Olusegun Sotiloye, a physiotherapist, is the chairman, Joint Health Sector Union, JOHESU, University College Hospital, UCH, chapter. He also doubles as the deputy president south of the Nigeria Union of Allied Health Professionals.
Both unions comprise all professional health workers in the health sector aside medical doctors and dentists.
In this interview with Ayodamola Owoseye of PREMIUM TIMES, he speaks on some of the challenges facing the health workers in the health sector, the reason for the incessant strike action by his union and the vote of no confidence passed on the Minister of Health, Isaac Adewole, by JOHESU
PT- A vote of no confidence was recently passed on the Minister of Health, Isaac Adewole, by JOHESU. What are your agitations and how can it be resolved?
Sotiloye- The president should call the minister to order or remove him and put somebody else. This is because the minister has shown time without number that he is not ready to be fair to everybody but just there to represent his constituency, the NMA.
Not only by body language, actions but even by his words. He has said it at different fora at different times that the court judgements that were obtained are not implementable.
In sane countries, he would have been arrested. That should be called contempt of court. When you have subsisting court judgement, several judgments hovering around same issue and you are saying the judgments are not implementable, that shows the level of bias that the minster harbours for other health professionals.
He mentioned at a time that other health professionals are agitating needlessly for improved or adjustment of salary scale. How can a minister alter such statement with the level of discrimination and disparity on ground between the medical practitioners and health practitioners?
Apart from the fact that they are on a different scale which is more juicer than the scale for the other health practitioners, in spite the new adjustment for the medical practitioners in 2014, and you are saying the other health professionals should keep quiet.
The president should call the minister to order for development in the health sector. The Nigerian health index since he took over has dropped and not improved. In fact, a lot of people thought we would be able to handle the labour issues/ industrial disputes in the health sector, but he has been getting worse since he took over. I wonder what other criteria we can use to assess his performance as the minister. The president might need to rejig his cabinet.
PT- With the unions’ allegation of bias on the part of the minister, are you expecting that the implementation of the union’s demands might see the light of the day?
Sotiloye- We are waiting to see. We have our apprehensions, time will tell whether our demands will see the light of the day. One thing that is certain is that we will not keep quiet. A time will come that we will go beyond passing vote of no confidence, and we will be agitating for his removal if this level of bias and discrimination continues. We have done it before. Onyebuchi (Chukwu, former health minister under President Goodluck Jonathan) was removed. Onyebuchi too started out as an agent of Nigeria Medical Association, NMA. Due to our pressure, he succumbed. Unfortunately, the time he was ready to succumb was the time he was removed as minister. We can agitate for his removal if he is going to be favouring only one professional group out of all the professional groups in the health sector.
PT- JOHESU wrote to the Minister of Health and the Presidency in December 6 that their demands are yet to be met. What is the likely implications of these unmet demands to the health sector and Nigerians?
Sotiloye- The likely effect is that the cycle of problems for the Nigerian populace is likely to continue. What government promised us after the letter is that our demands will be met immediately in the New Year, (2018 which we already are in) because it is already on the table of the president. But if that happens to be untrue, I will just feel sad for the Nigerian populace because it means that there will likely be another round of strike action.
That seems to be the only language the government understands. The only time the government will sit down and talk to you is when there is a strike action going on. Immediately you suspend the strike action, they forget about you, go back to their shell and forget the agreement signed with them putting it aside; until the unions resume the strike before they remember to take action and this shouldn’t be.
If government fails to do what they are meant to do, I will only feel sad for the innocent Nigerians that will bear the full brunt of any strike action?
PT-How can the rivalry between the health workers and medical practitioners which is getting more pressing by the day be resolved?
Sotiloye – In the first instance, I totally disagree with the word rivalry because I don’t see it as rivalry.
To my own understanding, rivalry is when you are claiming supremacy or fighting for supremacy with another party or different parties and that is not the issue on ground. It is not about supremacy but fairness.
When there are two groups or several groups and one is being treated as second class citizen when compared with the other; that is not rivalry. What we then have is more about discrimination, but it is an avenue to claiming fairness, justice and equity.
To answer the question as to what can solve the discrimination in the health sector, what can solve it is the general reorientation of the leadership of the health sector in the country.
When I say leadership, I mean those heading the health sector in the country, the ministers of health, top echelons in the ministry and the presidency itself because there is a need for the presidency to put its foot down that those overseeing the health ministry should make the sector a level playing ground for all professionals involved.
There is a difference between equity and equality, we are not asking them to give us same thing as the medical practitioners, what we want is for them to bridge the gap as it is currently too wide.
Until we have a minster or ministry of health that is ready to do that, there will continue to be problems. Nothing is stopping the ministry of health from calling a round table meeting where each parties will state their grievances and fair solutions would be proffered to everybody’s problems.
They might not be able to solve all the problems at a go, but they should take steps towards bridging the gap. That is what will solve the problems on ground.
