Hospital or Morgue?

I will start by telling you two stories from two perspectives: The first incident happened in March 2014, at the time I was in London studying at the London School of Hygiene and Tropical Medicine. It was around midnight when I got a message that my uncle, someone I was quite fond of, had just suffered stroke. He had been rushed to a hospital in Kano, but he was unresponsive. I panicked knowing the state of our hospitals. Fear came over me as I began to play out the worst-case scenarios in my head. When I spoke with my family I was already in tears. I had no hope in the system and I knew it would take a miracle for him to turn around. He passed away two days later. Just like that he was gone. He was only 30. A life cut short, dreams vanished.

I will now take you back to 2013, it was around 7 pm on a Thursday evening, I was on call in a hospital in Kano. A mother had just brought in her son who suffered a seizure. She reported that a motorbike had hit him on his way back from school. He was fine after it happened she said. He was fine and was just lying down when he started jerking. She held him in her arms, as there were no beds available. She held on to him while I examined him or tried to examine him in the hospital corridor. I tried to explain that it is possible he may have had a bleed into his brain so we need to do a brain scan. I proceeded to order the scan and he was wheeled down to the radiology department only for them to return moments later that the room where the CT scanner is, was locked and no one could find the key. I looked over to my left and the blood samples I had taken were still lying in the tray, as the lab will only run them in the morning. The 24-hour side lab was only able to estimate his blood level, that is PCV, which was not of much help. I consulted with my superiors and they advised that I admit him for observation and prescribe some anti-seizure medications. There was neither a bed for observation nor anti-seizure meds available in the pharmacy that night. I had done absolutely nothing I thought, as much as I wanted to help, my hands were tied. It broke my heart. 

These two stories paint a picture of our dire health care system from two different vantage points, the patient/patient-relatives’ and the doctor’s perspective, but whatever side you are on or whatever level you are at, good health care is simply not accessible in Nigeria.

Health Care Budget, Hospitals or Pockets?

One of the big advantages of being back in school for me is it makes me constantly reflect on our own system. Yesterday, we had a lecture by the Assistant Sec. General for Policy Affairs, Supreme Council of Health in Qatar, in Nigerian terms probably the Health Minister. For a country like Qatar where money is no issue, its amazing the amount of planning that they do (at least according to him). The key message of his lecture was, when you want to improve health outcomes, it’s not how much you spend but where you spend it.

This inspired me to look at our health system and how we spend the health budget.

In 2015, the budget for the health sector was N257 Billion, of which recurrent costs were N237 Billion. That’s over 90%. You wonder how we are ever going to get to build more hospitals etc. I am not going to attempt to scrutinize the whole budget but just point at a few things I found quite interesting and thought provoking.

When you look at the break down of which hospital/department gets what, it is striking and you wonder what formula is being used. In health I believe the main aim is to improve health outcomes and should be about directing resources to the areas that need them the most. I doubt anyone can disagree on this point.

So on that note I will quote a few hospitals and the share of budget assigned:

FEDERAL MEDICAL CENTRE JIGAWA STATE	N1.5 Billion
FEDERAL MEDICAL CENTRE NASARAWA STATE	N6.8 Billion
FEDERAL MEDICAL CENTRE BAYELSA STATE	N 2.7 Billion
FEDERAL MEDICAL CENTRE ABAKALIKI	N 9.2 Billion
UNIVERSITY OF NIGERIA TEACHING HOSPITAL, ENUGU	N9.2 Billion
LAGOS UNIVERSITY TEACHING HOSPITAL	N6.5 Billion
UNIVERSITY COLLEGE HOSPITAL IBADAN	N9.7 Billion
ABUBAKAR TAFAWA BALEWA UNIVERSITY TEACHING HOSPITAL BAUCHI	N3.5 Billion

I really do not know what formula the allocation is based on. Looking at this figures it is worth noting that the large majority of these are all spent on recurrent expenditure so it will be important to know the staffing ratios relative to the need in these areas. Otherwise it puzzles me why FMC in Abakiliki should get 3 times the allocation of ATBU teaching hospital Bauchi. I will let you draw your own conclusions.

