CPAN Says~ : "MDCAN and APCOM do not prioritize patients/community interests over personal gains, going by the duo's recent press releases"

The Clinical Pharmacists Association Of Nigeria (CPAN) hereby places on record her total condemnation of the position of the Medical and Dental Consultants Association Of Nigeria (MDCAN) , and the Association Of Provosts Of Colleges Of Medicine in Nigeria ( APCOM) over their recent Press statements on the Bill titled: A bill for an Act to amend the University Teaching hospitals ( Reconstitution of Boards) Act, Cap U15 LFN 2004. The Bill was sponsored by Hon.Bamidele Salam , representing Ede North/Ede South/Egbedore/Ejigbo Federal Constituency.
CPAN is a registered body corporate of Clinical pharmacists in Nigeria (and in diaspora) with the fundamental aims and objectives to provide direct healthcare to individual patients and the general population through advanced Clinical Pharmacy services. CPAN believes that Nigerian people deserve and should get optimal healthcare that fits global best practices, and that achieving this goal should override any other chauvinistic professional interests and considerations.

Some other Aims and objectives of CPAN include;

(1) To foster and support excellence in clinical pharmacy practice, research and education so that practitioners can provide outstanding patient care.

(2) To collaborate with other healthcare specialists, governments and NGOs ( Non governmental Organizations ) to develop clinical pharmacy practice guidelines that will be used in all healthcare settings as essential sources of pharmacotherapy and pharmaceutical care towards improving the health of the community at large .

(3) To maintain a pool of relevant data on pharmaceutical care, adverse drug reactions or toxicities , pharmacotherapy etc , and make this available to other members of the healthcare team and the general public as the need arises.

4) To advise the government and policy makers on aspects of pharmaceutical care in particular and health care in general.

5) To encourage collaborative health care practice amongst the multidisciplinary healthcare teams in line with international best practice.

CPAN as an international clinical Pharmacy Association domiciled in Nigeria, finds it difficult understanding the statements credited to both MDCAN and APCOM in various News media recently about the health bill , claiming that Physician led hospitals are universally better managed than non physician led hospitals. We hereby state that such claims lack verifiable evidence and are aimed at misinforming the general public and our lawmakers.

For instance, in the US, according to publicly available publications; physician CEO of the nearly 6,500 US hospitals declined from 35% to 4% as of 2009.
The US has steadily embraced trained hospital managers (who could be physician or non physicians) over time.
Gunderman R, Kanter SL. Perspective: Educating physicians to lead hospitals. Academic Medicine. 2009 Oct 1;84(10):1348-51.

In South Africa, a medical degree is not a requirement to be hospital CEO.
But the person has to be a health worker.
"It clearly stated that the basic requirement is that whatever the qualifications of an individual are, they must first and foremost be a health worker."

CPAN is not opposed to any particular healthcare professional group members being the heads of Nigeria's university teaching tertiary hospitals, but we in CPAN are deeply concerned about the continued deleterious outcome of sacrificing competence and merit on the altar of ego of a certain group of Nigeria's health care Professionals.
The continued decadence and downward trend of the critical comparable health indicators in Nigeria for several decades now is the strongest evidence against status-quo.

Now is the time to change; we cannot continue to do the same things the same way and expect a different result. The Health Bill in reference should be appropriated and allowed to be passed after a constructive debate on the floor of the Nigeria National Assembly.
Our national health indices represent a national embarrassment to us Nigerians in the committee of nations.

The issue should also be about global best practices in the right sense of the clause as quoted by APCOM and MDCAN in several press releases.
What is proper, is that physicians who get such apex appointments should be hired based on merit and competence , and not based on their first degree, because this is not the practice anywhere known to us in the world.
The position of the Chief Medical Director is indisputably a top management position , and not a direct patient care or clinical position.

Globally, it is clear that there are basically two criteria required for top management positions such as headship of hospitals.
The criteria are qualifications and cognate experience.
Generally, anyone vying for the position of headship of hospitals must have the relevant qualifications. It could be a Masters in Business Administration (MBA), Masters in Health Management, Masters in Health Administration or Masters in Medical Management or other equivalent administrative postgraduate qualifications .
This is the area MDCAN and APCOM are expected to be looking at, as observed in many countries with enviable health care systems.

MDCAN and APCOM admitted that Nigeria's healthcare sector is an ailing one, yet they do not want to agree that the country needs to change her ways of doing certain things especially the way of managing our health sector.
It is painful to see MDCAN describe this God inspired Bill as obnoxious, without remembering that continually doing the same thing in the same way, and expecting different results is nothing but complete madness.

Therefore CPAN hereby wishes to describe the call or bill for a reform in the process of appointing Hospital Heads in Nigeria as a heroic one. No well exposed and informed, except a selfish person and an enemy of health seeking Nigerians, will oppose such a laudable proposed bill by our lawmakers.

May we remind the duo of MDCAN and APCOM that setting aside the sponsored bill will bring an end or death of the already sick Nigeria's health care sector.
Contrary to the assertion by MDCAN and APCOM that the sponsor of the bill is a lawyer , and therefore not competent to understand happenings in the health sector, it should rather be a welcome development by every Nigerian, because lawyers are conversant with jurisprudence, ethics and bureaucracy of the different professions; and this is why lawyers are frequently used in management of affairs in many developed countries. Kudos to Nigeria's President ( Muhammadu Buhari) who just appointed a lawyer as Minister Of State for health.

