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.”
https://www.gov.za/health-minister-dr-aaron-motsoaledi-press-statement-appointment-hospital-ceos

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.

TOGETHER WE CAN GET IT RIGHT FOR HEALTH CARE IN NIGERIA.

Thanks.

Signed.

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

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

The post THE POSITION OF THE CLINICAL PHARMACISTS ASSOCIATION OF NIGERIA ( CPAN) ON THE HEALTH BILL CURRENTLY BEFORE THE NATIONAL ASSEMBLY . first appeared on CPAN WORLD.

Federal lawmakers have expressed their support for a private member bill for an Act to amend the University Teaching Hospitals (Reconstitution of Boards etc.) Act, 2004,’ sponsored by Hon. Bamidele Salam.

Tribune reports that members of the House of Representatives on Wednesday expressed overwhelming support for a bill that seeks to reconstitute the Governing Boards of Federal University Teaching Hospitals across the country.

Hon. Salam, a member representing Ede North/Ede South/Egbedore/Ejigbo Federal Constituency of Osun State who spearheaded the debate explained that the bill seeks to restructure the composition of the Governing Boards of tertiary health institutions with a view to making them more vibrant and efficient.

The Bill further aims to: “review the terminology of the heads of the hospitals, redefine the qualification of the Head of hospitals, provide a definite tenure of office of the heads of the hospitals, including students of Health Sciences in the training programmes of the hospitals and include hospitals established post-enactment of the extant legal framework in the schedule and for other related matters.”

Hon. Salam said “It could be recalled that, currently, the terminology used in referring to the Head of tertiary health institutions in Nigeria is called ‘Chief Medical Director’. He is accountable to the Board of the institution. The Chief Medical Director is responsible for the execution of policies and matters affecting the day to day management of the affairs of the Hospital.”

“Before one can be qualified to be appointed as CMD, the person must be Medical/Dental Practitioner registered with the Medical and Dental Council of Nigeria of not less than 10 years post qualification.“

“In addition, the person must be a fellow (s) of either the National Postgraduate Medical College of Nigeria or the West African Postgraduate Medical College or its equivalent registered by Nigeria’s Medical and Dental Council.

“Furthermore, the person must have been a consultant for a minimum of 5 years. Administrative qualification and experience is only an added advantage, amongst others. The Medical/Dental Practitioners who solely enjoy the privilege of being made the Chief Medical Director constitute not more than 5% of the total number of medical personnel in the Health Industry.

“The current legal regime excludes other health professionals – Pharmacists, Nurses, Social workers, Occupational therapists and physiotherapists, Psychologists, Bereavement Counsellors, Paramedics, Dieticians, Lab Scientists’ and Speech Pathologists, amongst others- from becoming a Chief Medical Director.

“Section 5 of the Principal Act, which provides for the appointment of the CMD, also provided the functions of the Office of the CMD, which includes: the execution of policies and matters affecting the day to day management of the affairs of the Hospital. A cursory study of these responsibilities reveals that the burden is purely administrative; it has nothing to do with a particular professional in the health profession.

“In the United Kingdom, to become a hospital administrator, one doesn’t have to be a medical practitioner. All you need is to be a Graduate from High School (4 years); Obtain a Bachelor’s degree in healthcare administration, business administration, or a clinical discipline (4 years); and a master’s degree in healthcare administration (MHA) or a related graduate degree (2 years).

“In the United States, there isn’t one specific path to follow to get a hospital administrator’s job. You may begin your career in some other role with that goal in mind (some start as Doctors or Nurses) and be promoted to the position. However, it’s common for hospital administrators to earn a relevant degree—and an increasing number of employers now require a master’s as well.

“Generally speaking, there are four basic steps to becoming a hospital administrator: Get a bachelor’s degree in health systems management and health services or related disciplines; Get a master’s degree in n hospital administration or healthcare administration; Gain experience and other certifications such as American College of Healthcare Executives (ACHE) Accreditation or Certified Medical Manager (CMM) Accreditation etc.

