JOHESU Response To NMA ‘Time To Caution Press Statetment

The attention of JOHESU has been drawn to vituperations directed against it by the loose canons who are in representative capacity at the hitherto vibrant and responsible platform called the Nigeria Medical Association (NMA).

Typical of the contemporary leadership of the NMA that we have encountered in recent years, the intellectual dwarfs who authenticated the unfortunate NMA position dwelt extensively on propaganda, threats, blackmail and other acts of skulduggery.

After our usual critical appraisal of all issues, JOHESU/AHPA wishes to posit thus on the various issues canvassed by the NMA:

1. JOHESU as a matter of fact is a legitimate conglomerate of 5 REGISTERED Trade Unions in the Health Sector. It is a metamorphosis from our old Joint Action Committees (JAC) with a more refined and structured depth to be truly impactful.

JOHESU has made Collective Bargaining Agreements (CBA) more convenient in terms of logistics for the Federal Government (FG) and State Governments (SG) because those Governments contend with one entity instead of 5.

If the NMA spokespersons were discerning wisely, they would have known that even the courts from the NICN, High Courts, Appeal Courts and the Supreme Court which have powers to interpret the laws have always recognized JOHESU as a juristic template.

This is why it can sue and be sued. It is this stupendous ignoramus that the NMA continues to exhibit that does not allow it to know that as a mere professional body, it should not be allowed to exercise the privilege of negotiating CBAs on behalf of its membership.

The tragedy of this aberration is catalysed by their members who hold sway today at both the Federal Ministry of Health (FMOH) and Federal Ministry of Labour and Productivity (FML&P).

2. The accusation of blackmailing the Senate and in particular Dr. Ibrahim Oloriegbe, the Chairman of Senate Committee on Health remains a figment of the imagination of the NMA hierarchy.

For the records and umpteenth time, we assert boldly and responsibly that Dr. Oloriegbe, who has complained of the tyrannical propensities of a perceived political dynasty until fate and good fortune smiled on him in the 2019 Senatorial Elections when he defeated then incumbent Senate President, Dr. Bukola Saraki has been more tyrannical than any other Medical Doctor Chairman of the Senate Committee on Health.

In the last 22 years of our democracy, at least the following, which include late Senator Martins Yellowne from Rivers West Senatorial District, Dr. Ifeanyi Okowa now Governor of Delta State, Dr. Lanre Tejuosho from Ogun Central Senatorial District have been Chairmen of the Senate Committee on Health. JOHESU/AHPA or any of the other Health professional bodies never accused these Medics of bias at hearings.

Dr. Oloriegbe stretched his misnomer at the Public Hearings he has presided on vis the NHIS Amendment Bill and the February 1, 2021 hearing by recognising his Medical Constituents above and over other stakeholders.

At the Public Hearing of February 1, 2021, JOHESU vividly declares again that Oloriegbe gave MDCN, NMA and a representative of Pathologists the floor three times spanning over fifteen minutes while professions like Pharmacy, Medical Laboratory Science, Nursing, Radiography and JOHESU representative got two minutes each to canvass their positions.

We challenge Oloriegbe and the NMA brigade to produce video and audio evidence contrary to this! The point here is Oloriegbe does not understand the philosophy and basics of running Public Hearings because he pointedly dominates discussions and debates himself while outrightly disenfranchising the stakeholders.

We must make the point that a third hearing (Public Hearing) at the National Assembly (NASS) even recognise Personal Contributions and not only group representation. Attempts to draw Oloriegbe’s attention to these facts have always been met by threats of eviction by the Sergent-at-Arms.

JOHESU therefore insists that the Senate must probe the February 1, 2021 Hearing and reorganize the Senate Committee on Health subsequently to prevent vindictive purposelessness associated with the tendencies of the NMA hierarchy as epitomized by Dr. Oloriegbe.

3. The reference to giving birth to other Health professions by Medicine is very ridiculous. All the health professions evolved from traditional and herbal medicine.

Even if by default we accept the NMA’s claim, it is a matter of fact that the birth process by nature is sequential. One entity therefore must evolve before the other without taking away its rights and privileges like the NMA is noted for in Nigeria.

