Monday, June 23, 2014


In an open letter written to the secretary to the Federal Government of Nigeria, Senator Anyim Pius Anyim, on the 10th of June and sent to him on the 11th of June 2014, the Nigerian Medical Association (NMA) under the leadership of Dr. Kayode Obembe as President and Dr. Adewumi Alayaki as secretary had written 24 demands that must be urgently met. They have given the Government a 14-day ultimatum, failure of which NMA would call her members out on an indefinite strike nationwide. NMA is made up of ASSOPON- Association of Pathologist of Nigeria, MDCAN - Medical and Dental Consultants of Nigeria, ARD-Association of Resident Doctors and smaller sister Associations, who are doctors in public and private practice. For many years, Allopathic Medical Doctors in Nigeria have always hoodwinked the Government and the general public, through falsehood and blackmail. They have coerced the Government to take unfavorable decisions which have always been detrimental to the health sector and the Nigerian populace. They have continually done this as a result of the structural injustice that has been perpetuated by many members of NMA in high places in Government. They undermine the laws setting up the hospital system, the Public Service Rules and above all the constitution of the Federal Republic of Nigeria. At this juncture let us have a critical look at those demands.

(1) APPOINTMENT OF THE POST OF THE DEPUTY CMAC IN HOSPITALS. In line with the University Hospitals (reconstruction of boards) cap U15, LFN 2004 commonly called decree 10 of 1985 which governs Hospital practice in Nigerian, there is the office of the CMAC but it never provided for the office of the DCMAC. In section 4, it provides thus; “there shall be for each Hospital, a Chairman of the Medical Advisory Committee who shall be appointed by the Board and responsible to the Chief Medical Director for all the Clinical and Training activities of the Hospital”. Section 2i provides that; the CMAC is a member of the board. There is no place in the organic law setting up the hospital that created the office of the DCMAC and there is no place it says that only Allopathic Medical Doctors should be appointed as such. Yet NMA is insisting that the Government must appoint four DCMAC in every Teaching Hospital and three in every Federal Medical Centre. All along, Boards of Hospitals as a result of threats from NMA have been allowing this illegal office to be used to undermine statutory approved Scheme of Service of other professional groups. The Public Service Rule in section 1-general in 160101 provides; ‘A Parastatal is a government-owned organization, established by statutes to render specified service(s) to the public. It is structured and operates according to the instrument establishing it and also comes under the policy directives of government. In line with 160201 (a) statutory boards/council shall set operational and administrative policies in accordance with government policy directives and supervise the implementation of such policies. A situation where Allopathic Medical Doctors in Nigeria wants the Government to continue to create post and responsibilities not backed by statutes undermines the principles of good governance. It is gross violation of the law setting the Government owned institution. Moreover, it is trite law that you cannot add to a statute. That will be ultra verse.

(2) NMA IS OPPOSED TO THE APPOINTMENT OF DIRECTORS IN HOSPITALS. It should be noted that this statement is laden with deceit as postulated by NMA, that having Directors in hospitals will affect patient care negatively. This is fallacy of the highest order. The truth of the matter is, NMA does not want professional departments as directorates in the various Scheme of Service, rendering professional duties like the department of Pharmaceutical Services headed by the Director of Pharmaceutical Services who is a Pharmacist. Department of Nursing Services under the Director Nursing Services, who is a Nurse. The Department of Medical Laboratory Services under the Director of Medical Laboratory Services, who is Medical Laboratory Scientist etc.And all are answerable to the Chief Medical Director. It should be noted that, NMA and her members were the ones who negotiated their present Scheme of Service that all their members can rise to level 17 without being called Directors. Other Healthcare Personnel have continued to follow their own Scheme of Service where only one person gets to level 17 and is designated the Director, which is the most popular path in the Public Service. Again in the criteria for employment as stated in the Public Service rule in 020205,-“to be eligible for appointment into the federal Public Service, every applicant must 020205(e) possess requisite qualification as provide in the Scheme of Service.” The Scheme of Service of all other Healthcare Personnel in the hospital provides for a Directorate system. Now NMA and her members want to go on strike for Government to jettison the Public Service Rule which is a Government Policy Document. The Scheme of Service for Allopathic Medical doctors provides for a non Directorate system. AND NO PROFESSIONAL GROUP IMPOSES HER OWN SCHEME OF SERVICE ON THE OTHER. SECONDLY NO EMPLOYEE DETERMINES THE CONDITION OF SERVICE OF ANOTHER EMPLOYEE. They are agitating for this in order to entrench professional imperialism, so that all other healthcare staff will not reach the zenith of their career. That is the singular reason, a doctor on level 15 is called a Head of Department heading someone already on level 17 and is designated a Director .This is gross absurdity against the Public Service Rule. There is no Government Institution in Nigerian where such is seen, only in our Hospitals. And that is what NMA wants to perpetuate. Rule 160103 of the Nigerian Public Service Rule provides –“Parastatals are to retain and improve existing rules, procedures and practices in their establishments and ensure that there are no deviations from the general principles contained in the Public Service Rules………………………………however in the absence of internal rules and regulations on any matter, the relevant provisions of the Public Services Rule shall apply”. This can also be seen in section 5(5) and 17 of the act governing hospital practice in Nigeria. NMA’s demands are anti- Public Service Rule.