“It is clear from the above cross-country discussion that to be appointed as a Chief Executive Officer, one doesn’t have to be a medical doctor. Persons with Bachelor’s in Management or Administration with requisite experience can be appointed to head a hospital. Similarly, in the composition of the Board of the Hospitals, other critical stakeholders were not included. Greater attention was only paid to medical doctors.

“Against this background, this Bill is proposed to address all these challenges and include all other health professionals in the capacity building and administration of the Federal Hospitals in Nigeria and related issues,” he noted.

Hon. Salam who solicited the support of members explained that the objectives of the Bill seek to, “review the terminology of the heads of the hospitals; redefine the qualification of the Head of hospitals; provide a definite tenure of office of the heads of the hospitals; including students of Health Sciences in the training programmes of the hospitals; and have hospitals established post-enactment of the extant legal framework in the schedule.“

“Hospital administration is a speciality within healthcare administration; it is one of the most advanced leadership careers in healthcare. It focuses on the overall operation of hospitals and other significant health facilities and requires both healthcare experience and administrative/management acumen.

“The purpose of the bill, therefore, is to strengthen the administration mechanism of University Teaching Hospitals through the broadening of its administrative heads and entrench greater professionalism in the management of our medical tertiary institutions.

“The Bill will also considerably reduce inter-disciplinary rivalry within the teaching hospitals by ensuring that all critical stakeholders are involved in the composition of the Boards of the teaching hospitals.

“This Bill is in tandem with global best practices with special references to the United Kingdom, United States of America and other countries where medical training have been successfully implemented through collaborative efforts of all practitioners,” Hon. Salam explained.

The post National Assembly Proposes To Include Pharmacists, Nurses & Other Health Practitioners In Headship Of Teaching Hospitals first appeared on CPAN WORLD.

The Nigerian physicians are really all out to champion a new course for themselves in line with the current realities in Nigeria despite the “No Work , No Pay” threat. Many of the physicians have perfecte plans to exit the country for a greener pasture. Though, the Nigerian Nurses have been the major group migrating outside the country in the highest number & rate, the recent recruitment exercise by some Saudi Organisations has coincidentally orchestrated & added value to the claims by NMA that its members are exiting the country.

Also thousands of Nigerian Pharmacists are emigrating into many foreign countries en masse & unannounced . Hence, there is a total “Brain Drain” in Nigeria. The physicians have actually been “taking the Bull by the Horn” by severally down-tooling. The Nigerian Pharmacists & the Nurses are also among the major & core health Clinicians that are grossly under paid relative to what their counterparts earn abroad. The Physicians, Pharmacists & Nurses are majorly the health care professionals who are usually regarded as “3-Digits” salary earners in US as their salaries are usually over 100,000USD per annum.

After the 1st wave of  Covid Pandemic, countries like the US & others started increasing the take home pay of the clinicians like the Physician, pharmacist & Nurses such that some Nurses now earn up to 15,000USD per month as their demands also have marginally increased. In Nigeria, the interprofessional rivalry among the health workers has become antithetical to the expected growth & welfare packages accruable to the health care professionals, especially the Physicians, Pharmacists & Nurses who are usually seen collaborating in most countries abroad. The sharp division has led to the almagamation of other health workers as a union while the physicians exist as an opposing union.

While the physicians appear to be making some waves, the Pharmacists & Nurses appear to be entrapped & entangled in a web. While most Government & Organisations abroad usually grant the nurses, pharmacists & physicians a decent “take-home” pay as the major pillar & core clinicians in the health sector based on the value & output of their contributions, these 3 core clinicians have allowed their geniun demands to be submerged by the “bogus” demands of many other health workers. Some of the health workers in Nigeria who are making “bogus” demands for appointment as specialists are regarded as technicians inother countries. Again, the take home pay of the core clinicians like the Nurses, Pharmacists, & Physicians cannot be compared with most other health workers in most countries.

