‘Ego, selfishness behind disharmony in health sector’
Dr. Lolu Ojo is the Chief Executive Officer and Founder of Merit Healthcare Limited, a Lagos-based pharmaceutical company. In this interview with SAMSON EZEA AND HENRY EKEMEZIE, he speaks on salient issues bedeviling health sector and the way forward
How would you assess the business environment within the health sector Behinices?
There are challenges and you may not be absolutely right to say that the practitioners are more interested in making money than saving lives. What happens in most cases is that the challenges of the environment sometimes overwhelm the practitioners in terms of the tools they work with and those facilities needed that are not there.
As you came into my office, you noticed we are on generating set and we just switched power from the smaller generating set to the bigger one. We have to run multiple generating sets to ensure uninterrupted power supply and this happens everywhere, including the hospitals. Yes, indeed, there are challenges everywhere. Having said that, there are also opportunities despite the limitations of the work environment. There are opportunities to do better than what is currently obtainable.
Added to the above are issues of poor funding, inadequate staffing leading to burdensome work load, interdisciplinary issues, decaying amenities, inadequate provisions of drugs, medicaments, diagnostic tools and materials and medical consumables, among others, all these affect quality of services
Talking about challenges, what can you say about practitioners who work in the public health sector but also operate private hospitals?
To me, it is part of the challenges of the operating environment. Why do we have such a slack environment that allows such things to happen? It won’t happen in the private sector. Despite that I am head of my organisation, I have my deliverables, which I must deliver, and I believe the same thing must happen in the public sector. Whether you are a doctor, pharmacist, nurse and so on, you should have a standard set of deliverables and you must have the discipline to deliver the set target.
There must be control measures that will ensure that each person in that system delivers on their target. You are a staff of a government hospital and you walk into your place of assignment by noon and expect to be paid at the end of every month. It is not okay and fair. It is not necessarily because someone is hurting anybody. It is a collective decay in our system that must be addressed.
There have been arguments for a very long time, that an average doctor working in the public sector has a divided loyalty, because he is constantly in pursuit of his personal business. How do we address this situation, where medical personnel have divided loyalty?
It is morally wrong, I must say, for you to leave your area of primary assignment for which you are being paid monthly and which in some instances, entitles you to certain privileges like the Head of Department or Chief Medical Director, among others, and then, concentrate on your private business.
I don’t think that this is happening on general scale even if it is true that some reports have been made. I think the challenge here is for the media to help push these issues out with concrete information placed on the public space for people to see. It may be clear that the people we celebrate so much are not doing their jobs. However, there are still some highly dedicated people in the system. Take General Hospital Isolo for instance, if you go there, you will see the huge crowd of patients waiting for attention at the same time but there are some personnel there who stay there from morning till evening attending to patients.
What I don’t like is where the system officially condones that practice where you can leave your paid employment and focus on your personal business and virtually everybody is doing it. The challenge is for us to bring these issues out in the open. Our healthcare system must not tolerate conflict of interest.
I believe it is not just about the challenges for Nigerians or the media, but about the conscience of those involved because the system is aware of these practices…
That was why I said it is morally wrong. For those of us who are in the private sector, we know this. You must do that which you are being paid to do and I think those who are doing it particularly the physicians need to understand that they are being paid to discharge a particular set of duties and it is important that they discharge it before any other thing.
In the evening after you must have been done with the one you are being paid for, since they have been generally allowed to do so, you can then go and attend to your business. Let us take the positive things that come out from some of this so-called crisis.
For instance, we can say they should be paid for the number of hours they put into their work. Most of our colleagues who travel abroad go there and get paid by the hour. We should see how we can introduce that kind of system here, such that people get paid according to what they put in.
Operators in the health sector have said that corruption and bureaucratic bottlenecks are hampering attempts by practitioners to bring in modern medical equipment and technology for the benefit of the country. How true is this assertion, especially given the fact that your company is into importation of medical consumables?