The grab-grab syndrome and know it all attitude of Nigerian Doctors is what has wrecked our Health System to become the hallmark of negative health indices as well as a wretched 187 out of 191 Health Systems globally.

We therefore have a responsibility as loyal and dynamic citizens to reverse through constructive action especially by embracing global best practices in the Health options in ultimate public interest. JOHESU will continue to uphold this without caring about who’s ox is gored.

4. The NMA leadership in the last few years has continually excelled in clever use of untruth. It attempts to reduce very serious matters through diversionary tactics to the realm of childish harlinquinade when it brands autonomous professions as allied to Medicine. This amounts to grandeur of delusion and outright tomfoolery.

Lying to oneself is much more destructive than lying to others and we therefore encourage those who are still at such debased levels to wake and grow up to new realities in the global environment. In one template NMA says the MDCN Bill is to regulate and control ONLY Medical practitioners and Dentists. In desperation, the true intendment is to violate the domain of Medical Laboratory Sciences and Radiography. This clearly manifests in Section 4(a) which states to wit “the MDCN shall make regulations for the operation and management of Clinical Diagnostic Centres”…

In healthcare practice, who are the health professions who work and manage Clinical Diagnostic Centres which are domiciled in Clinical/Medical Laboratories or X-ray Centres as well as related facilities?

You do not have to be rich in common-sense to appreciate that this is a direct violation of the professional privileges of Medical Laboratory Scientists and Radiographers who hold sway ordinarily in these diagnostic facilities.

The NICN and several High Courts have validated the rights and powers of Medical Laboratory Scientists to take charge of the Medical Laboratory facilities through the instrumentality of the MLSCN Act, but even the FMOH aids its Medical Doctors to violate valid court orders and judgement in this regards.

Presently, the litigations have shifted to the Appellate Court at the instance of Medical Groups who are not satisfied with the plethora of court judgements against them.

We observed with dismay at the February 1, 2021 Public Hearing that when Oloriegbe was reeling out his “decree” on the rules at that hearing, he insisted references must not be made to court processes or judgements.

This is contrary to Order 41 of the Rules of Proceeding of the Senate which empowers the Senate to step down any matter that is pending in a law court when considering any Bill.

In the light of the foregoing, Section 4(9) must be expunged from the MDCN bill in its entirety in conformity with Order 41 of the Senate rules.

5. Medical Doctors are not known to display humility even when they err in Nigeria.

After it was challenged that Doctors cannot carry the title of Apothecary because it is Pharmacists and Pharmacies that are globally Apothecaries, the NMA now says “while we may agree that the title “Apothecary” is not a title used by Doctors….. A sense of integrity should have compelled a more honourable group to accept it erred in simple terms.

As usual in the workings of propagandists, the NMA says JOHESU took a position that Medical Doctors in Nigeria should cease to use the title of Doctors which of course is fallacy.

The position of JOHESU was that any healthcare worker could assume the use of the title of “Doctor” based on a NUC approved curricula. Already, the NUC has approved a Doctor of Pharmacy and Doctor of Optometry for Pharmacists and Optometrists. Others will follow suit and so MDCN cannot and will not be allowed to legislate on a NUC jurisdiction like we shall resist in other regulatory realms where exclusivity is required for sanity.

6. If anybody doubted the insincerity of the NMA about its intention to extend regulation and control beyond the frontiers of Medical Doctors and Dentists, then the proviso in Section 45(3)(d) and 45(3)(e) is the perfect symbol of how Medical Doctors look for trouble by standing on age-long hypocritical platitudes.

S.45(3)(d) reads Only a Registered Pharmacist shall dispense medicines prescribed by a Registered Medical Practitioner or Dental Surgeon. while Section 45(3)(e) reads Nothing in the foregoing shall preclude a Registered Medical Practitioner or Dental Surgeon or a Registered Nurse under the supervision of a Doctor or Dentist from providing medicines in the absence of a Registered Pharmacist.

Pray what is the jurisdiction of the MDCN to create rules for Pharmacists like it seeks in Section 45(3)(d) when it says the MDCN Bill is limited to Medical Doctors and Dentists?

