Not a few people doubted the ability of Nurse Abdrafiu Alani Adeniji to pilot the affairs of the National Association of Nigeria Nurses and Midwives (NANNM) when he emerged as president of the group in 2012. However, within just a year in office, he has repeatedly proved himself a capable captain of NANNM. Recently, he led a protest against the imposition of a medical doctor as the chairman of the Nursing and Midwifery Council of Nigeria, a position which has now been ceded to Nurse (Alhaji) Musthafa Jumare.
In this exclusive chat with Temitope Obayendo, the NANNM helmsman condemns the gross injustice and corruption in the health care sector, as well as negligence of the role of nurses.
Below is the full text of the interview:
Could you briefly introduce yourself?
I am Nurse Comrade Abdrafiu Alani Adeniji, national president, National Association of Nigeria Nurses and Midwives (NANNM) which is the professional association and trade union organisation for all registered nurses and midwives in Nigeria.
As the president of NANNM, how far have you gone in achieving your goals for nursing and what are the strategies on ground to see your vision accomplished to the letter?
The goals of my administration for the pursuance of my set manifestoes are based on the philosophy of the organisation in Article III (a) which read thus:
“The National Association of Nigeria Nurses and Midwives believes in activities which will bring about positive changes required in making nursing profession more responsive to health needs of individuals, families and communities. It is the belief of the Association that the broad interest of its members should be protected and well represented before contemporary professions, employers and the public at large. The Association believes in continuing education of the nurses and nursing research as a major way of attaining perfection in nursing practice. The Association believes in promoting unity, co-operation and understanding among its members and other working class organizations generally.
My Vision and Mission as documented in my manifesto are as follows: Vision – to lead Nigerian nurses/midwives to the next level of being virile professional body representing the interest of her members across the boarders. Mission – to provide adequate qualitative, democratic and responsive leadership in discovering our latent potentials, minimising our weakness, harmonising our strength and reconciling our differences.
Regarding achievements, we have put in a lot of attention to our membership drive, mobilisation and organisation cutting across nurses in Federal, State and Local governments and those of our members in private practice. We met an ongoing reconciliation among the national leadership and members in the Federal Health Institutions who, until then, had contracted out of NANNM; but, today, our peacemaking and reconciliation has brought them back to the fold of NANNM.
It was during this regime that the long-awaited provisional (temporary) accreditation was given to Nursing Science programme at National Open University of Nigeria and the first graduation of thousands of Nurses with Bachelor of Nursing Sciences came into reality. The association leadership is leading the stakeholders in nursing education in contributing a great deal in ensuring that our Bachelor of Science graduates are allowed to do clinical posting in form of internship after 5years of academic and clinical trainings in the University to sharpen their professional skills.
We have always defended the rights and privileges of our members and protected them from exploitation in the labour markets. We hold regular programmes like the celebration of Annual Nurses Week which incorporates continuing education programmes and social interaction. We have also succeeded for first time in recent years to hold separate celebration of the International Midwives Day in Abuja on 4-7 May, 2013 along with collaborating partners. Gaps in midwifery education, legislation, association and practices were identified and solution proffered.
We have participated in international programmes like the West African College of Nursing in Liberia, African Midwives Conference in Kenya, International Council of Nurses in Australia (also in May, 2013) and International Council of Midwives workshop for leaders in Ghana between October and November this year. All these programmes are done with the good will of the employees and members of Nurses and Midwives Association. Our staff welfare has been stepped up and we hope to do more to motivate them for higher performances. Our main strategies are investing in manpower development and regular consultation with elders and leaders of thought, as well as regular meetings and in-service trainings. Some of our members are presently undergoing in-service training both in Nigeria and abroad.
What is your opinion about the recurrent doctors’ strike in the nation?
Recurrent industrial disharmony leading to strike is not limited to medical and dental practitioners alone. Nurses, laboratory scientists, physiotherapists and other health care personnel are also involved in strike actions at different times.
I think generally it’s due to maladministration of health care services in Nigeria. It has a characteristic nature of lopsidedness, inequity, monopolisation of power and absence of team spirit which health care delivery services require, and as is the case in other countries.
My opinion is that all stakeholders in health care services should be allowed to participate in health care administration in Nigeria. If resident doctors are on strike because they want an improvement in health care infrastructural development, it is in right direction. It is the concern of all the health care professionals that our health care facilities are equipped with modern equipment, and that infrastructures are developed to meet modern standard.
There is always this power tussle in the health sector, where the doctors are always assuming the headship of the group. How true is this assumption and how can it be rectified?
