Leadership in Service

Protocols,

1. The world owes a debt of inexhaustible gratitude to our medical doctors who spend much of their days in sacrificial service to humanity, restoring life and hope to individuals and families by the work they do in our health facilities, medical colleges and research institutions and in all the frontiers of service where they deploy their skills, energy and passion to save lives under what is often very difficult conditions to give their patients, even those with near-zero chances of survival, one last opportunity to experience empathy, compassion and the very best of human spirit and love.

2. God did indeed create doctors to be a special breed which perhaps explains why it is almost the exclusive preserve of the most brilliant and focused individuals. I say this as the father of a medical doctor myself. It is not for nothing that the profession has remained prestigious and its practitioners accorded great social esteem since the days of Hippocrates. Doctors serve people irrespective of their economic and social backgrounds, acknowledging their humanity like God demanded of us and ultimately teaching all of us very important lessons in service, humility and the sacredness of the human life.

3. Doctors, including many in this auditorium, have been known to go above and beyond the call of duty to save lives and provide support to those under their professional care. Beyond just attending to patients, your role in the last few decades has expanded to include several other responsibilities that would usually weigh down the unprepared. Today’s doctors are lifestyle counsellors, campaigners for noble causes, community leaders, philanthropists and mentors to many. The addition of new roles to your regular job speaks to the trust and confidence the society has in you for reasons of your integrity, discipline and capacity to consistently make sound judgements, even outside the boundaries of your individual expertise.

4. The average doctor trained or practising in Nigeria belongs to a very rare species of the human race. You make the best of impossible situations to graduate and then begin your practice in an environment that many outside here can never contemplate, and yet you are still ranked very high on the basis of the excellent results you produce in the course of your career. The Nigerian doctor, practising in Nigeria or anywhere in the world, is a champion and should be praised for constantly drawing water from rocky grounds in a passionate zeal to apply themselves to all that is noble. At home you save lives by attending to the sick and when you go elsewhere, you still do not forget home — constantly sharing your earnings with your loved ones here, supporting families, sponsoring the education of your younger ones, and several community development projects relating to education, health, and the welfare of the underprivileged.

5. The world would have been dramatically different without the passionate commitment, brilliance and sacrifices of those who serve humanity as doctors. Today presents us a very beautiful opportunity to come together as members of one human community and appreciate these selfless individuals for completely giving of themselves that we may overcome the limitations and misery of ill-health, live full and healthy lives while enjoying the abundant blessings of God’s earth. On this note distinguished ladies and gentlemen, permit me to join the chairman of the Nigeria Medical Association (NMA), Abia State Chapter, Dr Ezurike Ezinwa, and members of the local organising committee to welcome you to the 2024 edition of the Annual Physicians’ Week. This gathering has expectedly brought together stalwarts of the medical profession from the State and beyond, senior bureaucrats, government functionaries and other key stakeholders from several walks of life to discuss how we can respond effectively to the realities of the time as it affects those who toil and labour to keep us healthy.

6. There is no denying the fact that there are very difficult headwinds threatening the dedication and commitment of our doctors to their Hippocratic Oath. As stakeholders in various capacities, these unfavourable developments bordering on economic and social difficulties should worry all of us. The issues we should be reflecting on over the course of this programme may include how to strike a balance between sacrifice and just reward for honest labour, responding to the threats of mass exodus of doctors which leaves our population in great peril and of course, evolving a dynamic system that offers commensurate rewards to the domestic health system for the contributions of our medical practitioners to the health and wellbeing of populations across the world.

7. My experience is that nothing is given if it is not asked and I am not in any way suggesting that someone else pays for our failure to provide the right environment for our doctors to function and thrive domestically. Even then, it has also become imperative for us to begin to look at ways of extracting some value from those who profit most from the professional services of medical personnel trained here, sometimes at public expense. There may be contentions about this proposal and they will be justified because a few things we are supposed to have done to encourage our doctors to choose home have been neglected.

8. At any rate, I would recommend that we go for bold ideas and thoughts as we debate the issues. No idea should be considered too outlandish or too infinitesimal to be brought to the table because in my experience, nothing should be dismissed until it has been thoroughly explored. There is no doubt that our doctors, your colleagues, 12,400 by recent estimates, are in very high demand across the US, UK and Canada. If the health systems in the developed economies are massively supported by doctors trained in Nigeria, it may be about time we asked for some compensation which will go exclusively into augmenting the pay of doctors practising here, as well as improving the general health architecture in the country to support service delivery and the welfare of personnel, especially doctors who have resisted the strong pull factors that had drawn many of their colleagues to other places. I would encourage you to look strongly at this proposal as made and flesh out the details for considerations by the relevant stakeholders.