Why did the MDCN and NMA decide to bother themselves about what should happen in the absence of a Pharmacist where they have no jurisdictional competence even in their admission that the scope of their law is for Medical Doctors and Dentists when they have not told us what should happen in the absence of Medical Doctors and Dentists which is the scope within their boundary and limitations?

The two well established Pharmacy statutes vis the Poison and Pharmacy Act and PCN Cap P.17 LFN 2004 are unambiguous about rights and privileges in sales, dispensing, procurement, importation, exportation, manufacturing, distribution and related responsibilities about drugs in Nigeria.

The PPA Cap 535 LFN in Part 3 Sections 7 and 8 makes it clear that only Registered/Licensed Pharmacists can dispense medicines. It also defines the framework for the handling of medicines in emergencies confronting Medical Doctors in Nigeria.

Section 1(1)(d) of the PCN Act which gives the PCN powers to regulate and control Pharmacy practice in all aspects and ramifications in Nigeria forbids any other regulatory agency from dabbling into Pharmacy practice in Nigeria.
More than 15 FHCs in various parts of Nigeria have affirmed that the PCN has a specific approbation in law to regulate and control Pharmacy practise in all its aspects and ramifications. In a landmark ruling of October 2007 at the FHC, Lagos in a suit by the Guild of Medical Directors vs PCN, the court declared that the PCN had a specific approbation in law to regulate and control Pharmacy practice in all its aspects and ramifications in both the public and private sectors in Nigeria. This suit is also pending at the Court of Appeal, Lagos which necessitates the need to invoke Order 41 of the Senate rules to immediately step down Sections 45(3)(d) and (e) from further consideration in the MDCN Bill.

The other reasons why Section 45(3)(d) and (e) must be expunged are:

A. The spirit of the relevant Pharmacy Acts vis the Poison & Pharmacy Act in Part III Sections 7 & 8 and the PCN Act CAP P.17 LFN 2004 in Section 1(1)(d) which gives the PCN a specific approbation in law to regulate and control Pharmacy practice in all its aspects and ramifications in Nigeria.

The Federal High Court, Lagos in a landmark ruling in October, 2007 affirmed the powers of the PCN as the ONLY body that can regulate Pharmacy Practice at both the private and public sector levels in Nigeria. The MDCN logically cannot therefore exercise the powers of the PCN to regulate Pharmacy practice through the back door.

The fall-out of this suit is also pending at the Court of Appeal.

B. Healthcare remains a global and internationally driven practice. One of the golden rules and norms in the prescribing and dispensing of drugs is that both the prescriber and the dispenser of medicines are forbidden to have pecuniary interest or gain so that the patient enjoys the best clinical decision that must be made by the prescriber.

It is interesting that in the MDCN draft bill, no consideration or thought was put in print for a next line of action in the absence of the Medical Doctor or Dentist.

Specifically, there was no clause to allow Nurses or any other practitioner to step in the shoes of the Doctor/Dentist which would have been within the jurisdiction of the MDCN. Rather strangely, the MDCN bill seeks to give Doctors/Dentists a loophole in the private sector especially to continue the many years of wreckless use of drugs through untrained hands.

This draft cannot legitimize the unlawful act of sales and dispensing of drugs by Doctors under whatever guise.

C. The scenario in (2) above is what has entrenched and formalized quackery in the Health system in Nigeria because private hospitals promote quackery through a periodic discharge of untrained elements. Such undesirable characters evolve as Auxiliary Nurses, Dispensing Assistants/Clerk etc.

D. Section 45(3)(e) in its totality will encourage the continued exploitation of the Nigerian people because WHO studies confirm pecuniary indulgences of private hospital facilities in the sales and dispensing of drugs. The study declares that prices of drugs in private hospitals is 184% above baseline prices in public hospital pharmacy and 192% above what is obtainable in private pharmacies. It is this huge profit that has always incentivized private hospital facilities to unlawfully stock drugs when they also fail to engage Pharmacists.

Moving forward, the way out remains that Doctors and private hospitals that cannot afford to engage Pharmacists should send their prescriptions to Community Pharmacies that are registered by PCN.

