Thursday, 27 October 2011

Are we listening to the Mo Ibrahim Foundation

There are many reasons we should be paying a lot of attention to the Mo Ibrahim Foundation. It is funded and led by an African institution, and is Africa's leading assessment of governance. The Foundation provides a framework and tools for citizens, public authorities and partners to assess progress in governance.  It compiles 86 indicators grouped into 14 sub-categories and four overarching competencies to measure the effective delivery of public goods and services to African citizens, using indicators from 23 data providers. 

Nigerian health sector rated 51 among 53 African countries 

Maybe it is time we "woke up and smelt the coffee", seen as when we are benched against other African countries, we are at the bottom of the pile. I remember being in Harare, Zimbabwe in 2006, at the height of the crisis in that country. Despite all the political turmoil going on, ambulances still worked. In Nigeria, we have ‘normalised’ a disastrous situation in the health sector, one in which no one has any confidence in the public healthcare facilities, rich or poor. Scratching around at the edges will not help either. If our leaders have the courage to carry out a Sanusi Lamido like exposure of our health sector, will we come to terms with the extent on the challenges in the sector.  We can do better, and it is not just us saying it at Nigeria Health Watch.





And if you do not trust the Mo Ibrahim Foundation, we invite you to visit the World Banks's  Africa Development Indicators 2011, the most detailed collection of data on Africa. It contains macroeconomic, sectoral, and social indicators for 53 countries. It is a reliable dataset for monitoring development programs and aid flows in the region and an invaluable tool for analysts and policy makers. 

To know how bad things are, we must benchmark ourselves with other African countries....maybe then, the penny will drop. The health sector in Nigeria requires nothing short of radical transformation. This will turn the sector into one that  truly serves the best interests of the Nigerian people. Again, scratching around the edges will not help......

Reporting 7 - 8% GDP growth in Nigeria means absolutely nothing to the "ordinary" Nigerian if this is not reflected in the quality of service provision to the citizens. It will remain a figure reported on the pages of news papers until it affects peoples' lives.

However, we will not get the transformation we seek by sitting on our backsides. We will continue to have the health service we deserve... until we do something about it!

Tuesday, 11 October 2011

Medical and Dental Council of Nigeria awakens

In most advanced countries, among medical professionals, the fear of the self-regulatory body is the beginning of wisdom. Getting into trouble with the Registration Body has grave consequences for practising physicians. But the entire system depends on records being kept. So an offence, no matter how small that might affect your practice is always on record....always accessible to those that need to know. Every member of the public, from anywhere in the world, can go the website of the UK's General Medical Council to check on the registration status of a doctor....anyone. All you need is a name! Employers can request for more details and patients can lodge complaints right there on the website. It is for the responsibility that we take, more than the skills we possess that doctors are paid relatively good salaries around the world. Our charater failings therefore can have profound effects on our careers....rightly so.

Is it really too much then to expect a bit more from the Nigerian Medical and Dental Council? A few years ago, I went to the Medical and Dental Council of Nigeria (MDCN), at their former offices at 25 Ahmed Onibudo Street, Victoria Island....and the experience was one of the dark ages. Folders stacked in piles on the floor, no electronic payment platforms, months of delays to get even the simplest things done..... Subsequently, our regulatory body commissioned what I can only describe as simply the most horrendous website you have ever seen...here. (watch out for the flying objects)!

But things are changing!


MDCN has launched a new ONLINE Registration and Payment platform for various services by Doctors, Dentists and Alternative Medical Practitioners.


I have just successfully registered and renewed my registration online! 


With the relatively good functionality, now is the time to drive traffic, ensure compliance, keep the website up....and maybe finally move into the 21st century. 

But we can still improve on the website. I do not see the point of filling your prime space on the front page of the website of 4 irrelevant rotating pictures of guys in lab coats looking around. It is sometimes worth it while developing a website not to re-invent the wheel (and do it so poorly), but to look at what our neighbours in Ghana, Kenya or South Africa have had going for quite a few years now. We are way way behind, not the West but other African countries....sadly.

The new online registration portal is not the first new development at MDCN. Followers of the medical scene may have realised that until last year, under pressure from political and economic Godfathers our medical schools were admitting more people as medical students annually, many medical schools topping 400 students a set! Well after some lost their accreditation......that has now been reverted and none will not be admitting more than 150 per year.