9. Beyond what we can get from the systems enjoying the services of our doctors, greater attention should be on how to address the push factors that have made it difficult to retain medical talents in the country, especially doctors. Over the course of the interactions this week, we should be able to answer very salient questions around the introduction of competitive incentives for doctors, capacity development and exposure to evolving industry trends. While it is true that the primary motivation for many of you may not be monetary rewards, it would also be naïve to imagine that we have an obligation to starve and treat the welfare of doctors with levity. I am all for a just wage because that is at the heart of talent attraction and retention.

10. We must, however, not be deceived. The challenge for our healthcare industry goes beyond money and it will be utterly irresponsible to assume that once money is thrown at the problem, it would disappear. No! The situation is more profound and there is the need for a holistic approach to a problem that has lingered for several decades. Doctors, like other professionals in the healthcare delivery ecosystem, are leaving the country for a number of reasons; money is just one of them.

11. My estimation is that even if we multiply the current pay package several times over, and not deal with the other critical issues around the economy, insecurity, poor working environment, limited opportunities for sponsored trainings and career progression, the burden of very low doctor-to-patient ratio and poor equipment in our hospitals, we will still struggle to convince doctors that this is the right place for them. This is why I would recommend that we take a more rounded look at the challenge and refuse to run with what Chimamanda Adichie referred to as a single story. The rot in the industry is deep and there has to be concerted effort, guided by sincere commitment and a genuine sense of patriotism to get a firm handle on the issues.

12. To be clear, we shall not get everything right in one day but our step to redemption can begin by taking necessary baby steps, informed by the awareness that we have not given the health sector in general, and the welfare of doctors in particular, the attention they deserve. Agreed that a lot of damage has been done due to corruption, incompetence, and negligence, we would also do well to acknowledge that the situation is not beyond redemption; if we adopt a more sustainable and result-oriented approach today, we shall in no time begin to see genuine improvements in the quality of outputs.

13. May I also remind us that we should not underestimate our capacity to inspire change in the system. We have enough intellect, reach and initiatives, right inside this very auditorium to drive the transformation of the entire healthcare delivery architecture in Nigeria. What we need to achieve the results we seek are a sustained capacity to demand accountability from the system, draw the attention of relevant stakeholders to the nagging challenges in the sector and develop the staying power to ensure that we do not back down until the right things are done. This would include the recruitment of very competent administrators for the entire healthcare ecosystem, development of an effective plan for the growth of the sector, setting up of a collaboration framework for funding and service delivery monitoring and assessment across the entire value chain.

14. My proposal must never be mistaken to suggest an invitation to needless strike actions for that would be counterproductive. I actually think that industrial action in the health sector is against the spirit of the Hippocratic Oath you took at the point you qualified to be a doctor. Such actions endanger human lives. It is always best to build a trusting relationship with the actors in the public sector and work out ways of prioritising the health sector like we find in the developed economies. Institutions such as the National Health Insurance Scheme (NHIS) and the entire system of support set up to improve affordable care for Nigerians, support the training of personnel and the upgrade and maintenance of facilities must be restructured to meet the needs of the stakeholders.

15. There should also be renewed efforts to stamp out corruption from the health sector. Structures and channels through which patients and their families are extorted must be shut down immediately. More importantly, practices that enable stealing and diversion of supplies to the public hospitals and institutions and other forms of sabotage should be addressed immediately through the setting up of an effective action-consequence framework. I would recommend that the highest standards of discipline be enforced in the sector because every action or inaction that subtracts from the system presents a grave threat to human lives. Poor remuneration and economic difficulties must never be an excuse to endanger lives.

16. Let me now come home and begin by appreciating the NMA for its extensive support for the enthronement of a new order of leadership in the State. Like all reasonable men and women living or working in Abia, you were individually and collectively disenchanted with the old system and worked hard to dismantle a leadership orientation that wrought destruction to not only the health sector, but every critical institution in our State. Thank you for the sacrifices and for sharing in our belief that a new deal that puts the concerns of the public first was imperative for our continuing survival. This is also a good time to appreciate you for your active support and cooperation in the last 17 months. We do not take your goodwill for granted.

