NSP Takes Clear Position On The Bill For An Act To Amend The University Teaching Hospital Act Cap U15 LFN 2004

The attention of the Nigeria Society of Physiotherapy (NSP) has been drawn to separate press releases by the Medical and Dental Consultants Association of Nigeria (MDCAN) dated 29th June 2022 and Association of Provosts of College Of Medicine (APCOM) dated 22nd of June 2022, respectively, in which they called for the rejection of the Bill titled “University Teaching Hospital (Reconstitution of Boards, etc) Act (Amendment) Bill, 2020 sponsored by Honourable Bamidele Salaam representing Ede North / Ede South / Egbedore / Ejigbo Federal Constituency of Osun State.

The bill amongst other things, seeks to: (1) change the nomenclature of the Head of Tertiary Health Institutions in Nigeria from Chief Medical Director (2) redefine the qualification of the Head of Tertiary Hospitals (3) provide a definite tenure of office for the Head of Tertiary Hospitals (4) include students of the Health Sciences in training programmes of Tertiary Hospitals (5) include hospitalsestablished post-enactment of the legal framework in the schedule and for other related matters (6) restructure the composition of the Governing Boards of the Federal Government Tertiary Hospitals.

In their press releases, MDCAN and APCOM tried to intimidate the sponsor of the Bill, black-mailed other healthcare professionals, tried to shift the blame and result of their administrative incompetencies on the government and misinform the generality of the citizens.

APCOM claims that they have not only been thoroughly trained in Medicine & Surgery but also in Pharmacy, Nursing, LaboratoryScience, Physiotherapy etcetera. We find it amusing that they missed out on so many other specialties such as Engineering, Law and Aviation. It's not only laughable but equally an unintelligent assumption from an organization that is meant to be a body of intellectuals, who are at the helm of affairs of our Colleges of Medicine.

Physiotherapy is a dynamic health care profession concerned with human function & movement, maximizing quality of life and movement potential within the spheres of promotion, prevention, prehabilitation, habilitation & rehabilitation. It's a very broad profession with multiple subspecialties such as Neurorehabilitation, Paediatrics, Cardiorespiratory, Oncology and Palliative Care, Trauma and Orthopaedics, Ergonomics and Industrial Physiotherapy, Sports Physiotherapy, Physiotherapy in Women's Health, to mention a few. In the current Nigerian education system, to obtain a baccalaureate degree in Physiotherapy, a minimum of 5 years is required with a mandatory one year internship programme. 

Recently, the National University Commission (NUC) has approved the commencement of the Doctor of Physiotherapy programme in tandem with the global guidelines of the least qualification for a Physiotherapist by the World Physiotherapy Organization. In light of all the above, it is improbable and mendacious of APCOM to state that they have been 'thoroughly trained in Physiotherapy'. If they go by doing a 2 hour summative posting in Physiotherapy as making them super qualified, it's only fair for Physiotherapists to claim same as we do postings in Medicine and Surgery such as in Obstetrics and Gynaecology, etc. It is important for them to know that we can also use their baseless and mundane justification to our advantage!

The Nigeria Society of Physiotherapy (NSP), the umbrella body of all Physiotherapists registered in Nigeria, would have written off the MDCAN and APCOM positions as mere vituperations from a set of arrogant, self-centered and self-seeking professional bodies, however, for the benefit of the general public and posterity, we need to set the record straight once and for all. By their press releases, these affiliates of the Nigerian Medical Association (NMA) are not in any way interested in addressing the many grievous health challenges of the Nigerian citizens but rather, they are solely interested and particular about how to continue to control and occupy ALL healthcare leadership positions in Nigeria. These, they have successfully achieved through propaganda, blackmail, lies, use of uncouth language, unwarranted attack and victimization of other healthcare professionals without commensurate evidence of positive outcomes of their control of all healthcare leadership positions in the country in the past 3 decades.

As the bill passed the second reading in the House of Representatives and was scheduled for Public Hearing, MDCAN, APCOM, and other affiliates of NMA embarked on an aggressive social media campaign to disparage the House of Representatives with a view to prevent the Bill from being listed for further legislative actions. As their usualtactic, MDCAN and APCOM have resorted to blackmail and intimidation of Hon. Bamidele Salaam, the sponsor of the Bill in a futile effort to truncate the Bill without following due process. APCOM in a spiteful and virulent manner referred to Hon. Bamidele Salaam as a lawyer “who may not be conversant with the details and tenets of the administration of the model of health facilities and particularly Tertiary Healthcare facilities”. For carrying out his legislative and constitutional duties, APCOM maligned the Honorable Representative and other healthcare professionals by alleging that Hon. Salaam “might have been briefed by some groups within the health sector who are perpetually and perennially bent on unsettling the health sector for personal aggrandizement".