PT- What are the agitations or wide gaps JOHESU is complaining about that are expected to be bridged?
Sotiloye- Our agitations are many, but I will start with the issue of professional recognition. To the medical practitioners, the other health professionals should only be seen and not heard.
When it comes to the issues of administration in all ramification as well, be it ministry of health, parastatals, research institutes, among others, you will notice that it is always a medical practitioner that is heading this organisations; and this should not be.
There is a general lopsidedness in the health sector in favour of the medical practitioners to the detriment of other health professionals. It is not written or documented anywhere that it should be a medical practitioner heading these institutions. It is not obtained anywhere in the world that it must be a medical practitioner that must head institutions.
There is also the issue of imposition of one professional over the other especially as it pertains to medical laboratory science, radiography, dental therapy, and dental technology among others. The medical practitioners want to lord over this other distinct professions and it shouldn’t be as it is not so in developed countries.
These other health professionals through the full gamut of training, obtained necessary certificate, some of them are even authorities and members of highest body of their profession in the world.
But when it comes to Nigeria, no matter where they have gotten to in the world, they are made to understand that they are still subservient to some groups of people. Just as you have the pathologist over the medical laboratory scientist, radiologist over radiographers, dentist over dental therapist and technologist and some other professions.
The remuneration is another major gap that needs to be bridged. Prior to the time of Olikoye Ransome Kuti, every player in the health sector was on one single salary scale and there was no problem. It was not like we were collecting same thing. We were not collecting same salary. Depending on the certificate or license you carry, depending on the job evaluation or schedule of duty, depending on the number of years spent in school was used to determine the entry point.
Some come in on grade levels 6, 7, 8 and 9 and there was no problems. Nobody was agitating for anything. Because the academic staff then agitated for a new salary scale then, and they were granted a separate scale. The medical practitioners also went to the government to demand for a separate scale, and foolishly, stupidly, naively the minister granted them and since then the health sector has not known peace.
The other health professionals have been agitating for something similar which as I am speaking to you is yet to be granted and there have been several grants like that that have been awarded to medical practitioners that are not awarded to other health professionals.
In 2014 for instance, despite the medical practitioners being on a different scale, they had an upward salary adjustment of that same scale that other health professionals are not yet on. They adjusted it upwards, meanwhile the other salary scale that other health professional are serving on have not been touched on. So already you have the gap getting wider such that you see a director who spends almost 30-35 years earning the same thing as a medical practitioner who just graduated.
To any sane human being, that does not sound logical. What they are saying in essence is that it is a sin to be a physiotherapist, cursed to be radiographer, plagued to be a medical laboratory scientist; and once you are not a medical practitioner you are doomed.
What a number of people forget especially in this part of the world is that everybody cannot be medical practitioners.
Some people choose other professions not because they are dullards or cannot gain admission to be medical practitioners, they chose those professions because they love those professions. Some chose to be nurses, (my daughter for instance even though I am praying that she should change her mind wants to be a nurse, which I don’t support, not in this country unless she wants to go practice abroad that is when I will allow her to be a nurse even though we are trying to change what is obtainable here).
For crying out loud, people should be proud that they want to go into the nursing, pharmacy, physiotherapy, laboratory sciences or other health related profession. But the way the health sector is being treated, especially the other health professionals, a lot of people want to be medical practitioners because that is the only place to get reasonable remuneration.
The remuneration is another sour point and of course leadership of the health sector. Go to the ministry of health, virtually 80 to 90 percent of officers in the ministry of health are medical practitioners. The full minister, minister of state, permanent secretary, director clinical services and so on.
Right now the world health governing WHO, is headed by a medical laboratory scientist. If it would have been in this country, it would not have been possible. No matter your level of education or world renowned you are, the system we have now is that if you are not a medical practitioner, you don’t know anything about health. As long as these issues persist, there might be no peace in the health sector.
PT- Does JOHESU on its demands have a scale of preference or pressing item which once met, other items can be foregone?
Sotiloye- Yes, we have a scale of preference for our demands; but that still does not imply there are other demands which are not also pressing and can be foregone. Though some demands we will say attract more priority than the others, but we will keep agitating for them until we get them because attending to every issue would make the health sector better than as it is right now.
But most pressing on the list of our demands includes adjustment of the COHESS salary scale the way it was done for the medical practitioners and payment of outstanding duties and allowances owed our members across the country.
We would also want the implementation of court judgements that are not yet implemented by the government. As I am speaking to you there are subsisting court judgments that are yet to be implemented.
We want those court judgement to be implemented to the last letter. The court judgements are: recognition of the medical laboratory science as a professional and that it should only be headed by a medical laboratory scientist, not a pathologist, ditto for radiographers.
Creation of medical laboratory science department in various institutions across the country.
Aside that, we also want the headship of teaching hospitals to be open to all qualified health professionals in the health sector. That is another sour point that is of importance.
