The facts support the view of most Nigerians who believe that the Nigerian Medical Association(NMA) is responsible for exacerbating problems of Tramadol/Codeine abuse among the Nigerian youths and the Joint Health Sector Union(JOHESU) strike that has resulted in the shutdown of the public health institutions since April 16. However, I will focus on the facts that make the NMA culpable for worsening the abuse of drugs such as tramadol and codeine among the Nigerian youths and recommend what the Nigerian government must do immediately to ensure that we no longer find our nation in this kind of terrible situation.
Politicians in white lab coats:
It's not a coincidence that both political appointees for the senior and junior ministers of health and the minister of labour in this current government are all members of the NMA. It has not always been so.
In 1991, the then Minister of Health, ProfessorOlikoyeRansome-Kuti got the IBB-led military government to approve a special salary scale for all the members of his professional group 'The NMA', and since then 'things fell apart and the centre could no longer hold' in the Nigerian health sector. To support this fact, the president of the Pharmaceutical Society of Nigeria (PSN), Pharm. Ahmed Yakassai, in his recent interview with The Punch newspaper, stated “it is important to take a walk down memory lane that contrary to the superiority mentality created in some quarters, pharmacists and doctors entered the public service on the same grade level up until 1991."
From 1991 till date, there has been a progressive debilitating and systematic mismatch between the human resources of the Nigerian medical doctors and the actual primary role they are supposed to play in healthcare, unlike their counterparts in other countries with better health indices than Nigeria.It is therefore so unpatriotic of NMA that has consistently categorised Nigeria as having insufficient number of medical doctors not to have discovered yet that most of the experienced hands among its members have cornered one political appointments or another thereby significantly reducing their individual inputs in direct medical practice.
These political appointments bonanza for NMA members include appointment as Ministers of Health, Commissioners of Health, Chief Medical Directors of public health institutions, Heads of MDAs to even MOH agencies of states and federal governments that are statutorily meant to be headed by other healthcare professionals like the case of the National Agency For Food, Drug Administration and Control(NAFDAC), where a medical doctor, Dr. Paul Orhih, was appointed to head and run NAFDAC for 7 years from 2009 to 2015 , the Nursing and Midwifery Council of Nigeria (NMCN) where a medical doctor, Dr. Abisola Clark was appointed in 2013 in a most shocking and bizarre manner, to head the governing board of the apex regulatory board for nurses in Nigeria, then followed by the hostile belligerent attempt by medical doctors to regulate the practice of medical laboratory science until it was resolved in favour of medical laboratory scientists by the judgment of Justice Esowe of the National Industrial Court(NIC), Abuja, who in his judgement in 2013 stated that "I hold that, based on the evidence before me, there is no conflict whatsoever between the job schedules of Pathologist(a medical doctor) and that of a medical laboratory scientist. The position is reinforced by the fact that their trainings, professional qualifications and schemes of service are different from each other..."
The effect of this switch of roles by Nigerian medical doctors from medicine to politics denied the country of value for her investment in producing experienced doctors and in turn, made these "politicians in white lab coats" shift their focus away from medical practice and the training of young doctors to playing hardcore politics in the hospitals and healthcare organisations.
Square Pegs In Round Holes:
Due to the limitations of the training of Nigerian doctors in management and areas outside their scope of training in healthcare, their tenures as chief executives in government agencies and most federal and state hospitals turned out to be monumental disasters.
With the unfair manner they achieved the political conquest of Nigerian health sector, members of the NMA attracted opprobrium from members of the public and their counterparts in the business of healthcare because they are seen as greedy and incompetent.
The period of Dr Paul Orhih, for example, reversed the positive grounds covered by the sterling performance of a Pharmacist like Prof. Dora Akunyili, who as Orhih's predecessor, had competently occupied the office of the Chief Executive Officer of NAFDAC because of her training and her professional experience as a drug control and administration expert (this kind of training is only available in Pharmacy schools and Pharmacy schools are distinctly not under colleges of medicine).
During the reign of Dr.Orhih, NAFDAC became an ineffective and corrupt organization. NAFDAC was chased out from the ports in 2011 thus allowing unchecked increase in the entry of these psychoactive drugs into Nigeria and the culture of using third parties for supply of sensitive equipment became rife leading to accusations and counter accusations of corruption between Dr Orhih and members of staff when most of these equipment were discovered to be of substandard quality.
The most debilitating effect was the dismantling of all structures that was professionally put in place by his Pharmacist-predecessor for effective drug control and administration because the medical doctor forced by the political machinery of NMA on a Pharmacist's seat in NAFDAC.
The results from a research done and published in the journal of Advanced in Psychology and Neuroscience by researchers from the school of Mental Health,University of Maiduguri, on Tramadol Abuse Among Patients Attending An Addiction Clinic in North-Eastern Nigeria between June,2012 to June, 2016, could not have revealed the monumental disaster in the nation's drug control under the administration of Dr Orhihbetter.
According to these researchers,"In terms of the Tramadol formulation, the overwhelming majority of the respondents (96.1% of the addicts) used the tablet form and almost two-thirds used multiple frequency dosing. This could be attributed to the ubiquitous availability of drugs without regards for locality due mainly to the activities of drug vendors who dispense these drugs without prescriptions."
