Controversy Over Headship Of Teaching Hospitals

‘A Bill for an Act to Amend the University Teaching Hospitals (Reconstitution of Boards Etc.) Act, Cap. U15, Laws of the Federation of Nigeria, 2004 to Restructure the Composition of the Governing Board, Review the Nomenclature of the Heads of the Hospitals, Redefine the Qualifications of the Heads of the 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.’

Having followed with considerable attention the diverse opinions, particularly from health professionals on the ongoing amendment to the University Teaching Hospitals Act, I consider most of the arguments needless and unnecessary. This however does not negate the necessity of certain clauses in the bill.

First and foremost, it is my considered opinion that the administration of hospitals and other government facilities should be an exclusive preserve of seasoned administrators and should not be made open to experts working in the institution, thereby allowing professionals to concentrate solely on their calling.

It is on the strength of the above that I consider the demand and positions advanced by unions of joint professionals in the health sector to throw open the headship of teaching hospitals as against the current practice where only medical doctors can be appointed as chief medical directors, as incompetent and capable of throwing Nigeria’s public institutions into deeper confusion.

The House recently held a public hearing on the bill, which among other amendments seeks to include pharmacists, nurses and other medical professionals on the board of the teaching hospitals.

According to the bill sponsored by the member representing Ede South/Ede North/Ejigbo/Egbedore Federal Constituency of Osun State, Bamidele Salam, the proposed law seeks to review the nomenclature of the heads of the hospitals (Chief Medical Director). It also seeks to 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.

Salam while leading the debate on the bill noted that in the United Kingdom, to become a hospital administrator, one does not have to be a medical practitioner.
“All you need is to be a graduate from high school (four years); obtain a bachelor’s degree in healthcare administration, business administration or a clinical discipline (four years); and a master’s degree in healthcare administration (MHA) or a related graduate degree (two years), he said.
“You do not bring in your wealth of experience as a Specialist Physician with a stethoscope to run the hospital system. It is the same with other Specialist Health professionals whether Pharmacists, Laboratory Scientists or the other experts in the team.”
According to Sallam, “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,” he said.
This position was corroborated by representatives of hospital professional unions at the public hearing, as they blame the rot in the country’s health sector on maladministration and corruption on the part of the CMDs.

While I agree with Hon Sallam to the extent that leadership of public institutions is an administrative role and does not require specialisation to be savvy, yet, I do not think that creating another defect can cure an existing defect. Amending the law to allow other professionals in the health sector eligible for the headship position is like expanding an error rather than curing it.

I imagine that crafters of the laws in an attempt to manage scarce manpower and ensure administrative convenience choose professionals at the core of public facilities to head such institutions. Perhaps, the lawmakers should just provide for a compulsory administrative or management course to create a balance of knowledge, should there be a complaint of inadequate managerial tact.

For instance, despite that there are other professionals involved in the running of the university system, the vice-chancellor has to be picked from the academic arm of the institution. The same applies to the court system, there are other support staff whose activities are also based on sound knowledge and professionalism, yet, only a judge can rise to become the chief judge and president of the court of appeal and Chief Justice of Nigeria.

For once, I thought the argument would be that the administrative system of the teaching hospitals should be completely separated from the core health professional duty and that the head of administration should be the chief accounting officer while the chief medical director heads the professional cadre.

This, to me, would be a more valid argument, but may as well not solve the problem of corruption which is the made-believe focal point in this discourse. Assuming without conceding that all specialist doctors are corrupt, hence, other professionals should be allowed to run hospitals for effective management, what will then happen is eventually we realise that pharmacists, nurses or psychotherapists are far more corrupt than doctors. I am not out to condemn the administrative acumen of any professional practice, rather, my point remains that you don’t have to be a doctor to be fantastically corrupt, corruption is a societal problem and all professionals are products of the same society.