They should make it open, let whosoever is qualified apply, and be subjected to whatever screening or test to know who will be most qualified to take the job. The government should stop screening out some people. In lot of cases, you have lot of people who are more qualified being screened out solely because the say the position is for medical practitioners.
The consultancy status for qualified health professionals should also be implemented. Even though there was a circular issued to the effect, but since the circular was issued not one single consultant have been conferred with such as a status and it is not that there are no people qualified.
PT – Controversies have trailed conferring consultancy status on other health workers. Can you be shed more light on why they are also deserving of the status?
Sotiloye – In the first instance, what is the meaning of a consultant? It is the ignorance being displayed by most of our medical professional colleagues who think consultancy status is meant only for medical practitioners.
A consultant in which ever field means an individual who has become an authority in his or her field. Somebody that his or her fellow colleagues can go to for professional advice. Somebody that can be held responsible if anything goes wrong under his or her watch.
In the legal profession, somebody you can equate as a consultant is the Senior Advocate of Nigeria. In the building industry, we have architects who are consultants and once you are conferred with that status, and you are involved in a project and something goes wrong, you will be held liable.
In my profession, physiotherapy, there are so many specialties. In my own specialty which is cardio-pulmonary physiotherapy, if I am conferred with the consultancy status, which I believe I already am, just that the government is not recognising me as one, I believe I am an authority in my field and I can be consulted from any part of the world to speak or advice on any issue pertaining to cardio-pulmonary physiotherapy.
So I can train several younger ones in my own specialty as a consultant. What I will do is that I will be training people in my field in my very narrow specialty who will be specialists in that field. And there are so many of the health professions, such as nursing, laboratory science among others who have specialty groups like that.
The question is: why do we have consultants in other professions in developed countries. In every developed country in Europe or America, we have all the other health professionals as consultants, so why are they saying we cannot have it in this country?
That is why the health sector and the country is still backward because we do not want to copy best health practices and move along with the world. Things have moved far away from the 1940 and 50s model that we are still holding on to, that is the problem. Our medical practitioners don’t want to let go of the ‘privileges’ (because they see it as such, not knowing that they are dragging the whole country back) they were enjoying up to 1940 and 50.
Medical care has moved on way far than the model we are still trying to hold on to in this country. Things have moved on.
PT – The exodus of health professionals in Nigeria; how has it affected the various health groups under JOHESU, the health sector and what is the way forward for Nigeria?
Sotiloye- Obviously, it has affected the health sector negatively because you will see our best brains leaving the country for greener pasture. What we lose in the country is another man’s gain. Other countries now use our brains to develop their system.
Not that I totally blame those who are leaving. If the quality of life in the country is not as good as it should be, then one option for those involved is to try and seek better quality of life elsewhere.
Our people are not getting the amount of care they should be getting. Go to a lot of institutions, you will realise that they are acutely short-staffed. Look at the ratio of the population to the health professionals in this country, it is way below what it should be.
Physiotherapy for instance; ideally, it should be one physiotherapist to four people. In a population of 180 million, we need between 30- 35 million physiotherapists in this country. Right now the population of physiotherapists in this country I don’t think it is up to 4,000.
I don’t have a figure of those who have left the country, but I can tell you physiotherapy for one, you have more Nigerian physiotherapists outside the country than you have in the country.
Of 3,000 physiotherapists we have in this country, I am sure we have close to 10,000 Nigerian physiotherapists outside the country, distributed to various countries across the world.
Even the nurses, go to America, England, Saudi Arabia, Iraq, Dubai there is virtually no hospital you go to in those countries that you don’t see a Nigerian nurse, whether male or female.
We are way below where we should be. Even for the medical practitioners, the medical practitioners in this country as at last count was about 25,000 to 180 million people, maybe we are even closer to 200 million now.
The mass migration is affecting the health sector seriously. Do you know what it takes to train one single health professional? And before the get the required or necessary experience and expertise in a particular field, it takes time. But you see that it is not only the fresh graduates that are leaving, even the experienced ones are even leaving.
It takes time for those on ground to get the necessary experience or expertise in the fields they want to specialise in. This is not to say that even if they stay here, without adequate funding, our people will still not get the best from the system.
There is a need for the provision of a very good environment to perform our duty. If the tide can be stemmed then things will get better for the sector.
PT – With all the problems in the health sector, what is the future like for the Nigeria?
Sotiloye- I will like to be optimistic. With the activism, if there is a turnaround in the health sector, the future is bright for the health sector, Nigerians and Nigeria.
If we get the right person to oversee the affairs of health in this country, Nigeria will be better off.
Just look at the time of Eyitayo Lambo; that was a good time for health sector as the Nigerian health indices improved tremendously under his watch. But it has been nosediving again since after he left office.
We will keep talking, we will keep agitating, better funding of the health sector, provision of adequate working equipment and adequate conducive environment, manpower development among others. If we start having that, then the country should be better-off than it is right now.