Then came the introduction of compulsory continuous professional development from January 1 2012. It is still amazing that we have not had this until now.

The Medical and Dental Council of Nigeria (MDCN) rose from its 7th Plenary session on Friday 30th September, to announce another series of changes focusing on practice, quality, safety and ethics of doctors and dentists. The completely unregulated standards of clinical practice is the biggest challenge facing our healthcare sector in the public and private sectors. There is little incentive to be a good doctor...other that one's conscience. In the public sector, the greatest challenge is the conflict of interest between working in public service, and in parallel in the private sector. It is no secret that for many doctors (by no means all), working in a teaching hospital serves the sole purpose of a conduit to his private practice. I dare say that this is inevitable. As long as the system allows it. This is even more unconscionable with the increase in public sector salaries, and the constant strikes to insist that this is paid. Finally, this is hopefully about to end and we  must make the choice every other professional must make- to work in the private or public service, We cannot, should not have your cake and eat it. It has not gone all the way...but started in the right direction.

MDCN at the 7th plenary decided to remind all doctors and dentists of what has been in the handbook / code of ethics designed and released by the MDCN. MDCN says that since no one can be in two places at the same time, it is about time that the laws on private practice are enforced for the good of the doctor and dentists, the patient; the public, and the government.

The highlights of their decisions are that:
  1. Only consultants with over10 years post qualification experience are legally allowed to engage in private practice, at the same time that they are full-time government employees;
  2. This private practice must be only consulting clinics and any intervention or investigation must be carried out within the government hospital where the doctor is employed;
  3. Private practice can only be engaged in the doctors free and non contracted time;
MDCN has given a period of grace of up to December 2011 for those affected to comply with the laws of the land. But the test of this will be in its implementation. Gone are the days of empty threats. Nigerians will be watching, and we at Nigeria Health Watch will be watching. December 2011 is round the corner. The doctors in LUTH, UNILAG, ABU and UNTH that run the biggest private hospitals around these cities are public knowledge. They have never hidden their practices. We will get back to you on this in January 2012.

But it can no longer be business as usual. If Nigeria is to change for the better, the change has to start from us.  Kudos to MDCN for taking on its leadership mantle under Professor Roger Makanjuola. We will get used to good leadership and we will expect nothing less in the future. We must hold ourselves to the very high standards that the Nigerian public rightly expects of us. ALUTA




The full text of the COMMUNIQUE from the meeting is below. Sadly...I could not find it on their website :)


The Medical and Dental Council of Nigeria has issued a press release which all doctors and dentists in Nigeria should read and, where necessary take appropriate action. The circular may come to you, and I am only helping in bringing it to your kind notice in case you miss it—Shima K Gyoh.

ON THE STATE OF MEDICAL AND DENTAL PRACTICE IN NIGERIA: THE ROLE OF THE MEDICAL AND DENTAL COUNCIL OF NIGERIA
The Medical and Dental Council of Nigeria has received information through a number of National Newspapers of critical comments made on the practice of medicine in our country during a lecture on September 27, 2011. The transcript of the lecture and the discussion thereafter are not available. However, it appears that during the address, the standards of practice of Nigerian doctors working in the country were heavily criticised and it was implied that the agency responsible for monitoring medical practice was not doing its job. The agency responsible for regulating the standards of medical and dental practice in the country is the Medical and Dental Council of Nigeria and the Council believes it is necessary to provide information to the Nigerian public concerning the actions it has been taking to enhance the standards of medical practice and to protect the people of this Nation from malpractice and unethical behaviour.
The Medical and Dental Council of Nigeria has four major functions;