NSP is of the view that MDCAN, APCOM and other affiliates of NMA whose members are all Medical Doctors need to be educated and enlightened that Hon. Bamidele Salaam is a citizen of Nigeria who might have been affected by and suffered from the effect of malfunctioning of Nigerian Hospitals. This is the negative outcomeof the leadership brazenly conferred on Medical Doctors  by one of her members, the late Prof. Olikoye Ransome Kuti, who as the then Minister of Health facilitated the promulgation of Decree 10 of 1985 without passing same through the office of the Head Civil Service of the Federation (OHCSF) or Federal Civil Service Commission (FCSC). Hon. Salaam besides being a legal practitioner is an Honourable member of the National Assembly who as a federal legislator is legally and constitutionally empowered by virtue of section 58 and 59 of the 1999 constitution of Nigeria  (as amended) to sponsor a Bill in the House of Representatives without fear or favour. Therefore, the decision of Hon. Bamidele Salaam to sponsor the amendment Bill is a good decision, in the right direction and in the best interest of Nigerians. The provisions of the Decree 10 of 1985 now ACT CAP U15 LFN 2004 set the pace for the nose-diving of the Nigerian health sector to the extent that Nigeria’s healthcare system is now ranked 163rd out of 191 countries.

It is on this note that the members of the Nigeria Society of Physiotherapy are saying loud and clear that the game is over for the members of MDCAN, APCOM and other affiliate members of NMA. Their past antics of intimidation, deceit, and bullying of other healthcare professionals and government officials into submission will not be tolerated this time around! Only a government and professional bodies that are not interested in changing the current pitiable state of the Nigerian health system for good would attempt to truncate the ongoing efforts to amend the University Teaching Hospital (Reconstitution of Boards, etc) Act U15 LFN 2004 as proposed.

It is common knowledge that the positions of the Minister of Health, Minister of State for Health, Chairman Senate Committee on Health, Chairman House of Representatives Committee on Health, the 36 state Commissioners for Health, the Chief Medical Directors and office of Chairman Medical Advisory Committee of all Teaching Hospitals in Nigeria, the illegal positions of Deputy Chairman Medical Advisory Committee of all Teaching Hospitals in Nigeria, Provost of Colleges of Medicine in Nigeria, 8 out of all board members of all Federal Teaching Hospital Boards and many other health statutory bodies and agencies like NHIS, NCDC, NPHCDA, etc. are all being occupied by Medical Doctors, yet the Nigerian health sector has taken a downward turn since 1985.

In the 1960s and 1970s when the Health Administrators were in charge of leadership of the Nigerian Health Sector, many foreigners including the Saudi Royal Family used to visit the University College Hospital (UCH), Ibadan for their healthcare needs. However, since 1985, when the position of the Chief Executive of Federal Health Institutions (FHIs) became monopolized by medical doctors, by unilaterally interpreting the term “Medically Qualified” in Decree 10 of 1985 to refer to holders of MBBS or BDS degree certificates only, the reverse became the case. Their leadership of FHIs and other health parastatals have been very unfair, unjust, selfish and parochial to say the least. They are selfishly adamant in not allowing major reforms of the Nigerian health sector even after it has become apparent to various governments that it was an error to have put the leadership of the Nigerian Federal Health Institutions in the hands ofMedical Doctors instead of Health Administrators who have verified qualifications in health management .

It is rather unfortunate that instead of the current leadership of the Nigerian Healthcare Industry led by members of NMA to acknowledge and accept the failure of their leadership style, which has almost resulted in the total collapse of the Nigerian healthcaresector despite huge allocation of funds by various governments on anannual basis, they keep re-echoing “Global Best Practice” but only in disguise as, they only pay lip service to international best practices. For instance, Jean-Yves Duclo, an economist and politician is currently serving as the Canadian Minister of Health; Xavier Becerra a lawyer and politician also is serving as the United States Secretary of Health and Human Services. It is also noteworthy to mention that Tedros Adhanom Ghebreyesus, the Director General of the World Health Organization is a Biologist, not a Physician. In Nigeria, it is on record that the best Minister of Health we have had since the promulgation of decree 10 of 1985 was Prof. Eyitayo Lambo who was appointed by President Obasanjo. Prof Eyitayo who served as Health Minister from 2003 to 2007 is not a Physician but Health Economist. His tenure witnessed relative peace in the health sector with evident improvement in health infrastructure and indices.

It is duty bound on Nigerian citizens to ask APCOM, MDCAN and other members of NMA to explain how and when the Nigerian Health Sector became FRAIL and DESPERATELY SICK because, APCOM in its memo dated 22nd June 2022 did acknowledge that the Nigerian Health Sector (which is currently under the leadership of members of her national professional association since 1985) is now FRAIL and DESPERATELY Sick. Secondly, NMA should be askedwhy Medical Doctors are vehemently opposed to any attempt(s) to revamp the frail and desperately sick health sector? One thing is sure, the Nigerian health sector became “FRAIL” and “SICK” under the leadership of the Medical Doctors as opposed to the era when Health Administrators were in charge! This in itself is a big irony considering the current trends, modern technological advancements and improved expertise recorded in medicine and health care globally.