There is always the difference between health workers & health care professionals as health Care Professionals are the core clinicians who have direct patient contact. The Physicians, Pharmacist & Nurses are the ones who operate as Consultants, Specialists, Prescribers, Diagnosticians, residents, etc & have seperate pay packages. The only way out of the present “mess” in the health sector is for the 3 core clinicians to unite & put pressure on the govt to improve their conditions of services, otherwise the Nigerian health sector will continue to collapse into a comatose state.

The post THE NEED FOR SYNERGISM & COLLABORATION AMONGST CORE CLINICIANS TOWARDS SALVAGING THE COMATOSE HEALTH SECTOR! first appeared on CPAN WORLD.

BudgIT, a civic-tech non-profit organization that has been at the fore advocating for financial transparency and accountability in public finances, made the revelation in a press release on Tuesday morning. This is despite the refusal of the government to increase the hazard allowance of medical personnel, who are still owed a backlog of salaries.

According to BudgIT the revelation was very disturbing considering the health infrastructure deficit and the raging Covid-19 pandemic affecting Nigeria.

There was a 14 per cent increase in the budget allocation to the security sector of the country from N1.78trillion to N1.97trillion. Between 2015 and 2021, over N10.02 trillion has been allocated to the security sector. BudgIT also noted that non-security related government agencies also receive “security votes”. A total of 117 federal agencies received “security votes” worth N24.3 Billion.

Nigeria currently has a N3.31trillion debt servicing burden, which represents 41.63 per cent of the 2021 budget, but continues to exploit loopholes for more corruption in the system. BudgIT noted that agencies also receive allocations for capital projects they cannot execute.

According to the BudgIT the National Agriculture Seed Council has an allocation for N400 Million to construct solar street lights across all six geopolitical zones, while the Federal College of Forestry in Ibadan in Oyo State got N50 Million for the construction of street lights in Edo State. The NGO is demanding Budget Reforms for Resource Optimization in government agencies.

BudgIT CEO Gabriel Okeowo noted that “the federal government can maximize the little public funds left by blocking the leakages BudgIT has identified”.

References :
https://yourbudgit.com/

Mbalu S, 2021, Foundation For Investigative Journalism (FIJ), accessed at https://fij.ng/article/breaking-2021-budget-has-316-duplicated-projects-worth-n39-5bn/

The post BREAKING: 36.4% OF 2021 BUDGET PADDING IS FROM MINISTRY OF HEALTH first appeared on CPAN WORLD.

The statement clarified that the government circular did not imply stopage of salaries for interns. It also stated that the government neither intended to interupt nor interfere with the salaries and allowances of interns in consideration of the fact that they are trainees under the various establishments they are working.

Recall that cpanworld had previously reported the circular on decisions of the National Council on Establsihments (NCE) to remove interns and NYSC professionals from the Federal Government Scheme of service. Leaving any futher payments of allowances to them at the discretion of the National Salaries Income and Wages Commision. This was as detailed in the document signed by the Head of the Civil Service, Dr. Folashade Yemi-Esan. The National Council on Establishments (NCE) is the highest decision making body in the civil sevice. The decision to remove Interns from the civil service scheme was ratified at its 42nd meeting held in Lagos on November 30, 2020.

The press statement is here reproduced:

“OFFICE OF THE HEAD OF THE CIVIL SERVICE OF THE FEDERATION.

PRESS STATEMENT

RE:CIRCULAR ON INTERNSHIP PROGRAMME IN CIVIL/PUBLIC SERVICE.

The attention of the Office of the Head of the Civil Service of the Federation has been drawn to publications making the rounds on social media platforms with regard to the ” Establishment Circular” on the above subject. It has therefore become important to make the following clarifications:

i. The Circular does not in any way suggest or prescribe the discontinuance of remuneration, salaries and earned allowances for interns as being speculated ;

ii. Moreover, internship is a period of work experience offered by an organization for a specified period of time. It is typically undertaken by students and fresh graduates to gain relevant skills in a particular field before being admitted as practitioners of the particular profession ; and

iii. The Schemes of Service details the requirements for full employment and career progression within the Civil/Public Service.

