Wednesday, September 12, 2012

Public health not doctors' preserve

By Sani Garba Mohammed

Public health is a term that is eliciting concern from health professionals; for, as the name imply, it deals with the issues pertaining health be it preventive, curative, promotive or rehabilitative.

In Nigeria, the rivalry between health professionals is making the term to lose relevance as to what public health stand. It reaches a stage where by one profession corner the title and determines what goes in and out, leaving large chunk of other health professional onlookers.
This comment will look at what is public health, whether or not one profession should be alpha and omega, and the need of collaborative approach towards making public health better.

Permit me to quote WHO [1952] definition of public health which is “the science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community efforts for the sanitation of the environment, the control of communicable infections, the education of the individual in personal hygiene, the organization of medical and nursing services for early diagnosis and preventive treatment of disease, and the development of social machinery to ensure for every individual a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to release his birthright of health and longevity”.

Based on this, we can deduce that public health consist of environmental health services [it has 18 components], medical, nursing, laboratory, other health services, including other sectors relevant to health like agriculture, science and technology, power, communication, engineering, etc., that address the physical, mental and environmental health concerns of communities, and disease prevention technologies interventions designed to improve and enhance quality of life.
Considering the all-encompassing scope of public health, no any profession, be it medical, nursing, chemist, etc., can lay claim to be its only promoter, as it is obtainable in Nigeria where the mere mention of ‘public health’, direction will look at doctors only, not all health workers.

Doctors have now appropriates public health practice as their own only, and determine how it should be run, from federal ministry level down to local government level; and any attempt to do the right thing by the right professionals in what they have interest will not see the light of the day.

Nowadays it has become a norm that every minister of health is a doctor, the same with majority of states, also many position are now reserved for doctors only like headship of hospitals, national primary health care development agency, etc., which any health practitioner like pharmacist, medical scientist, environmental health officer, nurse can hold with the necessary managerial skills. These, give rise to a situation that very health policies, tend to be one-sided, from the prism of medical practice, with the exception of other sides which are equally important.

For instance, the effort to prevent/and or reduce the endemicity of malaria could not succeed, because the emphasis is based on curative approach that hinge on only provision of insecticide treated nets, provision of drugs, to the detriment of more effective control of environmental health management of our surroundings, which harbor the vector that causes it, because money is involved from donors.

Now doctors are penetrating in to many professions and forcing their thoughts on how to do or not do this and that; they are into radiography, laboratory science, pharmacy etc., but still want to usurp the role of those who start from degree level.
”Take a look at a scheme of service, from 2001” said Godwill Okara “ addressed to the minister for health, telling him of eleven schemes of service for professionals in the health sector, to be implemented. The then minister caused this letter to be circulated to all chief executives of hospitals for immediate implementation. Up till now, this scheme of service has not been implemented because doctors feel they are the ones to [lead]”, daily trust 3rd July, 2012.
He also added “There are laws: do your own, let me do my own. When people think that they are above the laws of the land, it is an open invitation to anarchy. And the kind of situation we see in the health sector, there could be no greater anarchy than it. Despite the immense human and material resources in Nigeria, the Nigerian health service is being rated 51 out of 53 in Africa. It’s a shame. Instead of facing these facts, they gang up, become partisan and want to protect the interest of their colleagues against all others”

The other area where other health professionals are being discriminated is their non-admission by many universities for Masters in Public health, which it seems is exclusive reserve of medical doctors; with the exception of few universities in the south-like federal university of technology, Owerri, University of Calabar, University of Port Hacourt, University of Uyo-all northern universities reject any non-doctor health practitioner from the programme, even if s/he has first class in his degree.

National Health Bill further creates another huge gap which if allows to be signed without the input of other health professionals, will do more harm than good, and public health services will suffer. “The new bill” according to Nigerian Health Watch “states that the "Executive Chairmanship of the proposed National Tertiary Hospitals Commission must be a Medical Director of the status of a Professor with a minimum of ten years working experience in a Teaching Hospital"

“This clause that limits the Executive Chairmanship to medical doctors in perpetuity has all the other health professions up in arms. Doctors argue that it is their traditional (read tribal) role to lead a medical team. The other health professions argue that they (their tribe) must also have a go at leading the commission.

“It is our contention at NHW, that this clause in the health bill is flawed, as it does not protect the best interests of Nigerians, and has placed tribal interests as belonging to a profession (a tribe of doctors), reaching an academic height (a tribe of professors) and having worked in teaching hospital (a tribe of public sector workers) - none of which ultimately guarantees a good leader and manager which the National Tertiary Hospitals Commission needs to fulfill its promise to the Nigerian people”.

I am not bringing this to castigate or blackmail my fellow practitioners, as I have many friend doctors, mentors, but just to highlight the issue at hand at its pertain the practice of public health, which are directly or indirectly affecting it delivery to the target beneficiaries, for no any profession is an island unto itself, as doctors needs pharmacist, radiographer, laboratory scientist, so also pharmacist need chemist, nurse, and other health practitioners. As a sanitarian [aka environmental health officers], I need police, lawyer, engineer, laboratory scientist, etc., to discharge my work accordingly, as such, public health services needs all of us to join hand and deliver, for, we own it up together.

So, for public health practice to prosper there should be no enmity, or feeling superiority of one over the other, we are all equal as all have undergone training of not less than 5 years. Let us join hands together if we are ever serious. Public health belongs to us not one of us. It is better late than never.

Sani Garba Mohammed, is of department of public health technology, federal university of technology, Owerri.