What I do know however, if the grand aim of the health system is to improve health outcomes across the country, then more resources should be targeted to areas that have a higher burden of diseases and population.

Another thing that really struck me about the health budget was allocation to professional bodies and councils. These bodies, which are in charge of regulating the different professions, get a staggering N2.6Billion for recurrent expenditure. I still can not understand why the federal government should foot their bills.

To illustrate this, I will use the Medical and Dental Council of Nigeria so I won’t be accused of bias. The MDCN got N211million in the 2015 budget. This covered expenses from salaries to cleaning and fumigation. It is all fine and good, but considering this council also generates revenue from annual charges and licensing fees, I really want to ask what do they really do with the money?

The MDCN charges doctors an annual practicing fee of N10000-N30000/doctor depending on the number of years spent practicing. There is an additional development levy of N6000 and N3000 for a code of conduct book. There are over 35000 doctors in Nigeria, with an average of N20, 000 per doctor that is N700Million!
This of course does not take into account  that new doctors that have to pay for registration. Considering the FG has paid the salaries and recurrent costs, what do they do with the money? Are they ever audited?

Most other countries eg UK, Canada, Ireland, these bodies are independent regulatory bodies financed by annual charges from their sector not the FG! I wonder why Nigeria is different!!!

Another joke is National Arbovirus and Vector Research which gets N100million of which N97mil is on personnel cost and N3mil on overhead. Does that mean they don’t do any research then, they just pay salaries?

If MDCN got N211, how many optometrists are there that the Optometrists and Dispensing Opticians Board of Nigeria gets N198mill. So many questions, very few answers!

Health care in Nigeria, what is the way forward?

A few days ago I posted a blog update on APC's plan or lack of it for the health sector. Some people said there were discussions going on behind the scenes. Some said APC did not quite want to reveal their exact implementation plans during the campaign period because PDP might steal their ideas. 

I think the populace deserves to know what candidates' plans are and how they plan to achieve them.

But in moving the conversation forward, I'd like to see the youth who played a vital role in the APC success, bridge into active participation in the planning processes as well as keep the wider public informed. "Behind the scenes" is not acceptable. People should be able to voice their demands and for these demands to be accommodated within the boundaries of feasibility and affordability.

When health in Nigeria comes up, people automatically think Maternal and Infant mortality, immunizations and primary health care. I believe however, the functions of our health system are much wider than these and these impressions are formed from the persistent focus on those areas usually driven by foreign ideologies and funding and they take away from establishing horizontal systems and capacity building.

To illustrate this, if you go to say AKTH with HIV (not in an emergency setting), you probably will have good testing and treatment for free, with doctors attending to you promptly. However if you go to the A+E department, with say Acute Kidney Failure, your tests might be delayed and the service far from free even though it's a worse situation.

While I do agree issues like HIV are important, I believe there is too much focus on it to the detriment of other areas. When I think of the health ministry and how it should work I believe it has so many roles and perhaps it should be broken down like the petroleum ministry is. 

The delivery of our health system is in 3 tiers: Local Govt., State Govt. and Federal Govt. In my opinion, this division is redundant in the way it is practiced now as most financing comes from the Federal Govt allocation but without any reciprocal accountability. In practice is has translated to tiers based on ability of a patient to pay.

Health care finance and accountability are perhaps the most crucial areas if we are ever going to see some measurable changes in the system. The APC in its manifesto said it would increase health care expenditure from N10 000 per person to N50 000. While I agree we definitely need an increase, to borrow their term, we need to ‘diversify’ the source of this health care finance. It has been largely reliant on Federal Govt. allocation aka Oil revenue; we all know where we are with that now.

This is where the NHIS comes in. There have been delays with the implementation of the National Health Insurance Scheme for a long time (bill was first introduced in 1962). This however is one thing I question and wonder if it is the right route to go down, 50 years later.

The NHIS has been stratified into Formal Sector, Informal Sector, Vulnerable Groups and Others.