E. Even at Public Sector level, the greed and avarice of Medical Doctors to dabble into areas outside their core competences which led to the decapitating of the DRF scheme in public hospital pharmacies when they spend DRF funds for purposes besides drug procurement.

More daring CEOs in some FHIs actually use some naive Procurement Officers to buy drugs through proxies in our FHIs. In one of the most notorious cases, a CEO in a particular Specialist Hospital in the South East buys drugs for the Pharmacy Department, while a counterpart of his in another Specialist Hospital in the South West gave directives that drugs be moved from a Public Sector window free of charge to a Private-Public-Partnership Pharmacy window in the hospital. The South West CEO has severely disrupted the hitherto smooth flow of the drug supply chain in that FHI which was hitherto a benchmark in the proper execution of the DRF scheme today.

7. The NMA accuses JOHESU of envy and jealousy in pedestrian and juvenile pedigree.

What is there to envy about a Nigerian Doctor? It is probably only at public sector level where Doctors have been over-indulged by the bureaucracy that they appear to earn a semblance of a living wage. Asking for equity in this regard is a legitimate and constitutional right particularly because the constitution prohibits discrimination to citizens of Nigeria.

In the private sector in Healthcare, our members excel in management of their resources than many Doctors who continue to wretched away in the Private Sector. Some of the most prominent Pharma manufacturers and importers are distinguished Pharmacists of repute. A Lady Pharmacist manufacturer in Nigeria is rated one of the 5 most prosperous female Nigerians currently. In absolute terms, no Nigerian Doctor has ever attained such heights.

One of the most successful Board room gurus in Nigeria is a Pharmacist-nonagenarian who is also a Past President of PSN.

In Medical Laboratory, some of the biggest and most notable diagnostic facilities are owned by Lab. Scientists.

It is only people who revel antiquity who imagine Doctors are benchmarks in success stories when we see what goes on in banking, oil & gas and telecoms sectors in our country.

Again we admonish NMA to get beyond these self inflicted paranoia as it will continue to inflict severe psychological atrophy on the evolution of medical practice in our land.

The attempts to portray other health-workers as dullards who want to get what they failed to get in school is lamentable.

We challenge NMA again using some of the three best Universities in Nigeria. The JAMB results at Obafemi Awolowo University (OAU), Ile-Ife was such that for the first time in recent years, Pharmacy and Medicine had the same cut-off mark. Pharmacy traditionally is higher than Medicine in that particular citadel of learning.

Surprisingly, at least to many, Nursing had a higher cut-off mark than Medicine at OAU, Ile-Ife in the current academic year. At University of Lagos (UNILAG), the cut-off mark for Pharmacy and Dentistry was same, while at University of Ibadan (UI), Pharmacy was higher than Dentistry and Veterinary Medicine.

Where is the superiority complex therefore coming from? It is just a manifestation of delusional tendencies of people who have refused to face new realities.

8. Finally, we urge the FG to be wary of the antecedents and pedigree of persons who emerge Vice-Chancellors of our Universities.

Prof. Innocent Ujah is the pioneer VC of the Federal University of Health Sciences, Oturkpo in Benue State and President of NMA who will train persons in all the Health Sciences including Nursing, Medical Laboratory Science, Pharmacy, Medicine, Radiography, Physiotherapy and others. In good conscience, how can products of such a University studying any other course apart from Medicine evolve as confident and world class professionals under the tutelage of the man Prof. Innocent Ujah with his type of disposition?

As DG NIMR, his legacies are worth reviewing especially in terms of relationship management with other professions in that capacity.

A lot is wrong with a system that allows persons who do not have PhDs to emerge as CEOs in a purely academic world. It is probably only in Nigeria that people bag professional appointments without PhDs are appointed as VCs of Universities a phenomenon that boosts the high-handedness of medics in the public space.

For the NMA, we send word with a deep sense of conviction that we shall no longer let you get away with the foolish mentality that in the world of power there is no equality, the strong must have their way, while the weak suffer what they must like Albert Camus says.

JOHESU will champion a true agenda of health reforms which will restore order, sanity, decorum and respect for all concerned in our health system.

Comrade Joy Bio Josiah
Chairman, JOHESU