Arising from an Emergency meeting of members of the Association of Resident Doctors (ARD), SHMB on 9th February, 2021, to among other things discuss the disparaging remarks against our members made by Mr. Godwin Obaseki, the Executive Governor of Edo State in a meeting he held with doctors in the state recently, the association observed as follows:
CORRUPTION IN THE HEALTH SECTOR
We noted the vexatious and unsubstantiated allegation of corruption against doctors in the employment of the State government. It is a notorious fact that several years ago, the Edo state government introduced a direct mode of collection of revenue for services rendered in all government health facilities that effectively makes it impossible for the management of these health institutions to have access to the collected revenue let alone the doctors who render only clinical services. Any lapses in the government revenue-collection process must not be blamed on any medical personnel.
We are unaware of any independent panel set up by the government where any doctor was indicted for any form of financial impropriety. If such an investigative body was ever set up, we challenge the government to make its findings public.
We are however aware that the entire 34 hospitals under the Edo State Hospitals Management Board (SHMB) survive on a paltry monthly subvention of about 15 million naira and are able to still generate substantial revenue that is collected directly by the State government.
PRIVATE PRACTICE BY DOCTORS IN GOVERNMENT EMPLOYMENT
On the issue of private practice by doctors in government employment, we wish to draw the attention of the Governor to that fact that there is an existing law regulating private practice by medical doctors in public service.
The “Regulated and Other Professions (Private Practice Prohibition) Decree No 1 of 1992”, exempts doctors from the ban of public officials from private practice. Additionally, the 2008 Code of Medical Ethics in Nigeria, Part E, 49 states: Medical and dental practitioners who are in full time employment in the public service in Nigeria are free to employ their spare time and unofficial hours to engage in private medical or dental practice.
It is therefore disingenuous to attempt to criminalize and demonize our hardworking doctors whose practice does not conflict with the code of conduct for public officials as they are even already working more than the period required by law.
Finally, if it is even true that doctors own private clinics, Central Hospital, Benin City is an unlikely place for patient recruitment as only indigent patients who cannot afford the cost of treatment in private and federal Health institutions patronize the hospital.
REFUSAL BY DOCTORS TO ACCEPT POSTING OUTSIDE BENIN CITY
Health workforce is made up of health workers which include people engaged in the promotion, protection or improvement of the health of the population and they play a critical role in achieving effective health care delivery.
The sight of long queues of patients waiting to see the doctor in our state hospitals is a familiar spectacle that drives home the message that the shortage of skilled health workforce in Edo State is an issue that warrants urgent attention. The shortage of skilled health workforce means that a limited number of doctors have to attend to hundreds of patients daily and it is known that quality health care cannot be rushed.
It is true that there is an unacceptable disproportionate distribution of doctors between the rural and urban areas in Edo State when you consider that the main urban areas of Benin and Ekpoma axis have UBTH, Central Hospital, Stella Obasanjo Hospital, Irrua Specialist Teaching Hospital and several private hospitals between them.
However, the Edo State government has 34 healthcare centers across the state and the distribution of the health manpower shows that none of the centers has up to 20-30% of acceptable manpower disposition
Consequently, the association has over the years shouted itself hoarse on the need for the State government to employ or engage the services of more doctors due to the acute and now chronic shortage of manpower.
During Mr. Governor’s first tenure in office, there was a promise to employ about 6000 workers in the health sector, including doctors in order to ameliorate the shortage of manpower in the system. We are however shocked at the statement credited to the governor which tends to create the impression that there are too many doctors in Central Hospital, Benin City doing nothing even when the employment is yet to be done. We strongly believe that His Excellency was misquoted.
His Excellency may not be aware that the suppose “over-bloated” medical workforce consists of about fifty (50) first-line doctors called intern or House Officers who are on a mandatory one-year Internship under supervision in line with the Medical and Dental Council of Nigeria (MDCN) regulation. These categories of doctors cannot be posted to hospitals outside Benin (Rural Hospitals) as they lack the Specialist medical personnel to supervise and train these interns.
His Excellency may not also be aware that the other categories of the “over-bloated” medical workforce is made up of doctors undergoing specialization (residency training) as specialist as no other hospital in Edo State outside the Central and Stella Obasanjo hospitals have the specialist manpower (also deficient) to train these category of doctors called Resident Doctors in line with the guidelines of the National Postgraduate Medical College of Nigeria (NPMCN) and other equivalent regulatory bodies. There are departments where residency training is presently ongoing which will be terminated when the trainee doctors are posted to the rural areas. The residency training is the source from whence consultants and specialist manpower are produced for effective healthcare delivery.
The medical students of Edo University, Iyamho also need the services of these specialists and residents in Central Hospital, Benin to sustain the accreditation for their training by the Medical and Dental Council of Nigeria (MDCN) and the National Universities Commission (NUC).
Doctors in Central Hospital, Benin are overworked, overused and under-remunerated. The department of Family Medicine for example has only 3 consultants, 6 senior registrars and 6 registrars who attend to about Four Thousand (4000) patients on a monthly basis. This is the same scenario in the department of Obstetrics and Gynaecology and other departments in the hospital.
We observed with outmost dismay that the governor was given a guided tour round a state owned hospital (Stella Obasanjo Hospital), last weekend by the Chief Medical Director of a federal teaching hospital in the presence of the medical director of that hospital alongside the Permanent Secretary overseeing the hospital. It is very unfortunate that doctors from the federal health institutions in the state are contracted to head and give instructions to state doctors of the same qualification and training. This is not only demeaning to our doctors but it is also an avenue for wastage of funds.
A GRIM SCENARIO
Presently, Central Hospital, Benin has only 1 general surgeon (who doubles as the Permanent Secretary of the Edo State Hospitals Management Board), 3 internist, Only 5 gynecologist in the Edo State government employ. It may interest His Excellency to know that the University of Benin Teaching Hospital (UBTH) has 7 or more general surgeons, 33 internist and 25 gynecologist. In all, there are about 200 doctors working with State Hospitals Management Board, overseeing 34 hospitals across the State (house officers inclusive). Of this number of doctors, about 50 are Resident Doctors undergoing residency training in Central Hospital Benin City. While in UBTH which is just a hospital within a confinement like Central Hospital Benin, has over 1000 doctors who work there on a daily basis.
This is not to suggest that our members are averse to being posted to the rural areas of the state, far from it. Our members are ready and willing to be posted to any part of the State. However, the government should also put every necessary infrastructure such as adequate medical facilities and equipment, power supply, quarters for accommodation, and adequate security in place so that people in the rural areas can also access quality healthcare services.
Consequently, in addition to the above, the association wishes to state as follows:
For the healthcare system to run efficiently, necessary medical equipment and facilities must be put in place as basic radiological and histological investigative tools are presently lacking.
There is an urgent need for the rebuilding of the more than 100 year-old dilapidated Central Hospital building to make it befitting of a hospital setting.
There is an urgent need for the employment of more doctors (consultants and medical officers) as well as other healthcare personnel to render health care services to the citizens of the State. The current situation stifles any plan by the state towards Universal Health Coverage (UHC) if not addressed. Providing adequate access to care for the entire population of the state will require enough professional hands, both in rural and urban areas. This will solve the heavy disease burden in the state and turn the tide of health indicators in the positive direction.
Dr. Osayande Edorisiagbon
Dr. Ovbiagele Uaboi