Firstly this kind of stratification I believe has no place in health care delivery. One should be able to get care irrespective of financial contribution, place in society or disabilities and this should be the basis of a so-called social health insurance system.

Secondly, the formal sector, the least vulnerable group, is the one currently being implemented.  This involves your employer, largely the government now, paying a premium on behalf of the employee. Further creating a gap in access between the rich and the poor (or the employed and unemployed).

I do not have the perfect solution for the health care problems in Nigeria, but I think we need a national and progressive method of health care financing which means the rich should pay a higher proportion of the income than the poor. In the absence of sound tax collection system, perhaps we should think of more innovative ways to tax the population and earmark the funds towards improving health care. A colleague of mine suggested taxation through mobile phones, since it has wide reach. Or perhaps taxation through bank accounts?

To be continued…

Please join the conversation…

Does APC really have a plan for Health?

As some people may know already, I am very passionate about improving health care in Nigeria. I believe a huge part of the problem we have is lack of structures and planning. A government comes in to power and their idea of improving healthcare might be renovating some hospitals or building more substandard skeletal structures without the required equipment or training of personnel.

I also believe there is a great deal of underestimation of the the dire state of our healthcare by most Nigerians. A lot may not name healthcare in the top 5 priorities. I can argue that it is second to security but then I am a bit biased.

I am currently doing a Masters in Health Policy because I believe health professionals need to take an active role in bridging between politics and health. We need to be on the table when plans are made not just be at the tail end to criticize. Today we had a lecture by Prof. Gabriel Scally, the health policy advisor to the UK Labour Party. It was very eye opening. He stressed on the need for active involvement in shaping the agenda by health professionals. I was in awe about the detail of thought processes and planning that goes on in the UK politics.

So now back home, I decided to open the APC manifesto and look at their plan on health. I was a bit disappointed:

• Prioritize the reduction of the infant mortality rate by 2019 to 3%; reduce maternal mortality by more than 70%; reduce HIV/AIDs infection rate by 50% and other infectious diseases by 75%; improve life expectancy by additional 10 years on average through our national healthy living program;
• Increase the number of physicians from 19 per 1000 population to 50 per 1000; increase national health expenditure per person per annum to about N50,000 (from less than N10,000 currently);
• Increase the quality of all federal government owned hospitals to world class standard within five years;
• Invest in cutting edge technology such as telemedicine in all major health centers in the country through active investment and partnership programs with the private sector;
• Provide free ante-natal care for pregnant women, free health care for babies and children up to school going age and for the aged and free treatment for those afflicted with infectious diseases such as tuberculosis and HIV/AIDS;
• Boost the local manufacture of pharmaceuticals and make non adulterated drugs readily available.

Firstly, I am really curious if there are any laid down plans on how to achieve these.

How does the APC government intend to decrease Infant or maternal mortality? Why 3%? Why not 2% or 1%? Are these just arbitrary figures thrown out?

Increase the number of Physicians from 19 to 50/1000? How? Are they planning to import doctors or rapidly train doctors within 4 years?

Although I quite like that they intend to increase expenditure but where will the money come from?

Investing in cutting edge telemedicine? I think we have more immediate concerns. Is there any evidence that telemedicine improves outcomes? And at what cost?

As far as I know there is supposedly already free maternal health care and also free HIV and TB care from international donors, are we duplicating efforts here?

I quite like the idea of locally manufactured drugs. In a Country where regulations are problematic, I am a bit skeptical.

To be honest I am not impressed.

I have not seen concrete plans based on evidence with projected outcomes and economic analyses. This is what we should have not arbitrary numbers.

There has been little or no mention of preventive health care, health care maintenance or the increasingly big killer- non communicable diseases such as hypertension, diabetes and heart disease.

Our focus on increasing doctors may be ill placed, perhaps we need more highly trained nurses, midwives lab personnel and community health workers.

How about primary health care service. There is need to strengthen and unify the fragmented service.

How about collaboration with other ministries, education and water resources, to see how education and provision of clean water can drive down disease burden.

Sanitation, housing conditions and health?

