Health sector crisis: Failure of leadership By Pharm. (Dr ) Lolu Ojo
Leadership, as described by Wikipedia, is “a process of social influence in which one person can enlist the aid and support of others in the accomplishment of a common task.” The same source also defines leadership as “organising a group of people to achieve a common goal.”
The emphasis here is on the achievement of the common goal. The common goal itself can be expanded to mean the aggregate of aspirations, expectations and direction shared by a set of individuals, groups, systems, organisations, and nations. It is for the achievement of the common goal that we all seek good leadership in our country, clubs, societies and individual organisations. We crave for leaders who will bring out the best in us. We seek visionary leadership that can see beyond the limitations of today. We seek leadership that can organise and deploy the available human and material resources for the benefit of all.
All great leaders have something unique about them. From the oldest of times, people have been led by efficient and progressive leaders. Such men and women have been responsible for ushering their people into a new and more modern world, as we now know of it. In recent history, we have some of the greatest leaders like Mahatma Gandhi, who led his Indian compatriots to independence in 1947; George Washington, founding father of the United States of America and leader of the American Revolution. He was a true visionary whose vision has endured for more than 200 years. There are others like Abraham Lincoln, Winston Churchill, Mao Zedong, Fidel Castro, and so on. What made these leaders great were their foresight, vision, strategic planning and ability to lead people to success.
Nigeria, as a country, has remained underdeveloped due to paucity of good leadership. Virtually everything that we used to know and described as good in the past two to three decades is now comatose. Public education has become a travesty of what it used to be and only people who cannot afford the private sector alternatives send their children to public schools. Transportation has become a nightmare. No particular unit has escaped the pervasive rot: air, road and sea.
No particular sector of the economy is really thriving. The euphoria of the breakthrough in the telecom sector has given way to despondence, due to poor network service. We can go on and on to bemoan the sorry state of our nation, due to bad leadership now and in the past.
The health sector of the Nigerian economy is in doldrums. The health indices are among the worst in the world. The Millennium Development Goal for the health sector is more or less a mirage and may not be achieved, just like the Vision 2010 fantasy and the dead slogan, “Health for All by the year 2000”!
Our hospitals are crowded and grossly underfunded. A visit to any of the General Hospitals in Lagos will reveal the unmet needs of the population. You will see huge crowds waiting for long hours to get health care services. You will see health care professionals stressed to the bone and struggling to meet the need of the crowd in a most unfavourable environment. There is really very little to cheer about and the level of discontent (and disconnect) remains, understandably, very high. The net effect is what we see in our daily lives: avoidable morbidity and mortality, low morale among health care staff, migration of qualified personnel to other climes, etc.
We are in this sorry state because of poor leadership at all levels of administrative set up: federal, state, ministry and hospital. Our collective destiny has been grossly mismanaged and the shared aspirations and expectations have become forlorn. We have become so disoriented that absurdity has taken over our health sector.
How else can you explain the unending acrimony and the cut-throat competition among the various cadres of the health care workers? I have been following the agitation of the doctors, vis-à-vis the groaning of the other health care counterparts: pharmacists, nurses, and the rest. So many times, the hospital system has been brought to its knees, as a result of strikes which come in quick succession. For several weeks now, docotors have been on strike and there seems to be no end in sight. Much of their 24-point demand borders on the wellbeing of the other health care workers, which, if granted, will only mean the beginning of another round of strikes.
I have read the many arguments for and against the demands of the doctors and I have come to the conclusion that this crisis can be attributed to the failure of leadership, on the part of the doctors. The doctors have failed, over the years, to mobilise and effectively deploy the available health care human resources for the growth and development of the sector. There has been too much emphasis on ‘me’ or sectional interest, which has subsequently bred mistrust among the different cadres of health care workers. It is always about the doctors: that doctors must be this; doctors must be that, etc. It has never been about the common good or about the patient.
If, truly, health care service delivery is a team work, then where can we situate the health of the team in the demands of the doctors? Can the hospital system really work with the doctors alone? I have engaged many senior doctors in discussions on how to find a middle ground in this unending sector crisis. Indeed, the doctor occupies such a unique position to be regarded as the leader of the health care team and I am not sure there is much opposition to this position. The major issue is what type of leadership the doctors have given to the health sector now or in the past.
Now, there cannot be leaders without followers. If the doctors are the leaders, who are the followers? What are our commonly defined and accepted goals? Followership is not something you can decree into existence. It needs a fertile ground to germinate and grow, based on achievement of common goals. The doctors’ attitude has been to force everyone to be followers in an environment where one depends on the other to get things done. This attitude has never worked and never will. It will be nothing but slavery and no one will accept to be a slave in his father’s vineyard.
This contribution has been long in coming because I do not want it to be seen or regarded as a doctor-bashing note from an aggrieved pharmacist. Rather, I want us to have a consideration that is fresh and solution seeking. The angle of consideration, so far, is myopic and so narrow that it leaves virtually no room for peace to prevail. The fierce argument that only doctors have the knowledge and experience to lead can only bring an equally vitriolic rhetoric from concerned parties, as we have witnessed in the past few months. It will be a hard sell for a party to agree to a position of permanent slavery in the hospital system. Even the accountants, the engineers and the administrators are complaining. What offence have they committed for seeking a career in the hospital system?
It is only in the hospital system that pharmacists find career growth and aspirations difficult to attain. At a time, in the history of the Nigerian telecommunication sector, the positions of chief marketing officer and chief sales officers of a major network were occupied by pharmacists!
No one is born a medical doctor. You go to school to study and acquire the knowledge and skills to practise, just like every other professional. I speak for myself and my colleagues who had very sound foundations at the secondary school level and could have proceeded to qualify for any profession of their choice. I could have been a rocket scientist, if it had been the will of God for me. I have some of my secondary school classmates who are now doctors as witnesses. Therefore, let us bury this superiority/inferiority argument permanently. Let us now begin to discuss common goals and how to achieve them.
To the doctors, I want to appeal for a change of attitude and a shifting of position. The current push will not favour anybody. It will breed eternal enmity between professionals and stunt the growth of the sector. The doctors need to demonstrate leadership, which is greatly in demand at this critical stage. I cannot follow you when you have continually denigrated my profession and demonstrate open hatred for everything that I represent. My natural response will be resentment and that is what you are getting now from the other health care professionals. That was what gave birth to JOHESU.
Dear Doctor, there are stages in life: dependence, independence and interdependence. The true growth comes when we are interdependent. Let us think about this. Let us expand the space to accommodate diverse interests and opinions. Let us create a hospital system that is free of discrimination of every kind. Let us create an atmosphere and environment which will allow every individual to develop his or her potential and be the best he or she can be. Let us plan for the future. A future where the next breakthrough drugs will be from Nigeria; where the next innovative surgical procedure will be from Nigeria; where infant/maternal mortality rate will be one in a million; where Nigeria will be the ideal place to be born.
This is the common goal and it will take an unbiased and focused leadership to take us there. God bless Nigeria.