This demand is not in line with Government approved Scheme of Service for Doctors.NMA in her usual falsehood has always accused JOHESU members of skipping when in actual sense there is nothing like that. The term is a misnomer this is because skipping is when a Civil Servant moves from a grade level to a higher grade level that is not provided for in the Scheme of Service e.g. when a worker moves from 8-10 and there is no approval for such a special promotion ,this is skipping. But when you move from 10- 12 this is not skipping because this is provided in the Scheme of Service and there is no level 11 in the Scheme of Service. A baby physician enters the Service on level 12, which is a principal grade. Now NMA is insisting that they must be appointed on level 13, which is an Assistant Chief Cadre. Haba! How can a beginner enter the Civil Service on an Assistant Chief Cadre? There is no Nigerian worker that enters the Service on such grade. There is no Nigerian Civil Servants that skips. This is not provided in any known Nigerian scheme of Service.

NMA is threatening to go on strike because the Government has chosen to obey Court judgment in favour of other Health Personnel that they can also be appointed as consultants in their chosen field. In a false sense of well being, NMA insists that they own the patients and as such only the medical doctor can be called a Consultant. Nobody owns the patient; rather the patient is the epi-centre of Healthcare Service. Medical doctors are just one of the professional skilled healthcare attendants in a hospital, attending to the healthcare needs of the patient. Each medical personnel are given a license to practice their chosen field. The various scheme of Service for Pharmacists, Physiotherapist, Nurses, Medical Laboratory Scientists etc provides that they can be appointed as consultants. All over the world, it is not only Allopathic Medical Doctors that are appointed as consultants. A simple google search will show that there are different consultants in the Health Field. The word consultant is not an exclusive term to designate Allopathic Medical Doctors who are specialists. William A .Cohen, PhD, in his bestselling book “How to Make It Big as a Consultant” has this to say on pages 2 and 3. “Consultants operate in many different fields. Import-export, management, human resources, engineering, and marketing are some of the more common ones. There are consultants in archeology and consultants in clothes selection. There are even consultants to help authors overcome writer’s block.” On page 3 he has this to say. “A consultant is simply anyone who gives advice or performs other services of a professional or a semiprofessional nature in return for compensation”. NMA wants to stop working because other Healthcare Personnel are appointed as consultants. Is NMA saying that they are the only Professionals in the Health Field?

On what basis is NMA still agitating for relativity when at the point of entry this has been taken care of and resolved based on the number of years one spends in school. Those who spend four years have their entry point as level 8,those that spend five years on level 9 ,those that spend five years with one year of internship on level 10,while those that spend six years with one year internship on level twelve. The agitation for the so called relativity is discriminatory and violates the Nigerian Constitution as stipulated in section 34-(1). NMA insisting that this must be sacrosanct in the Health Sector is on what basis? It should be noted that members of NMA are just employees of the Government, just like every other Civil Servant, and as such no employee determines what another employee is to be paid. It is never done anywhere in the world. This is a sense of megalomania, and so this jack of all trade mentality must stop.