To say they are going to increase the quality of Federal Govt. owned hospitals to world class standard in 5 years is either being ignorant of what world class standard is or being plain delusional.

Please if anyone knows where I can find further information on the health plans by the APC govt, please direct me. 

I think we are have our expectations way too high!r

#BBOG

Bring Back Our Girls Campaign: Protest? 

Let's be honest, are you one of those who looks at the protesters in red and kinda think, 'Oh get over it!', or 'enough of the show', or 'when are they going to give up', or 'this is just politics'? Even for a fraction of seconds, do you sometimes think 'what's the point of the endless protest' or 'do they really think this protest is going to really bring back the girls?'

There are so many variations of silent criticisms, some think, how about the Baga Killings or how about so many other boys and girls/women that were kidnapped? Are these protesters really about a purpose or just because the Chibok Girls were famous and then it became a spiral such that giving up would look somehow.

So many, including myself think like this even if for a fraction of a second. 

And for that fraction of a second, we seized being human, we stopped imagining what if they were our sisters or daughters, we forgot to empathize, we looked at the heroes as the problem. 

Those who have continued to campaign regardless of the motive have kept the hope for the return of the Chibok girls alive. Else they would have been long forgotten, like so many other atrocities that are brushed under the carpet.

As we mark a year since they were abducted, I hope we all stop to think and empathize.

I pray they return to their families.

And to the BBOG campaign, I hope it goes beyond the protest on the streets, to real empathy in the heart and even beyond to see how citizens can work together with the security forces to ensure the safe return of the girls.

May this tragedy come to an end soon.

May the new government mark the end of Boko Haram and all its evil! 

Wife or Doctor, Choose!

How many of you reading would like your daughter to be a doctor?I'm guessing plenty hands are up!

How many would like to be(if girls) or have a doctor as wife? Perhaps less hands now!

How many would prefer your daughter/wife/sister to be examined by a female doctor? All hands?

Now let's examine this hypocrisy! 

Everyone wants the benefits but no one wants to pay the price.

A little chit chat with a friend of mine inspired this post. She is a doctor as well.

See, I'm writing this from the perspective of a young female doctor and pressure of the "northern culture".

While growing up everyone wants you to be a doctor. They even help you grease your elbows right through secondary school and may be first two years of university. Then the support starts waning. Your other age mates are getting married while you are doing boko, your aunties might say. 

Some uncles might then tell you why do you have to wait till you finish before you get married. "Ay aure baya  hana karatu".

Your grandmothers are like "ki fito da miji".

If you're really lucky your parents will still be behind you.

So may be you manage to finish medical school and hopefully you're still within marriageable age despite the strikes and haven't scared all the men, I mean boys, away with your MBBS. "Ay wannan Tsohuwa ce" "Ay ta waye dayawa" etc

But if you cave in and get married while you are medical school, God forbid you have a baby especially during exams, you're on your own! Actually you're in with to the most unserious students in class. You will repeat!

But let's say you manage to graduate and find a good man to marry..

Well you have to be a "good wife" and a doctor. You are also expected to be a mother asap. Anything beyond nine months is suspicious!

So now your life is struggle of trying to find the balance. You have to be on top of your game at work, even if you got 2 hours of sleep because your baby kept you up all night. You have to be a good wife and make your husband nice meals, take care of the house and be there for him all the time. But don't forget about your baby too. You may have to bring the baby into the hospital because nobody does day care. So your baby sits with your underage nanny in the on-call room while you attend to your patients. All within breathing distance of mycobacterium tuberculosis .

Yes! Were you not the one that wanted to be a doctor? Deal with it!

The male doctors look at you with insincere sympathy silently thanking God they have a non-doctor wife waiting at home for them. They will get home to a nicely prepared meal and be fresh for work the next morning.

Some consultants might look at you as some incompetent doctor who can't manage her responsibilities!

Meanwhile your friends who were "smart" enough to marry that Alhaji daddy are flipping channels from E! to Africa Magic sending you eyya smileys on whatsapp. They are thinking their looks and probably "fair skin" is worth more than your guruness now!

But who is fooling who 'actualey'?

