NSP response to NMA article

TO
The Minister of Labour and Employment 
Federal Secretariat 
Abuja, FCT.

Honorable Minister Sir,

RE: AN URGENT CALL FOR AN INTERVENTION TO REDRESS ABERRATIONS IN HEALTH SERVICE IN NIGERIA (AN ARTICLE BY NMA)

The Nigeria Society of Physiotherapy (NSP) wishes to call your attention to the falsehood being propagated by the Nigeria Medical Association (NMA) against the agreements reached between the Joint Health Sector Unions/Assembly of Health care Professionals (JOHESU/AHPA) and Federal Government. The NSP will also use this opportunity to refute the false claim and misinformation propagated against the Physiotherapy profession by NMA. 

ADJUSTED CONHESS AS IT WAS DONE FOR NMA:-The NMA leadership is highly misinformed for rejecting an agreement between JOHESU and the FG on this and other issues because they are not our employers. Secondly their agreement with government is not binding on us. It must be pointed out that they have no right under the Nigerian laws to reject an agreement freely entered into by FG/JOHESU. Furthermore, the CONHESS and CONMESS were two similar salaries approved by FG in 2009.The NMA rejoiced when FG approved CONMESS despite our objection to it. We warned government of the negative consequences of multiple salary structures in the sector as it happened under Prof Olukoye Ransome Kuti as Minister of Health. So whatever happens to either of the salaries in future must be applied to the other, hence, when CONMESS was adjusted for NMA in 2014, we did not object, instead we made a convincing case to FG which yielded a signed agreement in March 2014. We urge the current administration to approve it and pay all arrears with effect from 1st Jan 2014.
It is very pertinent to put the record straight that whatever form of relativity that can exist in salary of all health professionals was already determined by entry level. A fresh MBBS graduate post NYSC enters the civil service on CONMESS 3 which is equivalent of GL 12. There is no other professional in health or any other ministry that enters civil service on that level. Other health professionals would have spent minimum of 3 to 9 years in the civil service before they get to the position where an MBBS graduate enters the civil service. What other relativity can be more than what we stated above. A Consultant, immediately after residency training of 4 to 5 years is employed directly on CONMESS 5 which is equivalent of GL 14 for other health professionals, specifically, the level of assistant director, it takes between 12 and 18 years in civil service for all other health professionals to attain this level which a Medical doctor attained in just 7 years. it's worthy of note that outside the health sector GL 14 is equivalent to the position of Commissioner of Police, Senior Lecturer just to mention but a few therefore asking for another form of relativity on this level is unfair to all other professionals in health and other areas in civil service. It should be noted that prior to this dichotomy in salary created by Professor Olukoye Ransome Kuti in 1991, all health professionals including medical doctors enter the civil service on the same level but different steps. Prior to 1991 the relativity was maintained by steps. For NMA to claim that other health professionals earn same salary with them is false because entry level newly employed MBBS graduates is equivalent of GL 12 , while the entry level of newly employed Physiotherapists is equivalent of GL 10 therefore the much talked about relativity was already granted at their entry into civil service; no other health professional goes home with same salary as medical doctors. We would like to say emphatically that we are prepared to resist this injustice and reject double relativity demanded by NMA because relativity has already been determined through the various entry levels. It is even better if we go back to Pre-Olukoye Kuti era when relativity was determined by steps and not GL level; let all health professions start on the same GL level and different steps.

 APPOINTMENT OF OTHER HEALTH PROFESSIONALS AS CONSULTANT/PAYMENT OF SPECIALIST ALLOWANCE:-. We would like to reiterate that consultant exist in all professional fields of practice therefore it is very wrong for NMA to claim that they are the only group of health professionals that can be appointed as consultants in health sector. Dr T A Oshin was the first consultant Physiotherapist appointed in Nigeria by University College Hospital Ibadan in the 70s; It should be noted that FGN had recognised other health professionals as consultants as far back as 1976 so we have consultant Physiotherapists which included late Profs Odia and Nwuga, Dr Oshin and others who were appointed Consultant Physiotherapists. We still have consultant Physiotherapists in many institutions till date so the claim by NMA is false and misleading. Paul Watson was the first consultant Physiotherapist appointed in UK and he was appointed in the year 2002 by UK National Health Service (NHS). K.M Vits 2010 (Journal of the Association of Chartered Physiotherapists in Women’s Health, 106, page 25 – 29), reported that in the year 2000, NHS announced the creation of new role, of the consultant allied health professional which would combine the responsibilities of clinical expert, professional leader, educator and researcher. It was envisaged that the Post-holders would develop clinical protocols and redesign services, and that the role would provide pathways for experienced clinicians to advance their career. By August 2009 according to Vits, the NHS had 64 registered consultant Physiotherapists, 34 consultant Radiographers, Occupational therapists and dietitian had 10 each just to mention but a few. The consultant only depicts an expert in his field and we have consultants from other health professions throughout the world. Consultant Physiotherapist, Dietitian, Radiographer exist in other countries and it doesn't create confusion. It is impossible for anyone to confuse consultant Physiotherapist with consultant Neurologist. These professionals do not perform the same functions but they all render professional services to Patients. The various professionals perform only the services they are licensed to render therefore it is a fallacy to claim that patients will be confused by the word consultant or patients are owned by consultants. Patients come to hospital to get well and they must be seen by all the experts that are required in their management. The NMA members are the only health professionals that enjoy fully sponsored post graduate training by FG of Nigeria, all other health professionals use their hard earned money to get post graduate training within and outside the country in order to deliver quality services in patient care therefore, it will be unfair for NMA to stop government from recognising the knowledge and skills that other health professionals have acquired at their own expense. In 2009, the labour leaders in Health advocated the creation of an allowance called specialist allowance to be paid to hospital based health professionals who possess similar post graduate qualifications as their counterpart in the University who have been enjoying clinical duty allowance since 70s. Therefore the current request is not a new thing altogether but a mere extension of the allowance to clinicians since January 2010. Specialist allowance should be paid to all health professional who have gotten post graduate qualification in his/her field and has attained CONHESS 13 and above.