At this point, it should be made known that rather than concentrateefforts in their clinical duties, Nigerian Medical Doctors are moreinterested in administrative functions which unfortunately, they havenot been equipped for. Ironically, they have gone ahead to createillegal administrative positions for themselves, like the post of Deputy Chairman, Medical Advisory Committee (DCMAC) which is not found in the Act U15 LFN 2004 or any other extant circular.

The Nigeria Society of Physiotherapy (NSP) is not surprised by the latest antics and spirited efforts of the Medical Doctors to frustrate the easy passage of the well prepared Bill because this is not the first time they would be frustrating genuine efforts to reposition and redress the injustices in the Nigerian health sector, the administrative structures of which was hijacked by them in the 1980s through blackmail, deceit and intimidation.

It should be recalled that a panel headed by the SGF set up by the regime of Gen. Obasanjo (Rtd.) in January 1978, which submitted its report in April 1978 recommended among other things that:

i. There should be a full time Chief Executive who will be responsible to the board of management for the affairs of the Teaching Hospital.

ii. That the Chief Executive should be either medically qualified with relevant administrative experience or not medically qualified but with relevant management experience.

iii. That where the Chief Executive is not medically qualified, the Dean / Provost should in addition to his main duties be responsible for clinical duties.

iv. That the Chief Executive of the hospital should be simply styled “Director”.

However in November 1978, upon consideration of the report, the government decided that the Provosts / Deans of Medical Colleges / Faculties of Medicine in various Universities should serve as Ex-officio Medical Directors / Chief Executives of the Teaching Hospitals. This position was hurriedly legalized through Decree 74 of 1979 which was promulgated 3 days to hand over to the civilian government in 1979.

ORIGIN OF DECREE 10 OF 1985 & HISTORICAL BACKGROUND

In 1983 through 1984, there was a serious industrial crisis in the then Ife University Teaching Hospitals Complex (now OAUTHC, Ile-Ife) which put the then Director of Administration, Mr Akinlawon and the then Ex-officio CMD. Prof. Femi Soyinka at loggerheads. This necessitated the setting up of the Umaru Shehu (a medical doctor) panel to investigate the matter by the Buhari / Idiagbon led military Government. The aftermath of the panel’s report was the promulgation of the University Teaching Hospitals (Reconstitution) of Boards, etc. Decree 10 of 1985 (Cap 463), which created the position of a FULL TIME Chief Executive restricted to ONLY "MEDICALLY QUALIFIED" PERSONS.

It is evident now that the enabling law in the Federal Teaching Hospitals, the Decree 10 of 1985 is a military promulgation and not a product of collective bargaining and dialogue. It accorded a lot of rights and privileges to medical doctors alone in a multi-disciplinary health sector and this has led to incessant strikes and contentions in the sector with deep-seated disharmony among workers and various professional groups.

The medical professionals who were conferred with undue advantages through the promulgation of Decree 10 of 1985 complicated the situation by arrogantly conferring on themselves the power to determine the growth and development of other professions in the health sector irrespective of existing regulatory laws of thoseprofessions.

In 2015, NMA, MDCAN etc. openly antagonized the Nigeria Society of Physiotherapy at the House of Representatives during the Public Hearing of Bill to establish the Nigeria Post-graduate Physiotherapy College (NPPCN) and vehemently opposed the passing of the Bill. In many Nigerian hospitals, Physiotherapists are being denied sponsorships for post-graduate studies under the false assertions by Chief Medical Directors that Physiotherapists do not require post-graduate qualifications to practice.

In 1999, late Prof. Olikoye Ransome Kuti (former Minister of Health) and late Dr Chiori (Director, Hospital Services and Training FMOH) attempted to close down degree courses of some health professions in Nigerian Universities. At a time when the rest of the world was talking of advancement and pursuit of excellence in every aspect of their national health services, these fellows were busy writing to the National Universities Commission  (NUC), urging it to close down degree programmes in Physiotherapy, and other healthcare professions. They claimed it was irrelevant to our health care delivery system.

Quoting from their letter to the NUC, it says “the ministry still supports the sub-degree programme as it’s taught in the Federal School of Radiography, Medical Laboratory Technology and Physiotherapy. A degree programme in these disciplines is irrelevant to our health delivery system. In view of the above, there is presently no justification for B.SC programmes in Radiography and Medical Laboratory Technology and other professions allied to medicine and I have been directed to convey this view to you”.