NMA is calling for the implementation of the National Health Bill which has been shown to contain a lot of clauses that are anti-people. Many professional Associations, Civil Societies and well meaning Nigerians have called for the removal of these obnoxious sections of the Bill. But NMA in the bid to actualize her set selfish agenda has refused to give good reason a chance. Again some part of the Bill undermines the Nigerian Constitution in use in a Federal System of Government. No Nigerian Health Worker is against having a Health Bill but all we are saying is that in order to meet Government set objectives to enhance the total wellbeing of the citizenry the obnoxious sections has to be expunged.

This office is not created by law. There is no Nigerian statute that says that we must have the office of the Surgeon General. Creation of this office will lead to more agitation and anarchy in the Health Sector which is already polarized. Every professional group will be agitating for the creation of X-general, e.g. Pharmacist general, Nurse general, Optometrist general, Radiographer general, Physiotherapy general, Dietician general; Medical laboratory scientist general etc. The creation of this post will lead to more problems in the health sector. Secondly of what role and benefit is the office of the Surgeon general when we already have two Ministers of Health and there are many Directors also having such functions?

This level is equivalent to grade level 10 steps 4. On what is this agitation predicated on, when such entry point is not supported by any Scheme of Service, used as one of the criteria for appointment into the Public Service of the federation? It should be noted that house officers are intern or Pupil Medical Doctors. There is no intern in Nigerian that enters the service on step four. Moreover, steps are indicators of the level of experience or years the person /officer have spent on that grade level. On what criteria is a neophyte/green horn in his profession placed on step four? What you have is either step one or step two. Government should not accede to this demand that undermines ethical procedural practice in the Public Service.

Early this year, under the immediate past President of NMA, Dr Enabulele, NMA had had an upward salary increase for their members. Not up to 5 months, NMA is now calling for another bloated allowance. Note that consultants are meant to render quality service as Attending Physicians, but what do we see daily in our hospitals? Most of the times, the “consultants/honorary consultants” are never around. Yet they want to be paid such a jumbo allowance. Those that are around, work four times in a month, having one clinic day in a week.

(10) NMA, with the huge sum they are paid, still wants adjustment in their specialist allowance to be paid to all doctors on CONMESS 3 and above, and must be paid its equivalent that is not less than 50% higher than what is paid to other Health Workers. How can NMA be the one to decide what other Health Workers get? NMA should go and read the Parable of one Talent Payment.

(11) NMA is calling for Government to pay her members 100,000 naira every month as just hazard allowance. How can NMA be demanding for such, despite all she is already receiving? She is being too selfish/greedy in her demands. Even other workers with worse occupational hazards are not receiving such.

(12) NMA insists on immediate release of circulars on rural posting, teaching and other allowance which must include House Officers. Since 2009 NMA and her members have been collecting teaching allowance even though that teaching allowances as approved by the Government was for very Senior Medical Doctors (Consultants and very Senior Registrars)that are involved in teaching of doctors in training, especially the junior and senior interns. House officers are the junior interns while Resident doctors are senior interns doing a student fellowship to become a specialist .Now NMA is agitating that the interns who are still doctors in training should be paid teaching allowance. House officers and resident doctors by government circulars are not entitled to this payment; it is because of them that Government is paying the teaching allowance. How can the doctor in training be asking for teaching allowance when he is a trainee, and who is he teaching? Since the approval in 2009 and full implementation in 2010, House Officers and Resident Doctors who are NMA members, have been fraudulently collecting huge monthly teaching allowances which they are not entitled. There is no government circular or template that approved such payment. It was in this year 2014, that the Government through the Call Budget Circular from the Ministry of Finance opposed and stopped the payment of teaching allowance to interns. For five years members of NMA who were not entitled to teaching allowance have been defrauding the Government. He who comes to equity must come with clean hands.

(13) NMA calls for immediate withdrawal of CBN circular authorizing the Medical Laboratory Science Council of Nigerian (MLSCN) to approve licenses for the importation of in vitro diagnostics (IVDS). It is so petty that NMA is going on strike because the Federal Government (which means well for Nigerians), has taken the bull by the horn to making sure that fake/ substandard diagnostic consumables are removed from the system, by effectively empowering MLSCN-the Agency who has the statutory function to do this job. Sections 4b, and 4e of MLSCN act 11 2003 provides- the function of the board are
(B) Regulate the Practice of Medical Laboratory Science in Nigerian.
(c) Regulate the production, importation, sales, and stocking of diagnostic reagents and chemicals.
Section 19 of the MLSCN act mandates MLSCN Board to also make rules. Section 19(d) goes thus-the board may make rules for the maintenance of good standard of Medical Laboratory practice and services with respect to the regulation and control of private practice including statutory inspection, approval, and monitoring of all Medical Laboratories including those adjoined to Clinics, Private and Public Health Institutions. Instead of NMA to partner with MLSCN to kick fake diagnostics out of Nigeria, she is out there encouraging quackery and fighting a lost battle by being anti-Establishment.