Injustice, corruption and inequitable distribution of health care resources have led to total collapse of genuineness and sanity in the health care Industry. Health care industry is a demonstration of the coming together of many professionals with collaboration and interdependency for efficiency and better health care services results. This working together is known as team work. It has the patient at the centre while other health professionals contribute their quota to oil the wheel of the smooth running of the system. But self-centredness, personal aggrandisement and ill-feeling have destroyed the team spirit where professionalism has been replaced with ‘proffesionism’ as theorised by professor Iyaji, in one of his research works on team spirit in health care industry.
The headship of health care services delivery is not the birth right of only one group of professionals, and no good result or patient recovery can be attained with a destroyed team spirit. It is affecting quality of health policy formulation, implementation and appraisal. It is also the cause of inequity and the incessant strike in the industry.
In other countries, other health care professionals other than medical and dental practitioners are allowed to contribute their own professional expertise to health care management. At the levels of Federal Ministry of Health, Board of Management of Teaching Hospitals, Federal Medical Centres, research institutions and other institutions collaborating with and allied to health services, this is like a taboo. The inordinate ambition and desire to stick to colonial/expatriates salary relativity which existed when very few doctors practising in Nigeria were from foreign and developed countries of the world because Nigeria had no indigenous practitioners. the key elements of the present day remuneration and endless struggle in Nigeria health care system is still based on expatriates salary relativity. Remuneration world over are based on quantum and quality of services you rendered.
International best practices allowed for all healthcare care professionals to have a stake in the efficient management of the health care services. In India, the Minister of Health is not a medical doctor; he holds M.Sc. degree in Zoology. In Botswana, currently, the Minister of Health is an accountant who took over from a nurse who was a Minister from 2003-2009; she also took over from another professional colleague (nurse). No wonder the country has witnessed tremendous development and advancement in health care services. Botswana is rated by WHO as one of the best in Africa in health care status.
In UK the present Secretary of State for Health holds a Master of Art in English Language; in USA, the Officer In-charge of the Department of Health and Human Services (equivalent to our own Minister of Health) in 2009 holds a bachelor degree in arts and a master degree in Public Administration. Coming down to Nigeria, it is on record that the tenure of many non medical doctors at the helms of Federal Ministry of Health witnessed stability and harmony as epitomised by the leadership of Admiral Patrick Koshoni, Admiral Jibril Ayinla, Prince Julius Adelusi Adeluyi, Prof. A.B.C. Nwosu and Prof. Eyitayo Lambo.
What is the position of NANNM concerning the National Health Bill, and National Health Insurance Schedule?
The National Health Bill is very necessary for efficient management of health care Nigeria. But the same factor of lop-sidedness and anti-multi-professional practices dimension has brought about the challenges it is facing today. NANNM, as a professional association, has participated in various attempts to correct the anomalies contained in the draft Bill like in section one subsection one, where the bills seeks to eradicate the roles and responsibilities of various professional regulatory bodies. This is not the best for Nigerian health system. Also Section eight, subsection two that entails establishment of National Tertiary Hospital Commission, as well as subsection four of same section eight, show that there is no fair representation of the health professionals in the commission.
The area that touches on sourcing fund for primary health care services seems to impinge upon the Nigerian federal system of government and administration that allows for relative autonomy of states and local governments. These and others are few of the offending clauses in the Health Bill that need to be corrected.
The same maladministration is applicable to the National Health Insurance Scheme. The Act that established the scheme did not take into consideration the relevance of other health care professionals in the selection of board members, criteria for selection of the executive secretary, and even in setting out the rights of nurses in day-to-day running of the scheme.
For example, the World Health Organisation describes a nurse as “a person having received authorised education and training, has acquired knowledge, skills and attitudes in the promotion of health, the prevention of illness and care of the sick. Thus making her/him an integral member of the health system, he/she is capable of solving within his or her competence of solving the health problems which arise in the community.”
The nurse has independent, interdependent and dependent roles in health care services. Often, the dependent roles of nurses are used for their placement in the scheme of things, including remuneration. World over, nurses serve pivotal roles upon which other health professionals revolve to have access to patients and clients. But, in Nigeria, it is irritating that even in remuneration, the classification is doctor; pharmacist/physiotherapist/laboratory scientist; nurses and others. You can imagine that kind of injustice. It shows that nurses are the most deprived frontline health care professionals.
It has been opined that to assess the efficiency of health care system in any country you should just simply do an appraisal of the kind of treatment and placement of their nurses and midwives. Without placing nurses and midwives on a higher pedestal like other health care providers, the outcome will be below average and continue to nosedive. Even if nurses do not agitate, the law of natural justice will demand for redress, failure of which will make heaven fight for the oppressed.
It was in the news recently that the federal government was trying to impose a doctor as the national leader of nurses. What steps have been taken to resist this move?