I must tell you this is one problem in Nigeria that we all need to take a decision against and say we do not want to continue on this path. I remember during President Olusegun Obasanjo’s regime, there was an attempt to equip all the major hospitals, but what happened? Eventually, nothing apart from the propaganda around it and I don’t even know if the equipment are still there. If it was a private medical centre that was to be equipped and the money is available, within days, it will all be set up.
Corruption is a problem and unfortunately now, it has permeated every fabric of the society, whether you are a messenger, doctor, pharmacist or nurse, it appears it has gone into our hospitals and practically destroyed everything we are supposed to be proud of.
Are you canvassing for the health sector to be privatised as against it being in the hands of the government?
Government should operate hospitals because these are essential services and it will be difficult for government to completely leave it in the hands of the private sector.
The point I am making is that we can take some lessons from the private sector that people do not need to be forced or excessively persuaded to do their works. Our people should imbibe that culture of doing their work. If I find myself working in the public sector now, I will be who I am because I am already used to doing my work. I will not allow my work to suffer, while I do something else, no. Let our people, doctors, nurses, pharmacists, take a decision that whoever works in a public place has a responsibility to discharge his or her duty.
The continuous fight among doctors, pharmacists and nurses on salary harmonisation and other disagreements, has greatly affected service delivery in the health sector with the different groups going on strikes to push their demands. How do you think this should be addressed?
It is unfortunate that we have allowed what I call mundane issues to affect our primary responsibilities. The health sector crisis that we have is a failure of leadership on the part of those who have been running the system over the years.
In the health sector, what are the health indices? We have one of the poorest health indices in the world. I am above 56 and as far as Nigeria is concerned, I am not supposed to be in existence because life expectancy in this country is about 55 and 56 years. Women are to live for 56 years and men for 55 years. The infant and maternal mortality rate is very high; the population living under the poverty line is very high and so on. We are being compared to countries such as Sudan, Somalia, Liberia among others, countries that should be eating from our hands. It is about leadership.
This issue that we are complaining about is more of an ego problem. The superiority contest, if you ask me, it is an illiterate preposition. What makes you to be superior to me? We can’t all be doctors or nurses or pharmacists and if we are all in one profession, who will do the other jobs? It is all about division of labour and each person get rewarded according to his input.
From when we were children, we depended on our parents and as we grew, we wanted to be independent but at a point, we would become inter-dependent and it is that inter-dependence that we should be talking about. This is where I will use this opportunity to appeal to the doctors that we should think and act like managers. The way a manager acts is very simple because people make the difference.
If we have the best equipment in the hospitals and we do not have the right people operating or maintaining them, they will go bad. The manager of the hospital, in this case, the chief medical director, should understand and appreciate the fact that people make the system and there are different categories of people under this system: the doctors, nurses, pharmacists, radiologists, therapists, laboratory scientists, among others. It is his responsibility to take care of everybody.
They say a chain is as strong as its weakest point. If the doctors are happy and the pharmacists are not happy, it is a problem. The tool that actually makes the patient benefit from the knowledge of the doctor is the drug that is applied. If you do a good diagnosis and the wrong drug is applied, what happens to the patient? If the right drug is prescribed and dispensed but wrongly administered, what happens to the patient? So, everyone needs to be happy and every doctor knows this. Once the nose is disturbed, then the entire body is disturbed. Before the Prof. Olikoye Ransome-Kuti era as Minister of Health, there was peace in the system.
As a young man, I joined the hospital as a Pharmacist Grade One and a doctor, who joined the hospital at the same time with me, was on the same grade, but different steps and no one complained especially, because he spent more years in the university than me. Right now, things have changed such that it will take about 13 years of working, post- qualification as a pharmacist, before you are qualified to earn the salary of a newly employed doctor and you begin to wonder why.
I can speak for pharmacists because I am a pharmacist and I know that they are experts and sound professionals at what they do. It is only in the hospitals that their potentials are sub-optimized. Take them out of the hospital system and see what happens. I was once in the hospital and I didn’t like what they were doing there. I did not want to sit there with somebody who spent only one year more in the university making me feel second-class (because they have a stronger union with better political access). So I left and got something else doing. But for our colleagues who are staying to serve, I think it is important for the system to recognise and treat them equitably.