2. It is important to reiterate that the circular does not seek to alter the wage structures of the internship programmes of different professions.
3. The above clarifications are for the avoidance of doubt and further guidance.

Signed:
AbdulGaniyu Aminu
Director, Press and Public Relations.
Office of the Head of the Civil Service of the Federation (OHCSF)
24/4/2021″

This rejoinder by the Office of the Head of Service raises even more questions as to the position of government on the status of Interns in the Federal Civil Service scheme. Both the circular arising from the decisions made by the National Council on Establishments and the rejoinder released by the Office of the Head of Service who signed the circular seem contradictory and will need further clarification among stakeholders to alay their fears.

The news generated backlash and fury from health professionals who took to social media expressing dissapointment and frustration at the seeming lack of concern of government for the welfare of budding Healthcare professionals which tends to demoralise up comming professionals.

The post HEAD OF SERVICE DENIES STOPPING INTERNS SALARIES. first appeared on CPAN WORLD.

The NCE says that in consideration of the fact that the Interns are presumed to be on training they should not be entitled to a full Salary scale from the government. The NCE further left payment of allowances to the interns to the National Salaries Incomes and Wages Commission. The circular was signed by the Head of Civil Service Dr. Folashade Yemi-Esan who is a Dentist and best graduating dental student from the University of Ibadan in 1987.

The press release is here reproduced as follows:

“Head of Service of the Federation
HCSF/SPSO/ODD/NCE/CND. 100/S.10/11/112

12th April, 2021

INTERNSHIP PROGRAMME IN THE CIVIL/PUBLIC SERVICE

The National Council on Establishments (NCE) at its 42nd meeting held from 30th November 4th December, 2020 in lkeja, Lagos State reviewed the current status of internship programmes/housemanship/NYSC Doctors in the Service, and approved their removal from the Schemes of Service as posts attracting grade levels in the salary structure.

The Council based its decision on the grounds that the period of these programmes/services form part of the trainings in their respective professions. Interns shall, however, be considered for the payment of allowance to be determined by the National Salaries, Incomes and Wages Commission. This approval will be reflected in subsequent edition of the Schemes of Service.

Signed

Dr. Folashade Yemi-Esan

Head of the Civil Service of the Federation”

Recall that Medical Doctors are paid based on an approved Consolidated Medical Salary Scale (CONMESS) outside of the regular civil service salary structure. Doctors on mandatory Internship/housemanship (House Officers) were previously on the CONMESS salary scale as Federal civil servants. It was based on this premise that states and private institutions place Doctors and Pharmacists on full salary scale.

For many years it had been a standard practice for institutions to pay Medical House Officers and Pharmacist Interns in Pharmacy, Optometry and other professions who are on the mandatory 1 year internship programmes prerequisite to full licensing by their various regulatory bodies after which they proceed on mandatory National Youth Service Corps (NYSC). House officers and Interns were previously entitled to full salaries and some of the allowances that government staff enjoy include designated accommodation depending on the institution they found themselves.

In recent years Medical Doctors on houseman-ship have been known to protest non-payment of salaries and entitlements for months even up till the end of their houseman-ship programme.
House officers have been known to take to social media to cry out against presumed injustice following the non- payment or half payment of their salaries after the centralization by the Medical and Dental Council of Nigeria (MDCN). Some accused Medical Directors of Federal Health Institutions of not cooperating with the Medical and Dental Council of Nigeria’s push for House officer salaries. Examples are protests which occurred in the University of Calabar Teaching Hospital and Jos University Teaching Hospital.