CPAN hereby advocates that the National Assembly should as a matter of urgency and necessity as well as of obligation, amend and pass the bill as sponsored by Hon Salam in the interest of Nigerians, to usher in growth, competition, comparison , and leapfrogging of Nigeria's health index on the international space.

Furthermore, it is important to emphasize that cognate experience in management is critical in holding top jobs all over the world. But how many of the Chief Medical Directors (CMDs) and CMAC ( chairman, medical advisory committee) jobs in contention, are being held by those with relevant and adequate cognate experience in management or administration, especially when it involves human resources? This is what the bill currently on the floor of the National Assembly seeks to address.

A good number of Nigerian physicians who currently head hospitals are associate members of professional management bodies, and were awarded those titles as a form of recognition ( not on merit of academic training of the recipients) by the professional management Associations.
Therefore such recipients do not actually have the academic or experience requirements.

CPAN will like to cite examples,of heads of hospitals in different countries as seen below;

1) Ms Angela Nolan a chattered Accountant is the CEO of St. Vincent Hospital Melbourne, Australia.

2) Karen Davis, a nurse is the CEO of St.Thomas Hospital, Ontario.

3) Mr David Probert is the CEO of University College Hospital London (NHS) , Foundation Trust (A Racer).

4) Mandeline Bell, a Nurse is the current President/CEO of Children's Hospital Philadelphia.
This hospital is one of the top ranked children hospital in the USA., and ranked number one , on Forbes 2022 list of America's best largest employers.

5) Gladys Bogoshi, a Physiotherapist is the current CEO of the Charlotte Maxeke Johannesburg Academic Hospital ( Wits University)
She has a Masters degree in public health for hospital managers.

6) Regina Cummingham ( a Nurse) is the CEO of the hospital of the university of Pennsylvania.

Finally, it is sad that the MDCAN and APCOM are trying to compare apples with oranges, and aim at misleading our lawmakers by stating that other healthcare professionals are paramedics and support staff. Suffice it to say that the leaders of MDCAN who made the misleading press statements have "murdered grammar.".
Paramedics or support staff is never a nomenclature used to describe other health care Professionals such as Nurses, Pharmacists, Optometrists, Physiotherapists etc , anywhere in the world. Paramedics denote a distinct set of health care providers.

MDCAN and APCOM, also argued that a priest heads a Catholic church while a Judge heads a court. If one may ask; is the church or a court , a multicomponent sector comprising of multiple service professionals like the health sector?
Why are they not looking at the Structural/Building team made up of various professionals such as Architects, builders, surveyors, engineers etc?
Whose exclusive right as any one profession, it is to head the Building team?
What about the defence team with the Army, Air force, Navy etc?

Which particular one professional soldier group has it as an exclusive right to head the Ministry of defence?

They argue that the Vice Chancellor of Universities must be an academic. What a lame argument !
Are academics or Vice Chancellors all of one particular Profession?
MDCAN and APCOM may also require tutoring on what constitutes a profession and Professionals, if they feign ignorance because of selfish reasons.
The health team comprises the health care Professionals and even the patients inclusive, and is never a monocomponent team of a particular set of professionals , like the legal team or the clergy . .

Our Recommendations.

CPAN will like to recommend some options to the National Assembly as concerns the headship of hospitals, so as to address issues raised by all concerned parties.

There can be the CEO management pathway of headship and the Clinical services Pathway ( Medical Director).
The CEO management pathway has to do with human and other material resources management, while the other pathway ( Clinical services management or CSM ) has to do with management of diverse disease conditions.
Interestingly, both positions can coexist side by side as seen in some countries, but the CEO is higher in rank than the CSM(medical director) even if the latter may collect higher remuneration based on some clinical practice perks.
The head of the clinical services team (CSM) can be appointed based on the situation as it bothers on direct individual patients care.

In that case a physician with a postgraduate qualification can always be the head, while a Pharmacist, Nurse, Physiotherapist or other clinicians should be appointed as deputy head by the hospital/appointing authority.
Then, there can still be the position of Director of Administration which also forms part of the management cadres.
But the CEO who must be highest in rank, must not necessarily be a physician or other health care Professional as he is never there to treat patients directly, but to manage the hospital more effectively.
If this is adopted, we believe that the baseless claim by some Physicians that patient care may be negatively affected must have been addressed.

Suffice it to ask again, what is the job of the different directors of medical services, Pharmaceutical services, Nursing Services etc?
If we have all the above mentioned directors who are professionals from the specific fields directing the clinical concerns of patients in our hospitals, what else do MDCAN and APCOM want the CMD whom they argue must be a physician, to be directing at the Patients' bedside before the hospital can do well?

CPAN once again wishes to use this opportunity to commend the laudable efforts of Hon. Bamidele Salam in particular, and the National Assembly in general for their efforts towards transforming Africa's most populous nation's health sector through the amendment and expected expeditious passage of the concerned bill.
All the examples of headship of hospitals across the world which we have cited here can be verified by our indefatigable law makers, and even the press who constitute the watchdog of the society.




Dr Moteehat Bukkie Olu-Lawal PharmD, MCPAN, MPH, FPCPharm.
National Secretary

Dr Joseph Madu PharmD, FPCPharm, DCPharm, MAW, MCPAN, FPSN
National Chairman

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