By Joseph Erunke, Abuja

The Association of Community Pharmacists of Nigeria, ACPN, has stated that incompetence, poor leadership and communication skills, lack of relationship management, as well as physicians’ inexperience in business management strategies, are responsible for the challenges in Nigeria’s public hospitals.

This is as the pharmacists’ association alleged that 90 percent of the nation’s health insurance scheme and the Drug Revolving Fund,DRF collapsed under the watch of physicians, insisting that the latter “diverted these funds, leading to debts of over ₦30 billion owed to the pharmaceutical industry”.

The association said for Nigeria to abandon the aimless wanderings of many years in the wilderness of healthcare, the government must embrace holistic reforms grounded in global best practices.

The ACPN, in a statement by its National Chairman, Pharm. Ambrose Ezeh, insisted that incompetence and other leadership deficiencies among physicians contribute to “why brand new and sophisticated equipment become moribund before replacements are even considered in all public hospitals.”

The statement was the ACPN’s response to the National Association of Resident Doctors,NARD’s position on its earlier open letter to President Bola Tinubu, in which it sought his intervention in what it termed the “dominance” of health sector administration by physicians.

“Our physician colleagues suffer from a lack of competence, poor leadership and communication skills, zero relationship management, and are generally too inexperienced in business management strategies,” it said.

Stressing that healthcare administration is not only ideal but also an autonomous professional field, the ACPN stated, “This is why trained professional administrators are appointed to head hospitals, as we see in other climes.”

According to the association, “This was the norm in Nigeria up to 1985, when the late Olikoye Kuti, in alliance with former military President General Ibrahim Babangida – his erstwhile boss – disrupted this ethical order with the infamous and outrageous Decree 10 of 1985, which has been manipulated to compel the headship of Federal Health Institutions (FHIs) by physicians in Nigeria.”

“Under the watch of hospital administrators in the 1970s and up to the mid-1980s, the hospital system was characterised by decorum and efficiency, especially because health professionals stuck to their areas of competence,” it alleged, adding, “The health system was so good that foreigners accessed care services in our country.”

The ACPN statement continued: “As we always say, UCH, Ibadan, was rated among the top five health facilities in the Commonwealth. The takeover by physicians ruined the health system in Nigeria.”

“The high-handedness of physicians destroyed civil service norms and protocols, leading to unprecedented corruption, which has now been institutionalised.

“Some D-CMACs are designated to take charge of catering and energy in some instances, and in almost all cases, physicians oversee the procurement of all hospital equipment and commodities, including drugs.

“The recklessness is both widespread and deep-rooted, such that a few months ago, the ICPC branded the health sector as the most corrupt realm in the national economy.

“To further substantiate this, at least two physician ministers have been disgraced out of office on corruption charges, including one under the Tinubu administration. Several other physician-CEOs have also been casualties.”

The ACPN further alleged that “90% of the DRF schemes in FHIs collapsed under the watch of physicians who diverted these funds, resulting in debts of over ₦30 billion owed to the pharmaceutical industry, as reported by the PSN in November 2023.”

Explaining that the National Health Insurance Authority (NHIA), which regulates social health insurance, achieved a coverage of over 10 percent in its first two years when pharmacists insisted administrators should be CEOs, the ACPN recalled that “Messrs Mustapha Sambo and Dr Mohammed Lecky were the pioneer CEOs with good records before the first physician, Dr Dogo Mohammed, was appointed.”

“Since that appointment, there has been a steady decline in fortunes with physician-CEOs at NHIA (formerly NHIS), where the coverage rate dropped to 1.72% since 2017 under the tenure of a surgeon, Dr Femi Thomas.

“Recently, another surgeon, who is now facing litigation over alleged excessive corruption, presided over the then NHIS before being dismissed, “ it said.

According to ACPN, “One of the most glaring legacies of physician leadership in MDAs is Nigeria’s infamous negative health indices.

“ In simple terms, Nigeria grapples with high infant and maternal mortality rates, counterfeit health commodities, poor logistics and supply chains, dismal immunisation networks, and substandard procurement practices in healthcare delivery.

“No wonder we continue to languish at a ranking of 187th out of 191 health systems.

“Physicians destroyed a culture of preventive healthcare in favour of curative methods due to pecuniary motives. Environmental Health Officers are often rendered ineffective as a result.

“For decades, malaria treatment – which accounts for 65% of clinical visitations in Nigeria – has been tackled solely through curative therapy. Alternatives, such as prevention via chemical spraying and environmental treatment, are neglected because physician-CEOs in primary healthcare are not interested, as it would affect budget allocations linked to financial gain, “it said.

It added:“When physicians claim they do not interfere in the affairs of other health professions, we are baffled – as evidence to the contrary is in plain sight.

“It is only in this country that people specialise in their field yet insist that other professionals in the sector have no right to expand their knowledge base.”

The statement read further:“Nigerians should be aware of the politics of salary and wages in the health sector, including the tendency of physicians to negotiate for their own benefit while dictating what should accrue to non-physician health professionals and workers.

“This is why the adjustment of CONHESS, as was done for CONMESS, has not materialised in 11.5 years – as the Federal Government remains harassed by its own employees.

“In similar fashion, physicians have perfected the absurd notion that opposes the appointment of non-physician caregivers as Health Ministers, Commissioners, and Permanent Secretaries at both state and federal levels.

“In 1993, when Pharm. Prince Julius Adelusi-Adeluyi was appointed Health Minister, the NMA threatened fire and brimstone if the decision was not reversed.

“Today, it takes a truly courageous president – as former President Obasanjo demonstrated for 7.5 of his 8 years in office – or a bold state governor to appoint a non-physician as Health Minister or Commissioner, owing to the intimidation by physicians who have entrenched a ‘grab-grab’ culture, aiming to appropriate all benefit packages and privileges in healthcare for themselves and their associates.”