1.     To ensure that medical and dental training in the country meets international standards
2.     To ensure that practicing medical and dental professionals provide health care of international standard.
3.     To ensure that medical and dental practitioners maintain the highest ethical standards and to protect the people of this Nation against malpractice by medical and dental practitioners.
4.     To maintain a Register of medical and dental practitioners, which should be published regularly.
In achieving these objectives, the Council has given priority to the following:
  1. Ensuring that the facilities, both physical resources and personnel, in the medical and dental schools are of high standard and that they admit the numbers appropriate to those facilities. This is to be achieved by close monitoring of the training institutions and taking firm action in respect of those institutions that fail to meet the required standards.
  2. Ensuring that doctors and dentists maintain the standards of professional practice through a compulsory programme of Continuing Professional Development (CPD), which was introduced in 2010. As from January 1, 2012, certification of having met the CPD requirement will be a condition for renewal of annual licences to practice.
  3. Prosecution of medical and dental practitioners who have engaged in malpractice or unethical behaviour through the Council’s disciplinary bodies, the Investigation Panel and the Disciplinary Tribunal. 
  4. Information and Communication Technology to be deployed for all the Council’s functions.
  1. Over the past year, 11 institutions that failed to meet the required standards or which have admitted student numbers greatly in excess of what they can meaningfully teach have had their accreditations withdrawn. The accreditations of those institutions are being restored only when they have restored these standards. The disciplinary actions did result in them taking action to rectify their deficiencies and restore standards, and those institutions are the better for it. Also, all the training institutions now know that we mean business and are striving to ensure that they adhere to the standards that the people of our Nation deserve.
A number of these institutions have taken steps to rectify these deficiencies and had their accreditations restored. These will be carefully monitored by the Council. The remaining institutions stand suspended until the Council has satisfied itself that they have rectified their deficiencies.
  1. The compulsory programme of Continuous Professional development has been established. Compliance with the CPD requirement is a condition for renewal of licences to practice as from January 1, 2012
  2. The two disciplinary bodies of Council, the Investigation Panel and the Disciplinary Tribunal, have been working vigorously to ensure that cases of erring practitioners are dealt with promptly and firmly, while ensuring justice to those concerned. At its most recent session, the Disciplinary Tribunal suspended the licences of two doctors and struck off the name of a third doctor from the Register of Medical Practitioners.
4.     Arising from its concern over the tragic effects of the recent series of strike actions by members of the medical and dental professions, the Council organised a Stakeholders’ meeting on June 23, 2011. All the major groups within the profession participated in the meeting. We examined the problem from all angles and it is to the credit of our profession that we did not shirk from examining ourselves critically and identifying problems within our profession that needed to be addressed. The communiqué of the meeting has been published. It identified the steps that must be taken to put an end to the tragic loss of life and human suffering that has been taking place by all those concerned – the practitioners themselves, the Government and the Council. The most important is that, while the Code of Ethics of our profession allows medical and dental practitioners to down tools under extreme circumstances that will be quite rare, when such industrial actions occur, the care of our patients is protected. The Code stipulates that no patient can be abandoned in the midst of his or her treatment; a striking doctor must make arrangements to hand over the continued care of his patients before he leaves his post. Also, provision must be made for the continued provision of services for accidents and emergencies and the care of those with serious illnesses and life-threatening conditions. The communiqué also drew the attention to a number of other issues that need to be addressed by our profession and the Government.  The Council intends to ensure that the resolutions in this communiqué are fully complied with.

The Hippocratic Oath to which we all swear on entry into the profession includes two statements:

“The health of my patient shall be my first consideration”, and
“I will maintain the utmost respect for human life.”

The Council’s position is that all doctors and dentists must abide by this Oath. The people of this nation are hereby encouraged to report cases of malpractice and unethical behaviour to the Council at the address at the top of this release.
 
5.     At its meeting on September 30, 2011, the Council directed that the Code of Practice concerning Private Practice by doctors and dentists in Government employment should be strictly adhered to. The relevant portions of this Code are to be published separately, along with advice to the public on the procedure for reporting cases of malpractice and unethical behaviour to the Council.

6.     The Council’s programme of harnessing Information and Communication Technology (ICT) has made great strides. ICT has been integrated into all the internal and external functions of the organisation. As an example of this,  registration and licensing operations are now fully on-line. The Council’s website address is www.mdcnigeria.org.
  1. For the first time in 10 years, the Register of medical and dental practitioners has been published, and is available both in hard copy and electronic form. The Register can be accessed on the MDCN website.
The Medical and Dental Council accepts that there are some medical and dental practitioners whose standards fall below those that the people of this Nation deserve. However, we believe that the majority of practitioners are dedicated and provide high standards of practice, standards that we can be proud of. The Council will continue to meet its responsibility to raise and maintain the standards of medical education and practice and to deal firmly with those practitioners who do not meet these standards.
Dr. Roger Makanjuola,
Chairman, Medical and Dental Council of Nigeria
01 October 2011