You can't have your cake and eat it.

We cannot expect women to be part of a profession that does not in the least bit cater for their needs especially in our society.

Ask about how many female doctors are divorced because they couldn't find the balance.

How many young girls are discouraged from going into Medicine because they actually want to get married and have a life.

Yet everyone craves for these female gynaecologists as if they are dropped down from heaven!

I hope our hospitals and medical council become more responsive to our needs as a society.

Our feminists, where are you when we need you?

I hope those of us that are lucky to have supportive families will work together to improve these working  conditions.

Let's all drop that selfish attitude of "since I suffered, y'all must suffer too". I hope our male counterparts will stand up for us knowing how good they have it.

For what is worth, I might as well add:

#Babanowthaturehere please fix this!

Hero!

Who is your Hero?

Mandela, Martin Luther King, or GEJ?

Hold up what?!!

So as all Nigerians celebrated the grand victory against the looting party along came this brouhaha that GEJ is a hero for conceding defeat. Some even went ahead to nominate him for Nobel Peace Prize.I just can't help but think, this is the root cause of our problems! 

Mediocrity!

Let's give credit to whom and only whom it is due!
We forget so easily how the president planned and connived to sabotage the free and fair elections every step of the way.
How they frustrated the opposition with dirty and callous politics.
Have you forgotten how they tried to disqualify GMB but failed? 
Allegedly took him to ICC
The tasteless documentaries
The divisive politics
The failed certificate saga
The postponement of elections
The sudden new fight against BH just to win back votes
The fight against card reader
Alleged (and likely true) bribery of religious and traditional rulers 
These are all within this peri-election season!
Not to talk of the complete obtundation of our Nation for the past 5 years!
The several corruption scandals, the insecurity, the economy..endless list!

I'm not one for conspiracy theories but the card reader show with Mr. President set the stage for the massive failure of card readers in the SE and SS and subsequent massive rigging.You can step up and say it was not GEJ but who ever it was, they are his allies and he chose to fund and associate with the most corrupt.

So after every attempt to sabotage our rights to the last second failed, all thanks to the leadership of Great Prof. Jega, the only two options left for Mr President was to concede defeat or put our country into turmoil. 
And let us not act like he saved us or he has nothing to lose.
Let's not pretend that there isn't international pressure from the U.S. and the EU for him to allow democracy to reign.
Let's not pretend they were not breathing down his neck.
Let's not pretend Mr President hasn't  seen where former Presidents who interfered with the democratic process and created violence ended up in- ICC.
Let's not pretend he did this solely from the goodness of his heart.(And if you listen to his speech and phone call to GMB, you can see it was obvious, he did not want to do it)

Perhaps you have suddenly developed some form of amnesia or perhaps you have been brainwashed by that NTA advert that you now think that GEJ is in fact Lee Kuan Yew.

(But really if GEJ is the Hero, who is Jega then?)

Rubbishhhhh!
Moving Forward!
Sai Baba!!!

As APC decides..

As APC decides today, I am guarding my heart like SAS with his guards, can't take chances!
It takes me back to 2011 when my hopes were high. I dreamt of a new Nigeria. A dream that quickly crashed and vanished out of existence with the emergence of GEJ as the "winner". We accepted our fate or forced fate and held up 2015 as the light at the end of the tunnel. 

Now that 2015 is right round the corner, I'm closing my eyes -real tight. I'd rather believe there is no light and be surprised than to raise my hopes only to realize, that light was only a mirage.

So as APC decides today, I hope they choose the most credible candidate to go against the incumbent.

People often ask who my candidate is. Well lets say I have 3:

1. Fashola-Kwankwaso

2. Buhari

3. GEJ

Wait wait, I'm no Ribadu! Let me break it down.

Fashola as President and Kwankwaso as Vice President would have been my ideal. I believe these two have the vision to take our country to where it should be. But I have since accepted that this won't happen at least in 2015.

So I then moved to Buhari. He was not my 1st choice mainly because I thought this route has been used one too many times. I think Buhari will give us or at leastqq improve the much needed security in the country and help stamp out corruption which is our cancer that had spread to every sector. Buhari is our chemo!