Thus, at about the same time when the Nigerian healthcare leadership was trying to relegate the Physiotherapy profession from degree programme to sub-degree programme, the United States of America was advancing to Doctor of Physiotherapy (DPT). In 1992, the University of Southern California, USA initiated the first post professional “transitional” DPT programme and this was followed by Creightoh University in 1993 which initiated the first entry-level DPT programme in the USA. It was with great effort that the DPT entry level was approved for Physiotherapy training in Nigeria in 2018 due to the high level of cooperation received from the National Universities Commission (NUC).

The medical doctors demonstrated their arrogance and poorleadership skills when they destroyed the team spirit in Nigeria health sector by using the opportunity of their headship of Federal Teaching Hospitals to pursue selfish and divisive agenda by pushing for introduction of circular 1 of 1991 which approved Medical Salary Scale (MSS) and Medical Super Salary Scale (MSSS) for medical officers and medical consultants respectively without consideration for other healthcare professionals. Their sole aim was to ensure that the take home pay of a House Officer (intern medical officer) was higher than that of a Director of Administration or the most senior officers of other healthcare professions.

The same feat was repeated in September 2009 when Consolidated Medical Salary Structure (CONMESS) circular was issued on 29thSeptember 2009 for Medical Doctors alone without consideration for other healthcare professionals including Physiotherapists. It took the leadership of JOHESU series of meetings, discussions and efforts before the Consolidated Health Salary Structure (CONHESS) was issued for other healthcare professionals on 8th December 2009. Even at that, certain allowances paid to medical doctors on CONMESS are not implemented for other health care professionals on CONHESS. Example of such is the Specialist Allowance.

Also, in 2014, during the era of Prof. Chukwu as the Minister of health, CONMESS was adjusted for Medical Doctors alone without adjusting for CONHESS. In 2018, during the tenure of Prof. Isaac Adewole, the CONMESS adjustment carried out in 2014 was implemented with arrears for Medical Doctors alone in the same healthcare sector whereas till the present moment, nothing has been done for Physiotherapists and other healthcare professionals despite various representations, meetings, and correspondences between leadership of health sector unions and various CMDs, Directors in the FMOH and various Ministers of Health.

It is in order to continue to enjoy the undue advantages conferred on the Medical Doctors to the detriment of all other healthcare professions by the promulgation of University Teaching Hospital (Reconstitution) of Boards, etc.), Decree 10 of 185 now being referred to as University Teaching Hospital (Reconstitution of Boards, etc.) Act CAP U15 LFN 463 of 2004 that the members of NMA and all her affiliates, MDCAN, APCOM, etc. consistentlyoppose and frustrate any attempt by successive governments to address the issue and reposition the Nigerian health sector. The outcomes and recommendations of Nigeria Health Summit 1995, the Inter-agency Job Evaluation Committee of 2008 and the 2010 Presidential Committee on harmonious Work Relationship Amongst Health Workers and Amongst Professionals Groups in the Health Sector in Nigeria have been suppressed by members of NMA and heraffiliates and they currently remain unimplemented owing to the fear of NMA losing their undue privileges and advantages.

CONCLUSION

The present attempt by the House of Representatives to amend the University Teaching Hospitals (Reconstitution of Boards, etc.) Act U15 LFN 2004 is the first bold and major attempt to get things rightin the health sector. This is taking place outside the direct control of the Federal Ministry of Health whose leadership are also direct beneficiaries of the lopsided nature of the Act in its present form. The leadership of the Nigeria Society of Physiotherapy (NSP) is therefore imploring the House of Representatives especially the Committee on Health not to succumb to intimidation or blackmail from any quarters but perform their constitutional functions in a patriotic and unbiased manner.

The Nigeria Society of Physiotherapy is in total support of the Amendment Bill and will continue to pray for the Sponsor of the Bill, Hon. Bamidele Salaam from Osun state, for his act of patriotism and the love for millions of Nigerian citizens whose healthcare needs are being affected through the maladministration occasioned by the provision of the University Teaching Hospitals (Reconstitution of Boards, etc.) Act U15 LFN 2004. We are particularly delighted that this move initiated by the Nigerian Union of Allied Health Professionals (NUAHP) since the late 90s to early 2000s under the erudite leadership of Dr Felix K Faniran, a committed Physiotherapistand Unionist, is finally gaining enormous public interest and those of our decision makers.

It is hoped that with the amendment of the Act and consequent redefining of the qualifications of the Head of Tertiary Hospitals, sanity would finally return to the Nigerian Health Sector so that millions of Nigerian citizens who have lost hope in the Nigerian health sector, including members of the Executive arm of government and the legislature will again start patronizing Nigerian hospitals for their healthcare needs.

It is the prayer of the Nigeria Society of Physiotherapy that God Almighty will give the committee necessary wisdom and guidance to accomplish the task before them. God Bless Nigeria!