Questions are being raised of what the future hold for young graduates in the Health sciences, such as Medicine and Pharmacy, who would otherwise be on internships. Surely applying to Federal government institutions for Internships will become less attractive. Also it is yet to be seen whether the state governments and other private institutions who absorb Interns and NYSC Pharmacists and Doctors will follow suite.

The post NO MORE SALARIES FOR INTERNS & HOUSE OFFICERS first appeared on CPAN WORLD.

The pharmacists alleged that wranglings amongst profesional groups, interprofessional rivalry and greed amongst amongst professionals has continued to encourage the inequitable spread of privileges and resources of players in the sector to the detriment of consumers of health.

Quoting from a statement issued by the ACPN National Chairman, Dr. Samuel Adekola, and the National Secretary, Pharm. Ambrose Ezehthe Association advised: “We Must Save the Health System in Our Country Now” and  noted that consumers of health had been short-changed by the Government and providers.

The ACPN expressed concern that despite the fact that the goals and objectives of both the National Health Policy and National Drug Policy which focuses on accessibility, affordability, safe and efficacious health care services, and credible drug supply system these objective may never be achieved.

They pointed out that there is Identifying a ’glaring ineptitude’ in the health system, which is against the international best practice that hinges on the philosophy of meritocracy which allows for selection based on merit and competencies. They sighted the repeated observation where appointments as Federal Minister for Health , State Commisioners for Health anf Permanent Secretaries in the Health Ministries were reserved for only Physicians. This ugly scenario is also extended to all appointments into the MDAs at Federal and State levels with deleterious consequences on Public Health output in Nigeria.
They stressed the need to have appointments in Nigeria’s health sector liberalised to give room for meritocracy.

“It should interest observers that all appointments into prime MDAs in Health sector for instance; NHIS, NPHCDA, NACA, NCDC, Essential Drug List Committee and all special Health intervention programmes including National Malaria Control, Tuberculosis Control, Leprosy Control, etc are dominated by physicians in Nigeria, including heads of all public hospitals at both State and Federal level. whereas, at the international fora and other saner climes, positions of leadership are based purely on merit, skill, and competencies.

They lamented that the Decree 10 of 1985  reversed the gains of the fruitful headship of Health Administrators in Federal Health Institutions and replaced same with the headship of Physicians as Chief Medical Directors, Medical Directors, Chairman, Medical Advisory Committee, Head of Clinical Services and they are numerous deputies in all Health Institutions across the board at State and Federal Levels.

“The domination is extended to even appointments into the Boards of Management of the various Federal Health Institutions where about 8 out of 13 slots are permanently reserved for physicians at the detriment of consumers of health. “Today as it stands when these serial violations failed with the implementation of the Yayale Ahmed Report, the MDCAN has rushed to the Federal High Court, Abuja, seeking reliefs to bar the National Assembly from enacting Acts of Parliament to regulate the plethora of health professions in Nigeria, while also praying that the Office of the Head of Civil service of the federation is stopped from drawing up the schemes of service for all cadres of health workers.

The ACPN further listed unethical conducts in task grabbing, alleging a recent attempt by Physicians to annex the statutory and professional responsibilities of pharmacists to dispense medicines legitimately in the Health System.
Consewuently the ACPN called on other professional bodies to join forces with JOHESU, Civil Rights Societies, and other patriots to form a workable coalition force to save the health system.

They called on all health workers and their leadership to convey a roundtable to strategise on how best to tackle the lingering Medical and Dental Council of Nigeria, MDCAN, suit at the Federal High Court, Abuja as well as come up with an agenda for a robust healthcare delivery system in Nigeria in the best interest of the people.

The post Community Pharmacists Challenge Government to Make Equitable Appointments in the Health Sector first appeared on CPAN WORLD.

The security risks inherent in guaranteeing universal health coverage have once again been brought to the fore as a group comprising eight Primary Healthcare workers from Oredo Local Government Area have been rescued by the Special Ant-Kidnaping squad Of the Nigeria Police Force in Edo state. The Health workers were rescued just as they were being taken to a kidnaping hideout.