You mean the position of the chairmanship of Nursing and Midwifery Council of Nigeria, where a medical doctor was proposed? Well, it is either that it was a mistake as we were made to believe by the Honourable Minister of Health, or that it was just an experiment to see whether they could achieve another incursion into another profession to assert their hegemony, further subjugating and causing more havoc.
In any case, Nigerian nurses unequivocally rejected the move, though we had long expected the council inauguration. But it is better that we do not have a council in place than having a medical doctor in that position. It is not a personal issue but one that borders on natural laws and world best practices. What would a medical doctor know about nursing and midwifery services? Though medicine and nursing are twin-sister profession, they are expected to move side by side without one impinging on the roles and responsibilities of the other.
It has to be said that no amount of resources expended on development of medical sciences will be seen to yield commensurable result if nursing sciences are left behind as it is today. How can you explain the huge investments in medical sciences, which have not in any way helped our bad and retrogressive health status in Nigeria among the committee of nations in Africa?
Still on the issue of appointment of a medical doctor to be the national leader of nurses and midwives, it was a bad dream that couldn’t have come to reality. If it had, then posterity would not have forgiven us and generations yet unborn would have cursed us. In fact, it would have been aiding, abetting and propagating high level quackery punishable under the law.
I am happy to inform you that a better option has been offered in person of a professional, Nurse (Alhaji) Musthafa Jumare as the chairman of Nursing and Midwifery Council of Nigeria. We are only awaiting the inauguration of the council and we pray that the council succeeds in the task ahead. However, the Nursing and Midwifery Registration Act (as amended) Cap 143 LFN is due for a review and the process has been kick-started to block the loopholes contained therein.
Record has it that the rate at which health practitioners abandon the shores of Nigeria to seek greener pastures is alarming. Do you think there can be a permanent solution to this problem?
The movement of skilled manpower in health care system abroad in search of greener pasture is erroneously called ‘brain drain’. I see this word as ill-motivated. The movement of skilled manpower from an area of low premium, low motivation and bad remuneration to a place of higher premium value and motivation could be known and addressed as ‘labour mobility’. This is not only related to fiscal or monetary value. It also entails the fact that in other countries where these people migrate to, the Nigerian nurses that are treated and rated very low in Nigeria are rated higher, well-placed and respected and, of course, also well-paid.
The solution to this for us in Nigeria is to study and adopt the treatment, placement, payment and respect being given to our nurses where they migrate to. We need a level of social-re-engineering in our value system for nurses. We equally need to be equitable in our policy formulation. If nurses are motivated and not caged, they will oblige to stay in Nigeria, their fatherland, and contribute their quota.
It is highly appalling that the traditional roles of midwives – that is, to take care of pregnant women, diagnose and treat associated illnesses, prepare them for delivery and eventually take the delivery – are denied them today in most of our teaching hospitals. Yet we are suffering from high maternal mortality rate and demoralising infant mortality rate. The perverted course of social justice has to be re-ordered in favour of equity, fair play and re-enthronement of justifiable jurisdiction scope in Nigerian health care professional practices.
Nurses in Nigeria need to be accorded rightful position in the scheme of things. Nurses need to be remunerated with a scale commeasurable to the quantum of the skills, knowledge and expertise we contribute to quality health care services and day to day running and administration of health care services in Nigeria. They need to be provided an encouraging working environment to stem the tide of workplace hazard for nurses, provide infrastructure, equipment and some social amenities to make work environment more favourable for nursing practices especially in primary health care services.
If there will be efficient primary health care services in Nigeria, we have to go to the forgotten healer of promotive and preventive health care services in Nigeria by empowering the community midwives and public health nurses whose roles are being eroded today in primary health care.
Could you mention some other challenges of the health sector as they affect NANNM?
The challenges are numerous. They include but not limited to: lack of equipment in our hospitals, acute shortage of skilled manpower, quackery, inadequate funding (it may interest you to know that, presently, Nigeria still budgets below the WHO benchmark for health), corruption, destruction of team spirit, incessant industrial strike, low ebb of technological advancement in health and low or under reporting of health care issues and incidences. These are general health care challenges in Nigeria today.
In nursing profession in particular, the bad image of nurses and nursing in Nigeria, absence of unified scheme of services for professional nurses, non-implementation of I.A.P award since 24 years ago and utter neglect of National industrial court judgement are few challenges that are confronting nursing profession in particular.
Most nurses are not going through well programmed continuous nursing education that’s in line with global standards. Nurses leaders at state levels ie ministry of health, and state NANNM officials are more interested in what they gain when they organise mushroom “mandatory courses” that doesn’t improve or update nurses knowledge. All they do too is approved by the Nursing and Midwifery council. These to me are the reasons and many more that cant be stated here that have contributed to decay in our health care system