While the incidence of drug abuse was already in place in Nigeria, the appointment of a professionally incompetent person led the avoidable worsening of the drug abuse plaque among Nigerian youths as there was free and regular supply of codeine syrup and tramadol tablets. This had a negative effect on national security as well,with the North West devastated by Boko Haram and sustained vandalization of oil pipelines in the South.
The consequences of the appointment of a square peg in a round hole for NAFDAC, had no doubt helped guarantee the sustained supply of tramadol tablets to the insurgents to keep them 'high'.
Corruption! Corruption!! Corruption.
Granted that it's not only the health sector in Nigeria that got consumed by corruption but what made the corruption in the Nigerian healthcare sector peculiar is the unpatriotic conspiratorial camaraderie among members of a single professional group(NMA).
Apart from the notorious incompetence seen in public health institutions under the administrative control of the members of NMA, there is also wide scale monumental corruption.
On May 3, 2016, the Global Funds to fight AIDS, TB and Malaria said it had evidence from an audit of its grants to Nigeria that $3.8 million was mismanaged, according to a Daily Trust newspaper report of 10 May, 2016. The reason Global Funds suspended it's global intervention funds to National Council on Control of AIDS, NACA,(under the leadership of Professor John Idoko, a medical doctor) for the treatment of HIV and Tuberculosis sufferers in Nigeria and the National Malaria Elimination Programme (under another medical doctor, Dr. NnenaEzeigwe) is because of large scale fraud and mismanagement of funds.
Since the 'coup' of 1991 by members of NMA, our critical public health institutions and agencies have been nothing but cesspit of incompetence and corruption.
The most recent is the corruption case reported in the National Health Insurance scheme(NHIS) under the management of a medical doctor. While NAFDAC (before the recent appointment of Professor Mojisola Adeyeye,a Pharmacist, to head and clean the mess in NAFDAC) was weighed down by professionally incompetent leadership and couldn't effectively control drug distribution and supply thereby sustaining the regular supply of tramadol and codeine to the youths for almost a decade under the leadership of Dr Orhih, other agencies that would have provided support and care for the youths who are already victims of drug abuse couldn't get help so the nation couldn't reduce the prevalence of drug abuse because those health institutions responsible for doing so were in the same comatose state as NAFDAC.
These corrupt and incompetent public health institutions all have something in common; they are headed by members of NMA.
Inchoate Codeine Syrup Ban.
The procedure for removal of a drug is stated in the National Drug Formulary And Essential Drugs List Act of 1989 Section 10(removal of drug from essential drug list)), it was stated inter alia "Notwithstanding the provisions of Section 5 (functions of drug review committee) of this act, the minister (may remove any drug from the list where it has been established to his satisfaction that the drug in question is no longer safe for use" but how the Minister arrived at his decision on "no longer safe for use" leading him to order the "ban" of codeine syrup is illegal and of no consequence since codeine is still safe for use as antitussive in children and adults.
This is the characteristic manner processes have once again been abused by NMA members leading the ministry of health and the result will lead to another national problem.Already there's an increase in the prices of codeine syrup for the majority of patients who have not abused codeine and who are in dire need of codeine syrup for pharmacotherapy.While codeine syrup has been withdrawn from the shelves of Pharmacies, the drug remain available in open markets where the unlicensed vendors of codeine syrup buy it and supply addicts.
The Association of Community Pharmacists of Nigeria(ACPN) has raised alarm that they weren't consulted before the ban and reminded the government of the need to ban open drug markets as recommended in the National Drug Distribution policy.Speaking to reporters recently, Pharm. Aminu Abdulsalam indicated that the right procedure wasn't followed before the Minister of health announced the ‘ban’ Iof codeine syrup.
He stated that he would have expected the Federal Minister of Health to place a suspension first on importation and production of these products first. Then, call for an audit of these drugs so that they can be sure of what is still in circulation.
He explained that some people would have had these products coming into the country, and that these people as well as those that already have these products in stock would have suffered economic loss.
So why did the Ministry of Health under Professor Isaac Adewole,a medical doctor, unilaterally announce a ban without consulting professional stakeholders in the profession of Pharmacy?
Why is it that it was after the protest by ACPN and appointment of a Pharmacist to head NAFDAC that the return of NAFDAC to the ports was announced by the office of the Vice President?
Interestingly, as a nation, we know what to do but I will appeal to the conscience of the father of the nation,President Muhammadu Buhari, to revert the rot in the Nigerian health sector.
To achieve this, he must do things differently. The nation did the same thing with aviation to end the era of plane crashes by appointing only professionally qualified and competent persons to head aviation agencies.
Only professionally licensed healthcare administrators should be appointed to run healthcare facilities in Nigeria like it's done in countries with better health indices than Nigeria.
The National Assembly, in conjunction with the executive arm of government, should enact a law setting up The Institute of Licensed Healthcare Administrators of Nigeria to specifically oversee the training and certification of all healthcare professionals interested in pursuing a career in healthcare administration.
The federal and state governments should stop appointing only medical doctors as ministers and commissioners of health to follow the examples of countries with better health indices than Nigeria like France,Germany,Saudi Arabia, Isreal, Spain, India, Canada etc and promote inclusiveness in a multi-disciplinary sector like healthcare.
About The Author
Sunkanmi Vaughan is an author and University of Lagos-trained Pharmacist.
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