The Health workers from Oredo Local Government Area of Edo state had gone to Umegbe Village to carry out a vaccination excercise and were returning back when they were abducted by armed bandits along Umegbe road by Iyekogba river of Benin City. The kidnappers had positioned themselves along the road proximate to the river in wait for unsuspecting victims. The bus conveying the health worked was intercepted by the daredevil and heavily armed kidnapers. The hostages were then forcefully led into the river where a boat was parked to convey the victims.

Unfortunately for the kidnapers a Police anticrime squad on patrol along the road spotted the victims being forced into the river. On sighting the Police the Kidnappers quickly opened fire. A gun battle ensued and as the police took defensive positions and tacticaly responded, engaging the kidnapers by the river. According to the Edo State Police spokesman Chidi Nwabuzor some of the Kidnappers escaped into the river with Bullet wounds.

During the rescue operation a suspect 32 year old Julius Apay was arrested at the scene as part of the kidnaping syndicate. The syndicate operates within the area by abducting victims by boat and transporting them to their criminal hideout pending demand for ransom. The victims are usualy ferried to an unknown destination through Ogba river in Benin. Julius Apay is to be arraigned before a court as soon as the Police complete their investigation.

As Nigeria gears towards mass vaccination against the dreaded Corona Virus the security situation in the rural communities poses a huge risk to ensuring adequate coverage of some hard to reach communities should the federal government decide to rollout vaccination excercises in these communities.

Don’t forget to tell us what you think in the comment section.

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Last year before the lockdown during a brief visit to Benin I visited a close friend, colleague and former classmate at the University Of Benin Teaching Hospital. She is a Deputy Director at the hospital and unit head at the Paediatrics Pharmacy Unit. One of the many things we talked about was the evolution of Clinical Pharmacy practice and inpatient Pharmaceutical care management. She spoke so passionately about her pediatrics unit and displayed a vast knowledge of drug therapy management in various pediatric conditions and then she expressed a need. She wished there is a specialty course in Pediatric Pharmaceutical care she could attend. I was so proud of her passion for Pediatric Pharmaceutical care. I recomended she check with one of the special centers between College of Medicine and Faculty of Pharmacy UNIBEN maybe they might point her in the right direction. Though I had never heard of any in Nigeria she may eventually need to do the certification online or abroad.

Pediatric Pharmaceutical care is a Clinical Pharmacy specialty that basicaly narrows down medication therapy management to specific age range of 0 to 12 years. Opara 2020 et al’., describes it as Pharmaceutical care in a heterogenous group with infants ageing from birth to 1 year and Children 1 to 12 years, and also includes neonates ageing from birth to 4 weeks and preterm babies. It is the provision of drug therapy (Pharmacotherapy) management to this specific age group based on their anatomical and physiologic peculiarities (age, body mass, organs at various stages of development and maturity, disease condition, genetic predisposition, pharmacodynamics and intersubject variability) with the ultimate purpose of achieving definite outcomes that improve quality of life. In plain English “you dont manage drug therapy for children the same way you manage for adults”

It explores dosage administrations and routes of administration based or peculiarities and disease conditions in children at various developmental stages.

Pediatric Pharmaceutical care is necessary because though studies show that Nigeria has ample supply of medications for primary care use, there is a deficiency of pediatric dosage forms for prescription only medications used for secondary and tetiary care. Consequently extemporanous reconstitution of prescribed medicines in the Pharmacy becomes necessary. Recostitution of pediatric medications is a highly sensitive but commonly overlooked area. Hospitals which take it seriously have had to locate a Pediatric Pharmaceutical Care unit within the Special Care Baby Unit (SCBU) and/or the Paediatrics Unit.