It is also pertinent to state that Physiotherapy is an independent health profession which makes use of Physical agents like exercise, manipulative therapy, Electrotherapy just to mention but a few as opposed to the use of drug and surgery in the prevention, treatment and rehabilitation of medical and surgical conditions. Physiotherapy has diverse specialised areas which include Orthopaedics and manual therapy, Cardiorespiratory Physiotherapy , Pediatric physiotherapy , Neurophysiotherapy, Community Health Physiotherapy, Women's Health Physiotherapy, Geriatric Physiotherapy etc. All these specialty areas do have known consultant Physiotherapists around the world. It is very wrong for a medical practitioner who is not trained in physiotherapy to claim that he oversees Physiotherapists. Professionals have autonomy in their fields; no professional can claim to know more in a field than those who have spent years in the university to train on the field. However, it is important that health professionals collaborate in order to render quality health care delivery to patients. International best practices on patient care/management emphasises interdisciplinary approach as patient care has gone beyond one professional believing that he can perform the function of other health professionals. Therefore on the claim that Physiotherapy is under Orthopaedic Surgery for supervision, we vehemently deny this and we wish to call on the presidency not to rely on any advise given by NMA on such matter. Physiotherapy is an independent clinical and doctoring profession which is at par with medical practice. 
 
 STAGNATION AND NUMENCLATURE:-It must be noted that NMA accepted that other health professionals should be allowed to reach grade level 17 but not to be designated as director. This does not lie within their powers to do that. JOHESU members have satisfied the requirements of Public Service Rule to be so promoted to GL 17 as Director. 

 APPOINTMENT OF CMDs/MDs OF TERTIARY HOSPITAL IN ACCORDANCE WITH THE EXTANT LAWS:- NMA was wrong again when they stated that NICN had defined Medically qualified person as medical doctors. We challenge them to produce that judgment. The case that went to NICN is yet to be determined. The NICN of Ibadan stated that medical practitioners are qualified to be appointed as CMD instead of defining the term. The case is now before an appeal court in Akure, Ondo state and will be determined soon. An existing judgment on a similar case decided by the Supreme Court in USA defined a medical technician as Medically qualified. American legal institute regards Nurses, Medical technicians etc as Medically qualified. Also the teaching Hospital Act, Nigeria made an indirect reference to and  mentions those referred to as medically qualified  to include: Nurses, Midwives, Medical doctors, and other health professions. It should be noted that the term was used to distinguish between the Health administrators of then UCH house Governor/CEO in our teaching hospitals before they were replaced by Medically qualified person of which medical practitioners were the first to benefit. The post was actually fought for by a conglomeration of health professionals at OAUTHC, Ile Ife in 1984 led by a Nurse, Mrs Ilesanmi.  As soon as medical doctors took up the post, it became monopolised through the misinterpretation of the teaching Hospital act of 1985 implemented during the time of Prof Olukoye Ransome Kuti between 1985 to 1993. Now is the time to bring about a positive change as applicable in other developed nations of the world. The Yayale Ahmed  and Abdullahi Bello Gusau committees supported this position.

CONCLUSION 

Honorable Minister Sir, the Nigeria Society of Physiotherapy (NSP) reiterate our commitment and support to the Federal Government of Nigeria and we are always ready to partner with the government in order to take the health sector in Nigeria to higher level where we would be able to compete favourably with the successful health systems in other parts of the world.

Accept the warm regards from NSP NEC 

Thank you Your Excellency

Signed
Dr Rufai Yusuf Ahmad -President NSP 

Dr Oyinlola F Odusanya PT- National General  Secretary NSP 

Cc
President of Senate, Federal Republic of Nigeria 
Speaker, House of Representatives, Federal Republic of Nigeria 
Secretary to Government of the Federation 
Chairman, Senate Committee on Health 
Chairman, House Committee on Health Institutions
Honorable Minister of Health 
Honorable Minister of State for Health
Office of the head of the civil service of the federation
Chairman, National Salaries Income and Wages Commission 
Permanent Secretary, FMOH
Head, Department of Hospital Services, FMOH
DG, Budget Office of Federation (BOF)
DG, Department of State Security Service