(14) NMA wants immediate release of circular on retirement age. Dear Nigerians by increasing retirement age from 60 to more years how will it bring better productivity in the health sector? When within the next ten years of a doctor starting work ,he can get to the zenith of his career which work will he be doing? And when most of our consultants are part time doctors because they work and have Clinics days only once a week.

(15) NMA , Residency and Oversee Training.NMA should look inwards and stop hiding under residency and oversee training to encourage medical tourism and waste of tax payers money. For self reliance and self determination the Alma Ata declaration has a lot to help a young economy like Nigeria. Health has a lot to do with socio-economic indices. Diseases in the tropics are not the same as in the temperate region. Alma Ata declaration of 1978, encourages young economies to look inwards locally in providing healthcare at low and affordable manner. All over the world it is not only one group in the health field that does residency. Veterinarians, Podiatrist, Medical Physicist, Optometrist, Pharmacist, Physical Therapist, Doctors of Ethnomedicine, Doctors of Holistic Medicine, Doctors of Natural Medicine etc all have residency program. Yet none of these group in Nigeria have gone on strike because of no oversee residency program. A privilege is not a right. There is no government law that says that Allopathic Doctors can only become good doctors only when they go oversee.NMA should stop encouraging this mentality that anything African is inferior.NMA should know that what they are asking is not part of the rules of engagement. This is the time for more humane and humble request. Indian doctors are becoming one of the best doctors in the world not because they are looking overseas but because they are looking inwards.

(16) NMA insist on payment of salaries of her member in Owerri. Her members should also meet part of their own responsibilities and agreement as workers. NMA must learn to obey constituent authority, and must make her members to be amenable to discipline.

(17) NMA members and IPPIS platform. NMA has always shown double standard on this issue. Before now, members of NMA went on strike because of the Government policy that all worker must be on IPPIS platform. How come it is now that NMA is just waking up from sleep, to say that if her members are not on IPPIS she will call her members for indefinite strike? The Government policy is that if you are not on a pensionable appointment you cannot be on IPPIS. So how can house officers and residents be on IPPIS when their appointment is not permanent? Moreover the 2014 Call Budget Circular from the Ministry of Finance provides that you cannot hold more than one appointment and be placed in two places under IPPIS platform. When IPPIS came many members of NMA opposed it because it did not allow them to be on Government pay role in two places.

(18) NMA wants to go on strike because House Officers are said not to be part of NARD-National Association of Resident Doctors. The big question here is, are house officers also paid the same as their senior residents? In as much that the House Officer is a junior resident while the doctor in training to become a specialist is a senior resident the duo cannot be part of any strike action even with their consultants, because they belong to an Association and not a trade Union.NMA is only calling for House Officers to be part of NARD for them to be part of their numerous illegal strike action.

(19) NMA accuses Medical Laboratory Scientists of harasment.NMA has shown herself that she is a Joker. The world knows that it is the other way round. That it is members of NMA that are harassing Medical Laboratory Scientists in Nigerian. The number of Medical laboratory Scientist that NMA members have instigated their sack/termination of appointment/suspension is worrisome. But thanks are to the Most High for the Judiciary who brings hope for the common man, by setting aside most of the sack/termination/suspension. Medical laboratory Scientists are people who do not act on impulse, or with impunity. Why is NMA resorting to self help when issues she has with members of Association of Medical Laboratory Scientists of Nigerian are in court? Why is she the judge in her own case? The spirit of Medical Laboratory Scientists can never be broken. We shall always move with great crescendo to protect patients’ interest and the public at large, despite the provocation and lawlessness that is being perpetuated by members of NMA in the Health Sector. The laws of the land shall be our strength, for he who holds the mace of truth and justice can never falter. We cannot be intimidated by her Goliath posturing.
(20) NMA says-‘the endless circles of incomplete salary payment to our members in many hospital in the name of short falls in personal cost must stop’. This is the only legitimate demand out of the 24 demands by NMA because the labourer is worthy of his wages. But NMA cannot call her members out for strike based on this, because she is not a registered Trade Union but a charity. This problem is not peculiar to only Allopathic Medical Doctors but to all personnel working in the Health Sector.