17. Since we assumed office, we have shown great commitment to improving the healthcare delivery system in the State. We may not have gotten everything right but there is no second-guessing our blueprint for the health sector in the State. Recall that for the first time in the history of our dear State, 15% of the entire budgetary outlay was earmarked for the health sector this year. Another way of understanding our approach to the transformation of the health sector is by taking a careful study of the quality of personnel we have hired to drive the actualisation of the health outcomes we promised the people, starting from the Honourable Commissioner for Health, Prof. Enoch Ogbonnaya Uche, and a carefully-selected team of very accomplished medical professionals who have distinguished themselves in other previous responsibilities. Their mandate is to support the administration’s resolve to give Abia a healthcare system that is effective, reliable and accessible to all, no matter their economic or social realities.

18. We have since gone ahead to revive major state-owned health institutions which lay in ruins as at the time we took over with reference to the State Specialist Hospital and Diagnostics Centre, and the Amachara General Hospital. In demonstration of our resolve to get it right, we wasted no time in addressing the challenges that led to the loss of accreditation for the training of medical doctors at the Abia State University Teaching Hospital (ABSUTH), Aba. On the strength of our efforts, the Institution has since regained its accreditation and in March this year, it graduated a new batch of doctors after several years of redundancy.

19. In the last six months, we have seen remarkable improvement in the quality of services at the Abia State Specialist Hospital and Diagnostics Centre, Umuahia with the introduction of a wide range of medical, clinical and laboratory services. There has also been a rise in the number of consultants working at the facility as we work to make the Centre a one-stop health services establishment. At other secondary health facilities in the State, we are also seeing an expansion in service provisions in line with the commitment to boost the confidence of the general public in our health institutions.

20. More fundamentally, we understand that we cannot accomplish our target for the health sector if we do not pay particular attention to the welfare of the personnel, especially the doctors who function as leaders and main drivers of the delivery outcomes. We promised on assumption of office that never again will doctors and personnel who work in our hospitals and medical institutions be owed their entitlements. I am glad to report that we have kept faith with our promise of prompt and regular payment of salaries to healthcare workers employed by the State Government. I have also directed my team to quickly conclude discussions and set out the modalities for the payment of the Consolidated Medical Salary Structure (CONMESS) and the Consolidated Health Salary Structure (CONHESS) to the relevant personnel in our employ. I have informed the Health Commissioner and his team that I am waiting to have their report on my table as soon as they can put it together.

21. As part of our general welfare and professional support package for the doctors working in the State’s public healthcare system, I have equally directed the Health Commissioner to work out the appropriate framework that the State can adopt to sponsor the continuing professional development of our doctors — including fellowship and post fellowship trainings. We are prepared to do whatever it takes to support the career dreams of doctors working for the State Government, in the understanding that they shall stay committed to serving the healthcare needs of our people in urban and rural communities.

22. Let me conclude by saying a few things about the carefully considered theme of this year’s event which is “Ensuring Universal Application in Remuneration: A Panacea for Talent Retention in the Medical Industry.” May I quickly say that I agree entirely with the demand that implicitly comes with the theme because I believe that it is unjust for professionals who do the same work to earn extremely different incomes.

23. This proposal should, however, be considered by also capturing the reality of the economic environment where we are working. Again, while I believe that it is just to reward everyone fairly for the services they render, taking cognisance of the training and skill required to function in the space, it may, however, be a little tough to expect an under-$500 billion economy to pay the same wage as a $30 trillion economy.

24. What I would rather recommend is that we evolve a system that pays our doctors a wage structure that is fair and competitive by regional standards. It will be hard to justify the odd reality of doctors in smaller neighbouring economies earning higher than their counterparts here. It is an injustice that has to end immediately.

25. Abia as I had mentioned remains firmly committed to the periodic improvement of the welfare packages of our doctors. We shall in turn expect you to consistently give your best by supporting our vision and being faithful to the Oath that guides your profession. You are expected to bring operational harmony in your different establishments by working closely with other equally important professionals in the system.

26. Let me once again thank you for your faith in the country and for placing the health of our people above material gains. I am optimistic that things will definitely improve and we shall joyfully tell the story of how our resilience and passion for service to humanity saw us through.

27. Thank you for listening and may God bless you all.

Dr Alex C. Otti, OFR,
29/10/2024