Do you agree that lack of good leadership is the major problem with our health care system?
That is exactly what I am saying. Who have been the leaders of the health sector? The doctors! There is need for introspection here and if you say you are the leader, then be a good leader (not a parochial and egotistical one). Be a leader, who understands that health care provision is an interdisciplinary team affair. What have we gained by your leadership? Do we have leaders without followers and who are the followers? Followership cannot be decreed into existence.
It must be earned or gained by what you say or do as a leader. It is the responsibility of the doctors, who are leading the hospitals, to ensure that others follow and the way to ensure that others follow is that there must be equity, justice and fair play.
It is not a global best practice that a doctor must head our healthcare institutions. In saner climes, the doctors lead the clinical teams and hospital administrators (who are not even medically trained) manage the institutions and they have results to show for it.
I think the time has come for us to try something else and be in tune with the global best practice.
Looking at the current problem, what are the major issues? Like I said earlier, there was relative peace before 1985 when the late Prof Olikoye Ransome-Kuti was able to get special advantages for the doctors. At that point, no one complained but there were skirmishes until at a point… (Interviewer cuts in)
Did you say Prof. Ransome-Kuti got special advantages for the doctors?
Oh yes, special salaries for them in 1985 when he became the health minister and that was the take-off point of the crisis on ground now. He is late now but the seed he sowed more than 33 years ago, has grown to a crisis proportion. Go ahead and ask the doctors what happened before 1985.
Did that situation get the backing of the law or did he do it by fiat?
He had access to the President and what they were given was gazetted and made official. Whatever method they used in getting it, the fact remains that it was done for the doctors.
Are you saying that such a fiat or law cannot be amended in any way?
The thing is that the people who should amend it are the same people that are against its amendment. It is as simple as this. The doctors ask for a certain amount as payment because they believe they are the leaders in the sector and want to dictate what is to be paid to other health personnel. That is the simple analogy of what it is, and we are saying it is wrong. If, for instance, I read Yoruba in the university and later joined the Ministry of Information, I would have progressed in my career and possibly, rose to become a Permanent Secretary and I would be very useful within the system. But in real life, I read pharmacy, a very tough course by any standard, and I joined the hospital system where l could not grow pass a pre-determined limit: I cannot head a committee, I will not be given a special project, I cannot take management position, I basically cannot do anything. I think this is wrong.
Is it that the joint health workers (JOHESU) are not aware of these facts and why has the union not been able to table the issues appropriately?
The union is aware of the facts because I read the position paper. May be what we can talk about is the articulation of the issues and the way we propagate it. I am in touch with the members and I have told them that this could be done better than it is currently.
We need to let the public know the true position. Nobody is saying doctors should be paid the same salaries as other health workers and it has never been like that. I graduated in 1984 and I have worked in several hospitals, as an intern, a National Youth Service Corps (NYSC) and as a pharmacist grade one and in whichever hospital I found myself, I discovered that the most senior person in that environment was a doctor. Everybody accepted his leadership, and nobody queried it.
The system allows you to have your position based on established procedures and everyone is okay with it. Within the hospital system, when they want to allocate accommodation; the doctors come first and for good reasons and I cannot stupidly argue against that. If there is only one room and they give the room to the doctor, it is because at night when there is an emergency, he will be called upon to quickly attend to it and things have been this way for long and it is acceptable by all. I tell you that the trouble started about 33 years ago with Prof Ransome-Kuti when he began giving preferential treatment to doctors as against pharmacists and others. Guess what, they have tasted it and never will want it to change.
Secondly, the doctors want the gap to be widened. I will not sit down here to condemn the doctors but the system that allows such lopsidedness to continue to happen. I still want the window of opportunity to appeal to the conscience of those who are ruling the hospitals and the ministries that they should think more about the whole and not a part. At the end of the day, what happens to the man on the street? That is the man that we should be serving.
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