The American Society of Health-System
Pharmacists and the Pediatric Pharmacy Advocacy Group in 2018 published a gudeline titled “ASHP–PPAG Guidelines for Providing Pediatric Pharmacy Services in Hospitals and Health Systems” to guide Clinical Pharmacists in meeting the special needs of the pediatric population. This underscores the importance of Pediatric Pharmaceutical Care as a specialty in Hospital Pharmacy practice. This is because studies show the pediatric population is a more vulnerable group to Adverse Drug Reactions (ADRs) than the adult population, exhibit higher variability in Pharmacokinetic and pharmacodynamic profiles of drugs and have pharmacogenetic variations such as Glucose-6-phosphate dehydrogenase(G6PD) deficiency, short gut syndrome and lactose intolerance. There is also a lesser tendency for recipients to report ADRs either because they are too young to recognise the injury(children), are too young to communicate (Babies) or are not being monitored by a vigilant caregiver. Pediatric Pharmaceutical care specialty is important because many drugs that are safe for adults are not safe for children.

There is even the school of thought which intends to include unborn children in pediatric pharmaceutical care by trying to prevent genetic anomalies or irreversible damage to the unborn baby as a result of substances consumed by the mother during pregnancy. For example, an eight month pregnant mother taking Tetracycline capsules as antibiotic treatment for her infective cough will likely cause bone distortion in the child as a result of calcium/phosphorus chelation and Dental dysplasia (brownish/yellow coloring of teeth). There is neonatal death due to chloramohenicol induced “grey baby” syndrome and Kernicterus from taking Sulphonamides. So should this be included in paediatric pharmaceutical care or left to the OBGYN?

A recent study by Tareq 2017′ et al’., insists that Pharmacists must have a baseline knowledge of Pharmaceutical care in pediatrics not only for the purpose of councelling care givers but also for dosage form reconstitution and inpatient interventions to correct medication errors that could result in ADRs (Adverse Drug Reactions) or suboptimal dosing.

For example, at the National Hospital Abuja in Nigerias Federal Capital Territory the Pediatric Pharmacy unit is tasked with the responsibility of carrying out interventions. The Clinical Pharmacists :

1. – recomend dose adjustments where necessary,
2. – proactively intercept medication errors during prescription review and revert back to prescriber, (dosage calculation errors are known to be the most common sources of medication error)
3. – Track patient adherence and persistence,
4. – identify drug therapy problems based on known classifications, and
5. – take appropriate action where necessary
6. – educate parents and children themselves.

In all these clinical pharmacokinetic parameters such as age, weight, Body Mass Index(BMI), Renal function, Cardiovascular impairments, Drug elimination rates, Bioavailability, Volume of Distribution etc are considered. The pharmacist actually takes a wholistic picture of the situation and arrives at a care plan which will also involve the patients parents or care givers upon discharge. This is all done in collaboration with the entire inpatient management team at the hospital. Nurses are very fond of crosschecking and reviewing medication administration plans with the pharmacist and it is not uncommon for them to frequently seek clarification for routes and modes of administration. Post discharge the parents or caregivers also maintain close collaboration with the pharmacists and report on progress and any unwanted effects observed. Communication is maintained effectively via phone and wattsap chats which also enable sending photos and screen shots as visual aids.

In Pediatric Pharmaceutical care one thing is most improtant, VIGILANCE. Its simple, the Pharmacist must remain vigilant in prescription review, extemporaneous preparation or precribed medication reconstitution, medication administration, patient/care giver counceling and ADR monitoring. Hence Pharmacovigilance within the pediatric inpatient unit takes a different dimension. The Pharmacist is aware of common drug related problems identified with specific medicines and takes measures to look out for them.

Pharmacists should realise that after discharge and the patient becomes an outpatient the larger burden subsequently lies on the pharmacist who will be frequently contacted by the childs caregivers for clarification on various drug related issues.

Picture this : For a drug like Digoxin the optimal dose for a Baby may instantly kill an adult. We all observe that children are prescribed lower doses than adults. But do you know that children actually require higher drug doses than adults? Doses are determined on a milligram per kilogram (mg/kg) body weight basis. Anyways, that is a story for another day.