My last and final candidate is GEJ. This is me being a realist, although quite sad, I'm choosing to be blind and I refuse to imagine there is a light at the end of this never ending tunnel! So Johnathanians, I'm joining the blind-wagon, simply because I believe the greed, selfishness and lack of foresight in Nigerians today is far greater than the desire for change.

Everybody wants change until they get a juicy contract or appointment. Heck it doesn't even have to be them, if one of their relatives get it they are sorted. That's the upper class.

The lower class will be satisfied with a 'mudu' of rice or a sachet of detergent. That's all it takes to buy their vote. Call it illiteracy, call it desperation, I see selfishness. No matter how desperate you are, there is a righteous part of you that will tell you it's not right but you chose to ignore it. It is a choice!

By the time you count out those that were settled with rice or juicy contracts, then there are bigots. Those who can't see past their noses. Those who are incapable of understanding that there exists a world outside their tribe or religion. Sadly these are in the majority.

Then there are those who can't be bothered because they have lost hope.

They won't bother to register talkless of wasting their time to vote, yet they want change. This is also selfishness!

They want others to sacrifice their time and energy to fight for a future they want? Let's be clear, they too don't want change!

Now who do we have left? Very few. Now tell me why GEJ armed with unrelenting desire for power against all odds, impunity, federal reserves at his disposal to soothe any flicker of the so called "change movement", please tell me why he won't "win"- by hook or by crook.

Come 2015 I really want to be surprised. I want to open my eyes and see that there indeed was light at the end of the tunnel!

Zainab who?

Over the last few days, I have seen how people have garnered help for Zainab Aliyu via social media. The story would touch anyone's heart.

But for me, it didn't only touch my heart but it made me angry. Now pop your eyes back.

Yes, I am angry! I am because Zainab couldn't get treatment in Nigeria but had to fly over to Egypt. I don't know her story but I bet even arriving at a diagnosis must have been a challenge in Nigeria perhaps after a series of- you have malaria, no you have typhoid.

I don't want to take away from the feeling of brotherliness and goodness that came with helping Zainab in whatever way you have, but just take a second and think for a minute what if Zainab was an ordinary Nigerian whose parents knew not of Egypt, talkless of taking her there, whose friends own not a phone to tell you all to donate? Who no matter how much you wanted to help, you wouldn't even know about her. These are the things that tick and tear my heart. 

Amidst this call for help, sometimes I just want tell some people to tell their parents to stop stealing so that we don't have to go through this. The height of injustice is having to pay through your nose for healthcare when you are at your weakest. The picture that made my eyes fill up was that of Zainab in her mother's arms. I didn't even dare imagine what she could have been feeling.

A big part of my dream is not only to be a doctor, that's done. My dream now is to be equipped and hopefully one day be in the position to challenge and correct the injustices in our healthcare sector. No matter how big our hearts are we really can't reach everyone with our donations, hence our health system must be addressed so that whether you are Dr Zainab, Ms Zainab(Aliyu) or Zainab from the most remote village, you should be able to get good healthcare.

A very big dream I know..but (Egypt and) other countries are also made of people not aliens!

On that note, a sincere and heartfelt prayer for Zainab for quick recovery and strength for her family and friends! May God help us all.

My responses to NMA's demands

It appears people think I am pro NMA. For anyone that has noticed all my comments have focused on a few particular demands which I agree with and I did not comment on others which either I don't agree with or in fact don't fully understand.

So my responses to the demands of the NMA From The FG:

That the post of Deputy Chairman Medical Advisory Committee (DCMAC) has been circularized and operational. Rather than abolish it, the NMA hereby demands that four (4) DCMACs for teaching hospitals and three (3) for the Federal Medical Centres be appointed forthwith to assist the CMACs whose statutory responsibilities are too heavy for any single individual to handle. Directors in other government agencies are supported by several Deputy Directors, why not the CMAC who is also a Director? Such a DCMAC must have same qualifications as the CMAC.