(21) NMA in her number 21 demand states ‘universal application of all establishment circulars on remuneration and condition of service for doctors at all levels of Government must be guaranteed’. NMA is not justified here, because this borders on Constitutional Matter. And the Central Government has some limits to want they can impose on the State, bearing in mind that we are practicing a Federal System of Government, where power is shared among the three tiers of Government, the Federal, State and the Local Government. NMA members should come to terms that they are the employee and not the employer. It is very interesting to note, that NMA who champions the lost battle, insists that the approved Scheme of Service/circulars of other healthcare workers will never be implemented is the one now agitating that even things not given by any Scheme Service/circular must be implemented.

(22) NMA demands that Government must urgently set up a health trust fund that will enhance the upgrading of hospitals.NMA is being sentimental here, the problems of our hospital is not funding but mismanagement and accountability. Even if the Government sets 100 trust funds with billions of naira much will not come out of it, because the hospitals are managed contrary to Government laws and principles. Hospital/health administrators should be the ones to head and manage the hospitals. Our hospitals have been poorly managed under the leadership of Allopathic Physicians. When there is good management and accountability Government set goals/objectives can be actualized.

NMA is always doctoring and adding to organic laws. In her 23rd demand, NMA stated “the position of the Chief Medical Director/Medical Director must continue to be occupied by a medical doctor as contained in the act establishing the tertiary hospitals. This position remains sacrosanct and untouchable.” I can beat my chest and say that the leadership of NMA have never seen nor read the content of University Teaching Hospitals (reconstruction of boards) cap U15, LFN 2004 commonly called decree 10 of 1985.There is no where it stated what NMA quoted above. In fact the term medical doctor was never used in that document or Act. Section 5 of the act provides;

(1) There shall be for each hospital a Chief Medical Director who shall be appointed by the president on such terms and conditions as may be specified in his letter of appointment or as may be determined from time to time by the Federal Government.
(2)The Chief Medical Director shall
(a)Be a person who is medically qualified and registered as such for a period of not less than 12 years, and has had considerable administrative experience in matters of health and holds a post graduate medical qualification obtained not less than 5 years prior to the appointment as chief medical director and
(b)Be charged with the responsibility for the execution of the polices and matters affecting the day to day management of the affairs of the hospital.
In the afore-mentioned Act, there is no place it said that the person must be a Medical Doctor. The International best practice is that, it is not only Medical Doctors that head Hospitals rather, in most places; it is a qualified hospital/health administrator that manages the Hospital. If you do a search on the internet on the criteria to become a truck driver in USA, note that you will see that it says that the person must be medically qualified. So does being medically qualified here mean that one must be a medical doctor to be a truck driver? The capital answer is “no”. It means being medically fit. The term medically qualified as used in the act has been misinterpreted to mean a holder of a certificate registrable by MEDICAL AND DENTAL COUNCIL OF NIGERIA.(MDCN). Currently there is a case instituted in the Federal High Court Awka by Comr. A. A Obi a distinguished Medical Laboratory Scientist and the suit number is FHC/AWK/CS/38/2013.The suit is to interpret the meaning of who is medically qualified as used in section 5 of the act. So why is NMA and her members jumping the gun to go on strike on an issue before the Court is that not subjudice? All along NMA has used acts of impunity to undermine the rule of law. The organic law did not say the person will be a Medical Doctor or be registrable with MDCN even though all adverts for the posts of CMD/MD have come to illegally say so.
It is lucid that from the foregoing, certain questions arise. Can NMA as an Association declare and call for strike, when it is not a Trade Union? Is NMA above the law, that it can undermine the provisions of the Constitution of the Federal Republic of Nigeria, by trampling on the code of conduct for Public Officers as stated in the constitution? Section 2 subsections 1,2 and 3 of the Trade Union Act, states “A trade union shall not perform any act in furtherance of the purpose for which it has been formed unless it has been registered under this act……………..”
section 2 subsection 2-where a trade union registered under this act ceases to be registered, it shall not there after perform any action in furtherance of this purpose…………….
section 2 subsection 3-if any act which is prohibited by section (1) or (2) of this section, is performed by a trade union, then
(a)The Union and every official thereof; and
(b) Any member thereof who, not being an official thereof, took any active part in the performance of that act, shall be guilty of an offence against this act.
NMA is not a registered Trade Union, so she cannot be doing this, entrenching sabotage and acts of impunity against the State. Above all, endangering the lives of the citizens, she swore on oath to protect. A situation where NMA is going on strike as a result of these frivolous demands is gross misconduct and acts of negligence. Section 3 of 030301( h) of the Public Service Rule terms negligence as a misconduct.030402 (e) terms absence from duty without leave as serious acts of misconduct. Sabotage in 030402(t) is also stated as serious misconduct. Section 33(1) of the Nigerian Constitution 2011 as amended provides every person has a right to life and no one shall be deprived intentionally of his life………section 172 of the same Constitution states “A person in the Public Service of the Federation shall observe and conform to the code of conduct of the Federation “.The fifth schedule part 1 code of conduct for Public Officers says:
(1) A public officer shall not put himself in a position where his personal interest conflicts with his duties and responsibilities.
(9) A public officer shall not do or direct to be done, in abuse of his office, any contrary act prejudicial to the rights of any other person or contrary to.
It is so glaring that what NMA is asking is prejudicial and tramples on the rights of Nigerian Citizens.