Let me know your thoughts by droping your comments below. As men of honour………!

References :

American Society of Health-System
Pharmacists, Inc., and the Pediatric Pharmacy Advocacy Group, 2018, ASHP–PPAG guidelines for providing pediatric pharmacy services in hospitals and health psystems. Am J Health-Syst Pharm. 2018; 75:1151–65.

DIGOXIN Pediatric Monographs, 2021, Copyright 2021, Medical Security Card Company, LLC, dowloaded at https://www.wellrx.com/digoxin/pediactric-monographs/ on 16th January 2021.

Enato E, 2020, lecture notes, Sukthankar V, Individualization of dosage regimen, Clinical Pharmacokinetics, Mpharm 2020, Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Benin.

Moles.R, Carter. S, 2028, Pharmaceutical Care in Pediatrics, Springer Link, downloaded at https://link.springer.com/chapter/10.1007/978-3-319-92576-9_31. on 16th January 2021.

Opara A, 2020, lecture notes in Pediatric Pharmaceutical care, Pharmaceutical care, Mpharm 2020, Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Benin.

Tareq L. Mukattash, Anan S. Jarab, […], and James C. McElnay, Pharmaceutical Care in Children, Sultan Qaboos University Medical Journal, downloaded at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6443271/ on 16th January 2021.

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● Most vaccines that are used in sub-Saharan Africa are from Europe and America. Africa has never had the capacity to manufacture them to meet her needs.

● Poisoning needs not come with anti-Covid-19 vaccines. It could be from yellow fever, polio, cerebrospinal meningitis, measles, and other vaccines if there was a plot to harm Africa.

● Those who think the anti-Covid-19 vaccines are to harm Africa should also realize that hydroxychloroquine, azithromycin, zinc, vitamin C, vitamin D, ivermectin and whatever else is used in the chemotherapy of Covid-19 are largely from the Western world. The drugs could have been laced with chemicals to kill Africans. Testing of imported medicines is still poor in most of Africa. The intention to harm should not be narrowed to vaccines only.

● Although there exist competent scientists in Africa, they are handicapped by lack of funds and basic amenities that drive research. Even when there are breakthroughs, there are hardly funds and will power to use them for the common good.

● Bill Gates and his wife have through their foundations been solving health and socioeconomic problems for resource-poor countries in Africa. It is irreconcilable that a couple that spends so much money to sustain life in Africa will spend money again through a single vaccine to kill Africans.

● It is difficult to imagine that all the Black scientists involved in the development of the vaccines are cooperating with their Caucasian counterparts to harm Afticans.

● It is difficult to imagine that all the Black scientists involved in the development of the vaccines are cooperating with their Caucasian counterparts to harm Afticans.

● Adverse effects monitoring is a never-ending process for any medicine. It is a post-marketing surveillance process (pharmacovigilance) on the medicine. Keep in mind that it took several decades of use before aspirin was associated with Reye’s syndrome. So, we might never know all we need to about any medicine, these controversial vaccines inclusive.

● Certain medicines may be donated to Africa and poor regions. Their prices may also be reduced and these medicines are marked “Not to be sold/used in…..”. This practice that is currently for redemsivir is a pricing policy and it is not new.

● Until Africans do thorough introspection, they will continue to depend on the Western World. A man that cannot help himself must be ready to be subjected to anything by his helper. So, regardless of the noise being made, Africans will ultimately take the vaccines.

● The points above do not counter the argument that the Western world does deliberately hold Africa down in socioeconomic ways. That debate is for another day.

● African leaders should ensure that like other medicines, the vaccines must meet the irreducible minimum requirements for quality before they are deployed. The tests are prescribed by the appropriate regulatory agency. I have no doubts that NAFDAC will ensure this.

My thoughts!

Raymond Ozolua is a Professor of Pharmacology and Toxicology with the Faculty of Pharmacy University of Benin.

Lets know what you think. Share your thoughts on this artcle in the comments section.

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