I don't agree with the above, mostly because I don't believe Nigerians work to their full potential, instead of creating more offices and more bottle necks, if everyone worked efficiently, we won't need additional offices that come with additional costs to the federation.

The NMA is opposed to the appointment of Directors in the Hospitals. This position distorts the chain of command in the hospital, induces anarchy and exposes the patient to conflicting treatment and management directives with attendant negative consequences.

I do agree with this in line with my above reason however.

The NMA demands that grade level 12 (CONMESS 2) in the health sector MUST be SKIPPED for medical doctors. Consequently no medical/dental practitioners should be on that grade level anymore.

All this CONMESS, CONTISS and CONHESS business in my opinion is evidence of the rivalry instead of partnership that should exist in the sector.

If it is agreed that doctors should enter the civil service at a higher level to compensate for the longer years spent in school, then making the others skip a level only goes against the 1st point.

Why are we even skipping levels? Why can't it be uniform and house officers are just admitted one level higher than other graduates? It doesn't seem that complicated to me.

The title “Consultant” in a hospital setting describes the relationship between the Specialist Medical Doctor and his patient. It will be a source of confusion if the title is applied to any other health worker who statutorily does not own patient. NMA therefore declares with unmitigated emphasis that if “non-doctor consultants” are appointed, it will lead to chaos and anarchy in the health sector. This should not happen.

While I do agree that the title should be reserved for doctors I do have different reasons.

I don't necessarily believe it's because doctors own the patient.

And I have gone through this in more detail in my previous posts.

http://amahzeeing.blogspot.com/2014/07/equity-or-equality.html

Relativity in health sector is sacrosanct. The NMA hereby demands for immediate implementation of the January 3rd, 2014 circular. The NMA also demands the immediate payment of the arrears of the corrected relativity for 22 years during which her members were short changed.

Much as we are not against salary increase for any category of workers, either in health or elsewhere, the NMA demands for immediate adjustment of the doctors’ salary to maintain the relativity as agreed and documented once CONHESS is adjusted.

The sad truth:

A lot of doctors in Nigeria today go into medicine because of the prestige and monetary value attached to it. This goes to attract the top of the class to medicine.

In order to maintain having the top go into medicine, we probably need to maintain this prestige attached to the profession.

On the other hand one can also argue that may be this is why we have doctors who are not so compassionate and passionate about their job if they are only in it for the money.

So my position is, as long as everyone is paid what they deserve I don't have a problem if it's relative or not.

That Government should expedite the passage of the National Health Bill (NHB), and extend Universal Health Coverage to cover 100per cent of Nigerians and not 30per cent as currently prescribed by National Health Insurance Scheme (NHIS).

I believe in Universal health coverage. I think that's all I need to say. 

Surgeon General of the Federation MUST be appointed with immediate effect.

I am really not pro creation of more posts and duplication of other roles, and I am yet to be convinced what unique role a Surgeon General will play.

The entry point of the House Officer should be corrected to CONMESS 1 step 4 as originally contained in MSS/MSSS while the Registrar/Medical Officer is moved to CONMESS 3 step 3.

Again as above with skipping and non skipping.

Clinical duty allowance for Honorary Consultants should be increased by 90% of CONMESS

I need to be educated on the role of honorary consultants, I thought they are basically doctors who stay in the academic field, why then should they be getting clinical duty allowance. My comments will wait till I know what they actually do.

Adjust the specialist allowance as contained in the 2009 collective bargaining agreement. Additionally, ALL doctors on CONMESS 3 and above MUST be paid specialist allowance or its equivalent that is not less than 50% higher than what is paid to other health workers.

When I was an intern, there was a cleaner in the hospital that earned way more than I did. Why should ones salary depend on another?

Abeg Abeg!

Hazard allowance MUST be at least N100, 000 per month for Medical Doctors.

How did they arrive at 100,000? So next year there will be another strike so we can make it 200,000 and so on?

Doesn't the higher salary for doctors compensate for the hazard. Nigerians like to create allowances where stealing may not work.

Immediate release of the circular on rural posting, teaching and other allowances which MUST include house officers.