(24) IN her 24 demand NMA forgot that she is an employee of the Government and it is not for her to dictate on how Optometrist or Medical Physicist should be paid. Nigeria is not Govern by the whims and caprices of NMA but by laws and polices made by the Government.

NMA and her members are not justified on going on strike. The only reasonable demand is demand number 20 haba! A student who scored one out of twenty four is not doing well at all. NMA members should know that as workers they have duty of Fidelity, they as Civil Servants are bound to only obey rightful orders from NMA. They also have duty of care and skill to the patient. And above all their loyalty/allegiance is to the Nigerian state. A situation where NMA gives her members unlawful orders undermines the rule of law and as such, such orders cannot hold sway.
NMA has become a fifth columnists working against the state. It is sad that NMA and her members who have benefitted so much from the state are now turning themselves against the Nigerian state to become the killer of the Nigerian People, instead of being the Physician who is to be the healer of the patient and people. Nigerians must rise and say no to this medical imperialism by using the instrumentality of the law to stop NMA from inflicting untold hardship on her citizenry. The Federal Government through the Ministry of Health under Prof Onyebuchi CHukwu must act to maintain law and order, now that NMA has told the world that it is because of some of the things She granted to JOHESU on merit, is the reason NMA is going on strike. She should seek an injunction restraining NMA from going on strike just as he did to JOHESU, pending the determination of the motion on notice to know if NMA has the locus standi to go on strike when she is not a Trade Union. JOHESU should be firm to seek a legal redress to restrain NMA in this acts of lawlessness,if the Government does not act.There must be a total restructuring of the Health Sector. All Nigerians from all works of life must condemn these acts of sabotage against the State by doctors of Allopathic Medicine under the auspices of NMA. The Nigerian Government as a matter of urgency should support the Natural Medicine Development Agency Kofo Abayomi Victoria Island, to reposition our Traditional Medicine to be like what is seen in China, USA, U.K, India, Korea etc. And it should be integrated into the mainstream Healthcare System in Nigeria. Allopathic Monopolistic Medicine should give way to Pluralistic Medicine. Government should create an enabling environment for the practice of the different Medical Systems like, Functional Medicine, Holistic Medicine, Ethnomedicine, Ayurvedic Medicine, Homeopathy, Osteopathy etc. All over the world, no country is currently solely dependent on one Medical System. Nigerians must say no to NMA that has become anti people. The Nigerian Government should not allow herself to be blackmailed by NMA. She should first and foremost challenge NMA for acts of impunity against the state. The federal Government should take a leaf from Governor Fashola of Lagos State, for enough is enough. The Government should also take a queue from the former governor of Anambra state, Mr Peter Obi

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