Ensuring inter-professional harmony in health sector

Dr. Joyce Barber is National President of the Medical Women’s Association of Nigeria (MWAN) a non-governmental umbrella body (affiliated to the Nigerian Medical Association (NMA)) of all registered female Medical Doctors and Dentists in Nigeria. She has been council member of the NMA and its Inter-professional committee. MWAN is also affiliated to the Medical Women International Association (MWIA). Barber in this interview with CHUKWUMA MUANYA, among other things, made recommendations on how to ensure inter-professional harmony in the health sector.

Most people in the health sector blame doctors for the lingering inter-professional rivalry. Why is that? What are you doing to address this?
Health care delivery entails teamwork and every member has an important role to play, there however has to be a leader or captain on every ship to offer direction. Clients primarily attend hospitals to seek attention of medical doctors who then work with other members of the health team to provide the needed care; it is therefore the Medical Doctor who bears responsibility for the client. The job description a of Medical Doctor includes having to take a detailed history from the patient, carry out a detailed examination, come up with a working diagnosis before other team members come in to carry out laboratory investigations if indicated, in-patient admissions if necessary, administer appropriate drugs if warranted or offer services like physiotherapy, dietary advice and so on as may be required. Training of medical doctors also entails some experience across all aspects of patient care.

Several factors, mostly beyond our control built up over the years have made other health professionals misjudge or misinterpret the leadership role of the doctor and have tried to detach themselves from working as a team with the medical doctor as team lead. It is imperative for a medical doctor to always promote teamwork and appreciate everyone’s role in the health sector.

As an association, we build capacity of our members for leadership by organizing annual leadership retreats for different cadres of doctors in leadership positions – Chief Medical Directors and Directors of Medical Services; conduct mandatory communication and management courses especially during residency trainings as a pre-requisite for becoming specialists in their respective fields; and encouraging those in leadership positions to lead by example and uphold the Hippocratic Oath.

Respective leaders of our Association have always extended their hands of friendship to other health workers’ Associations particularly Pharmaceutical Society of Nigeria, National Association of Nigerian Nurses and Midwives, Association of Medical Laboratory Scientists, just to mention a few. We invite them to participate in our programmes and we attend theirs, all in a bid to foster harmonious working relationships. We have to forge ahead as a functional team to move our health sector to the desired level.

What is your association doing to address brain drain and lack of space for residency programme for graduating doctors?
Brain Drain is a multifaceted problem that does not have one straightjacketed solution. In Nigeria today, thousands of young Medical Doctors are produced annually, most without a definite plan of specialization despite their desires to, because of paucity of spaces for residency or with the aim to leave the country for greener pastures. To combat these serious problems, we organise mentorship programmes for young medical doctors as a guide in career choices and specializations. We also collaborate with our colleagues abroad to share some of their experiences with us back home through workshops, seminars, training programmes and medical outreaches. ‘Brain Drain’ can actually become ‘Brain Gain’ if harnessed appropriately.

Our association together with our parent body the Nigerian Medical Association (NMA), has reiterated to the regulatory authority the dire need for, and many of our members have been at the forefront of ensuring more health institutions get accredited for Residency Training Programmes, which creates more space for graduating doctors. The State and Federal Governments have been urged to recruit and upgrade the necessary human resources, provide the right infrastructure in the health institutions and the right equipment to ensure that many health facilities get accredited for the Residency Training Programmes.

Despite efforts by government, the country has continued to record high maternal and child deaths. Why? What is the solution?
Maternal and under five mortality indices have continued to be high in Nigeria despite efforts by health care givers to curb the menace. It is clear that independent efforts cannot in isolation deal with the situation, it requires harnessing all multifaceted efforts together in order to achieve the desired positive change. There needs to be greater political will by government, adequate budgetary allocation to health, legislation for health especially to the vulnerable which encompasses women and children, Universal Health Coverage and professional commitment towards tackling the preventable causes of deaths which incidentally make up the greater chunk.

