workers. The trend, Lambo said, also contributes to: further weakening of the national health system and the nation’s poor health outcomes; and client dissatisfaction with and loss of confidence in the public healthcare delivery system.
To manage and resolve the disharmony and unhealthy rivalry among the health professionals, Lambo urged government to take the need to bring all stakeholders together seriously and adopt an impartial approach in order to effectively resolve most, if not all, of the outstanding causes of the trend. He also enjoined the leaders of the relevant professional groups to come to the table to resolve all outstanding issues with an open mind. In other words, he said, the round table conversation should enjoy the attendance and frank participation of all concerned with a spirit of no-victor-no-vanquished.
Government and other relevant stakeholders, he said, should promote mutual respect and trust among the various professional groups as well as create a mechanism for ensuring adequate involvement of all groups in decision-making concerning the care of patients. They should also make industrial relations mechanisms and collective bargaining more effective and transparent as well as ensure the timely honouring of any collective bargaining agreements.
The former Health Minister further called on government to: adopt a holistic approach in dealing with issues relating to health workers; establish open communication channels for groups of health professionals; review existing legislation concerning Federal Tertiary Health Institutions, taking into consideration the best practices from other countries with better health systems; and vigorously promote inter-professional collaboration in health care.
He itemized the possible benefits of harmony among health professionals and inter-professional collaboration to include the enhancement of patients’ satisfaction with care, enhancement of the co-ordination of health services, improvement of patients’ care and outcomes and the enhancement of patients’ safety.
To health professionals he said, they would reap the benefits of improved job satisfaction, reduced job- related stress, lower staff turnover, maximized utilization of the skills and expertise of health professional, improved understanding of roles and improved coordination among care givers.
Lambo, who said it would be a win-win situation for all, added that health care organizations stand to gain the benefits of improved effectiveness and responsiveness, improved health outcomes, increased capacity to serve a variety of healthcare needs, and reduced medical errors.
Reflecting on his tenure as Health Minister between 2003-2007, Lambo attributed his widely acclaimed success and the industrial peace experienced in the health sector during the period to: the grace and mercy of God; his not being a member of any of the health professions which enabled him to deal with issues dispassionately and impartially without bias in favour or against any group; and his leadership style and skills which encouraged most of the professional groups to work closely with him Other factors were his vision for the sector which was shared by most members of each professional group and the development/implementation of the nation’s first comprehensive health sector reform program to attain the vision. That, he noted, was a major unifying factor.
Other factors that contributed to industrial peace during his tenure were: the maturity exhibited by the leadership of most of the professional groups; the open door policy adopted which encouraged the various groups to approach him for necessary consultations, even at short notice, on any relevant issues; commitment to transparency in the appointment of heads of federal tertiary health institutions; and the strategic support he got from President Olusegun Obasanjo and the Finance Minister to make money available to settle outstanding payments to health workers.
Lambo said there were no “sacred cows” under him when there were known infractions while the leadership of the unions were regularly updated, especially when monies and dues were involved. They were also informed of releases and cash backing as and when due.
He said no personal demands were placed on federal tertiary health institutions and their management by the Minister beyond the line of duty, which he said gave no opportunity for the unions to accuse him of putting pressure on the finances of the institutions, thereby creating conflict.
Lambo also spoke extensively on the appointment of Ministers of Health, which has been a major sore point in the relationship among the various groups in the health sector. As against the popular trend and agitation by some for medical doctors to always be named ministers, he was emphatic that what was required of a Health Minister is not the knowledge of medicine per se, since a Health Minister is not required to perform surgeries or attend to patients in health facilities. Rather, the most pertinent requirements for an ideal Health Minister, according to Lambo, include: a very sound knowledge of the national health system (which has health service delivery as just one of its six major pillars or building blocks); strong management and leadership skills including being visionary and a strategic thinker; ability to make economic and political arguments with the President, Finance Minister and the leadership of National Assembly for financial resources and elicit high level support for health system changes; skills required to effectively engage the Ministries and Departments of Government that oversee the key determinants of health that are beyond Health Ministry’s purview as well as engage with non-state actors which have expertise and vested interests in health, including private providers of health services, special interest groups, advocacy organizations and donors; and ability to ensure the provision of essential health functions directly or indirectly through the agencies and private sector parties.
To support his position that Health Ministers do not necessarily have to be medical doctors, Lambo presented the profiles of the current Health Ministers in 80 of the Member-States of World Health Organization (WHO) of which almost half are non-medical doctors. Among the countries with non-medical persons as Health Ministers currently are the United States, the United Kingdom, Canada, Denmark, Norway, Australia, New Zealand, Israel, Ireland, China and The Netherlands. In Africa, he said Ghana, Zimbabwe, Cameroon, Sierra Leone, Lesotho, Mali and Kenya are among countries that have Health Ministers who are not medical doctors.
The audience gave Lambo rapt attention as he waded through the fairly long presentation and rewarded him with a resounding standing ovation at the end of the engagement, which some of those who made comment on the occasion said was sure to elicit a change of thinking in the nation’s health sector.