The struggle to be accepted as most important profession in health care; struggle for leadership posts in the health care

system, and parity in remuneration.

This is the goal of every person who works in the hospital not doctors. The health sector revolves around the doctor. Its a question of qualification and function. Decree 10 is not the law that vests such a function on the doctor. Health care is universal and this is the situation worldwide. The central person in the health system is the patient. The patients come to see the doctor not any other health professional. The responsibility for patient management and care rests with the doctor. It is the doctor who necessarily coordinates and coordinates patient care. Doctors make a clinical diagnosis and take the decision about route and type of care patient requires. The doctor decides the treatment plan. The doctor decides whether the patient requires nursing care, decides on whether he requires admission, decides on whether he requires laboratory test, decides whether he requires drugs, Whether he needs to be seen by any other doctor. The buck stops with the doctor. The fact that other professionals are sometimes consulted does not alter this fact. Liability for patient care rest with the doctor

What the committee now suggests is that this should change. This is reinventing the wheel as it regards health care worldwide. What we require if the committee report stands is to remove professional liability for patient care also from the doctor. This should be backed by an enabling Nigerian law which will be unique in the annals of medical practice. It will be analogous to ceding the practice of law to the administrative workers or paralegal staffers. The paralegal will take responsibility for administration of legal practice. In the same wise the technicians in an engineering organization should be placed on functional and practice parity with the engineers. The same committee members including the chairman come to the hospital to see doctors not any other medical support staff now called professionals. They travel abroad to see doctors not nurses or lab scientist or physiotherapist. The attitude of the other workers has no basis, else how will you explain why they only seek the doctors out in the hospital to treat their ailment while trying to diminish that position. No child born in Nigeria today or in any other part of the world is encouraged to go into other professions in the medical field over and above medicine. Decree 10: The reason why this continues to generate controversy is explained by the way doctors have

behaved and used the position of chief medical director The vice chancellor of the university is a position uniquely reserved for lecturers. Doctors if truth be told apart from a few have not done justice to the position. We have not added value to this position. The question is why? The vice chancellor selection process rests with ASUU. They handle all aspects of selection and screening of candidates. Final selection of candidates is by council (dominated by lecturers). Doctors were once given this unique role ironically by a non doctor. It was however a doctor as minister who stripped doctors of this role. Reinstatement of this role by doctors is urgently needed. Qualifications for the position of the vice chancellor and the roles (administrative and academic) he performs makes the position a position only a lecturer can occupy. The medical director of the hospitals performs only administrative roles with no academic fuction. The administrative role of even the vice chancellor can be performed by any one. It is the academic role that allows the position to be the exclusive preserve of lecturers. Postgraduate training and other training programs of the hospitals need to be reorganized to allow the medical directors be the academic head of a training institution just like the vice chancellor. Only a doctor for example can understand postgraduate medical education.

The administrative structure has to be designed in such a way that only doctors just like lecturers can aspire for the position of medical director In the university the vice chancellor has as lieutenants two deputy vice chancellors, and the provost of colleges and administrators of campuses. The deputy vice chancellors with respect to function and importance are in no way comparable to the chairman medical advisory committee. The manner of their selection and function defines the position. Even when the chairman medical advisory committees are elected they are easily sidelined by the medical directors if he desires. The function of the deputy vice chancellors makes this impossible within the university. The provost being an elected position is unique and acts as an independent voice. Top Management of the university consist of the the vice chancellor, the 2 deputy deputy vice chancellors, provosts of colleges, the deans, and directors. (All the deans are elected meaning they are independent). The only other members of management of the university who are not lecturers include the bursar, registrar and librarian. The top management of the university is staffed with lecturers who dictate the direction their industry take. This is not the case in the hospital The administrative structure of the hospital creates dictatorial and bad CMDs. The top management of

the hospital is made up of the medical director, the chairman medical advisory committee the director of administration and sometimes the deputy chairman medical advisory committee. Other members include the director of finance, the director of audit, director of nursing. Composition varies from hospital to hospital reflecting the ambiguity of the decree. The chairman medical advisory committee is in experience from all the hospital an appendage of the chief medical director ditto for the deputy chairman medical advisory committee. This means that only one voice exist for doctors in the top management committee (that of the chief medical director). This translates to no voice at all as the views of the medical director may not always tally with that of the doctors. In the same way as the voice of the vice chancellor does not always tally with that of lecturers.\ There is a provision in the civil service regulation for a senior staff committee for all ministries and extra ministerial departments. The committee is responsible for appointments/recruitments, promotions and discipline of senior staff. The committee should comprise all the directors in the ministries and extra ministerial department. The interpretation of this means that every consultant on level 17(CONMESS7) and other workers in the hospital who are on this level are automatic members. Implementation of this provision of the

civil service rule will go a long way in addressing marginalization of doctors and indeed other workers of the hospital. No hospital to date has implemented this provision of the civil service rule. All important position in the university is headed by lecturers. Admission, appointments promotions, pensions, etc to mention a few,. (Indeed all appointive positions). This is sadly not the case in the hospital. The provost, deans directors and heads of departments in the university in terms of structure and function have no parallel in the hospital. They handle all appointments promotions and disciplinary procedures within their colleges, faculties and departments. Criteria for appointments, recruitments of staffers including clinical staffers, promotions are handled within the hospital by an ubiquitous administration. This is equivalent to leaving the appointments, promotions of lecturers in the university to the registrar. Decisions about such are the exclusive preserve of lecturers. Potential directorates within the clinical department abound, director of postgraduate training, director for NHIS, director infectious diseases, director of maternal fetal medicine, director infertility and endocrinology, director palliative care committee. Director pensions, SERVICOM. Indeed all the

committees of the hospitals are potential directorates that can be manned by doctors. Inclusion of these directors in the top management committee will strengthen the administration of the hospital. The senate of the university has no equivalent in the hospital . The senate is a unique forum that has served to stabilize the polity within the university. The need for the creation of a forum like the senate needs to be urgently addressed. The hospital can borrow from the university. The issue of membership of the board of management needs to be addressed. The NMA representative on the board in many cases represents HIMSELF AND FAMILY rather than NMA. Else how can you explain the actions of many of the NMA representative? The manner of their selection does not help anyone. The provision of decree 10 talks about selecting a doctor who is not a staff of the affiliate university. This implies that all hospital consultants who are not primarily employed by the university should serve as the NMA representatives on their boards. University council is populated by lecturers who are members of staff. They are nominated by senate and congregation (another unique university creation). Lecturers in council act as the eyes and ears of the lecturers at the highest level. While we work towards having a more representative board, we can in the interim

address the issue of appropriate representation in line with the provision of decree 10. Lets exploit the breather offered by the existing rules. I believe if we restructure the hospital along the lines above. We will restore sanity to the health sector. Let us stop being apologetic about what we are. In secondary schools the top performers get admitted in to medicine. Persons who go into other paramedical professions do so only when they fail to get admission into medicine. The medical school has no age limit for admission if they feel they can be doctors. You cannot be a doctor through the back door. A laboratory technician is not a qualified laboratory scientist. A chemist is not a pharmacist. Let us not reinvent the wheel. I have deliberately not addressed other issues raised as the suggestions are so ridiculous and silly. NMA I trust will be in the best position to expose those positions for what they are: being a doctor by other means Thank you Dr Yerumoh. Warm regards to family. Please keep up the good work

Dr Joseph Eigbefoh Consultant Obstetrician/Gynaecologist