I wish I knew what the circular was about.

Immediate withdrawal of the CBN circular authorizing the Medical Laboratory Science Council of Nigeria (MLSCN) to approve licenses for the importation of In-Vitro Diagnostics (IVDs).

Again this is another point where my knowledge on the issue is limited.

Should NMA have the final word on the importation if in-vitro diagnostics? 

What are the real issues, for anyone that knows more than I do.

Immediate Release of Circular on retirement age for Medical Doctors as agreed with the Federal Government (FG)

I agree with retirement age of 65 mostly because I have worked with doctors past 65 years and I believe they still have a lot to offer up to that age. I believe Judges have the same extended retirement age in Nigeria. We shouldn't be quick to dispense of such experience.

The Federal Government through the Federal Ministry of Health should formalise and implement the report of the interagency committee on residency training as well as release the uniform template on appointment of Resident Doctors in line with earlier agreements. Moreover, a concrete Funding framework for residency training must be established. The Overseas clinical attachment must be fully restored and properly funded in the interest of the nation.

NMA's demands about money are tiring me already. From my little knowledge I believe this is about getting allowances for courses/exams. While I do agree with this, I hope it's not limited to just doctors.

That in the interest of harmony in Federal Medical Centre, Owerri the government should pay the salaries of our members in the centre as agreed on 21st October, 2013.

Sure. Why not?

Immediate concrete steps must be put in place for the reintegration of our members back into the IPPIS platform.

Is my memory failing me? Or did NMA fight against IPPIS initially? 

All attempts to coerce house officers not to join NARD must stop.

I see no reason why house officers should not be part of NARD, they are all doctors in training afterall.

The orchestrated intimidation, harassment and physical assault of our members in departments of Pathology (Laboratory Medicine) by Laboratory Scientists which is being tolerated by the Federal Ministry of Health (FMOH) must stop.

Agreed.

The Endless circle of incomplete salary payment to our members in many hospitals in the name of shortfalls in personnel cost must stop.

This is a problem not unique to doctors and one that Nigerians must fight for. It's a new form of stealing with numbers. If one person is paid say N100 less, it may not mean much but by the time you add what that means for a 100,000 workers, you will see it's major stealing.

I have heard people complain about this, not just doctors.

Universal applicability of all establishment circulars on the remuneration and conditions of service for doctors at all levels of Government must be guaranteed.

Government should as a matter of urgency set up a health trust fund that will enhance the upgrading of all hospitals in Nigeria.

So we can have more directors in charge of more stealing?

 Duplication.

The reason our hospitals are dilapidated is not because we do not have a health trust fund, we should fight for a trust-worthy health ministry.

The position of Chief Medical Director/Medical Director must continue to be occupied by a Medical Doctor as contained in the Act establishing the tertiary Hospitals. This position remains sacrosanct and untouchable.

Why did they not ask that the post of Vice Chancellor be open to everyone in the University since ASUU and SANU are made up of graduates.

Can you be a judge of the high court or court of appeal if you are not a lawyer?

Why do they think the hospitaals where lives are saved everyday should sacrifice the established leadership I.e Chief Medical Director?

I have addressed these issues previously. While I do agree, I have my reasons which I have over flogged already.

http://amahzeeing.blogspot.com/2014/07/doctor-dr-or-dr-who-cares.html

My note is that they should get someone to draft their demands better next time.

It sounds like a cat fight. Rather than demanding, they should produce facts to back them up.

Phrases like "sacrosanct and untouchable" are just asking for it to be touched.

I probably agree with 3-4 points on NMA's demands.

And to be frank, a lot are about saving their pockets not saving health care delivery.

We hereby appeal to all Nigerians for their understanding and to press on Government to meet with our demands to avoid the STRIKE which is scheduled to start on the 1st of July 2014 from 00.10 hours GMT.

My feeling towards strike action in hospitals is and has always being:

"We took an oath before we signed a contract"

Strike seems to be the 1st point of call in Nigeria even though we are told negotiations have failed.

It is unfortunate that both the government and the NMA/JOHESU allow things to degenerate to a strike level.