A multi-sectorial approach is essential to provide Universal Basic Education, provide safe water and adequate nutrition, good roads to promote access to health facilities, optimal communication, ensure poverty eradication and ridding harmful cultural and social practices that are inimical to health. The Federal Government in collaboration has initiated the programme of Maternal and Perinatal Death Surveillance Response with the Society of Gynaecology and Obstetrics in Nigeria to address these mortalities in a holistic manner but many state governments are yet to show commitment towards this program.

The elections are here again. What agenda are you setting for the next President and other contestants for elective positions on how to improve healthcare in Nigeria?
We call on our prospective President and indeed all contestants into elective and even appointed offices to initiate a culture of diligence and transparency, and honour their campaign promises. Women and Children’s health should be a priority and feature prominently in their agenda.

Secondly, we must keep State-by-State scorecards on health by ‘naming and shaming’ non-performing States. Nigerians are proud people who love recognition and when they see that people are keeping scores, they will sit up. However, we should be proactive, meticulous and deep in our assessments to avoid peripheral works for show.

Healthcare in the country has become unaffordable even for the rich. Why is that?
First, I’d like to say, healthcare globally is expensive, not just in Nigeria; someone somewhere has to pay for it either as an individual or collectively through an insurance scheme. Lack of a mandatory well-executed Health Insurance Scheme that is closely monitored to avoid diversion of funds is a major cause of its non-affordability in our nation.

Furthermore, there is a very poor emphasis on prevention of diseases except for immunization – “Prevention they say, is better and cheaper than cure”. People have to be taught to nip a lot of devastating health conditions in the bud. Take breast cancer for example, by simple monthly breast self-examination, a woman can pick up a lump and get it removed at a relatively low cost before it spreads and becomes more difficult or impossible to manage. However, due to poor health seeking behaviour, many women wait until it is advanced then start soliciting for funds to handle it or to travel abroad as part of Medical Tourism expecting miracles, when it is too late and sadly, not much can be done.

It seems the National Health Insurance Scheme (NHIS) has failed in Nigeria. Do you have solutions to workable health insurance programme?
I actually would not say the NHIS has failed; it can be made to work. There has to be wider coverage and greater accountability for its impact to be felt. We encourage the National Health Insurance Scheme to review the programme and address whatever problems are identified so that the Nigerian populace can be better for it.

I believe what we need is the political will to put the effective legal framework in place for the Nigerian social health insurance scheme to work for the benefit of all Nigerians. It has to work and it must work.

What does your association stand for? What do you intend to achieve?
Medical Women’s Association of Nigeria (MWAN) is a non-political, non-sectarian, non-profit making organization, made up of registered female Medical and Dental Doctors in Nigeria. We are dedicated to promoting women’s health, improving professional development and personal wellbeing of our members, and also increasing the influence of women in all aspects of the medical profession.

The association has been carrying out programmes targeted at achieving MDGs 3, 4 and 5 which have now been subsumed by SDGs 3 and 5 which all revolve around promoting gender equality and empowering women, reducing child mortality, and improving maternal health.

What have been the challenges as a female doctor?
Balancing the demands of the home front and career is a major challenge for a female doctor but with dedication and prioritization, it is possible for us to fulfill our dreams of achieving both, as women naturally are good at multitasking.

Getting appointed into leadership positions is another challenge, women have to work twice as hard as their male counterparts in order to prove themselves and be considered eligible. The tides are however changing as many more females are enrolling into medical school and graduating as doctors than males.

It seems that women are more affected by HIV/AIDS and cancer. Why? What is the way forward?
Females are more predisposed to getting infected by HIV than males by virtue of the anatomy of the reproductive organs wherein women are the ‘receptacles’. As for cancer, breast cancer is the most prevalent and because of the nature of the woman’s breast, more women are affected and very few men get breast cancer. Cervical cancer that is almost as prevalent as breast cancer can only affect women while prostate cancer occurs only in males and is quite common as well. The way forward is early detection and healthy lifestyle. People need to change their health seeking behaviour and utilize the available preventive health services.