Doctors, pharmacists fight dirty over appointment of pharmacist- consultants

The Nigerian health ecosystem is gradually moving towards a dangerous rupture, and if the rising tension between the Nigeria Medical Association, NMA, and the Pharmaceutical Society of Nigeria, PSN, is not nipped in the bud, it will morph into a conflagration that has the capacity to consume the already fragile health sector. The fight between the two critical professionals in health sector is not new, but it is assuming another dimension.

Last week, the NMA  raised concerns that the recent execution of the consultant pharmacist cadre at two federal health institutions in Lagos State may, in the long run, destabilize patient care, healthcare delivery, and professional harmony.

The medical body also noted that the appointments and implementation have no clinical value, as it does not advance the cause of healthcare delivery in any tangible way..

The NMA Lagos State chapter, in reaction to the actions of some medical directors of two federal health facilities in Lagos, who allegedly established the consultant-pharmacist cadre in their respective institutions, frowned at the action, calling for its immediate suspension.

NMA Lagos Chairman, Dr. Babajide Saheed, and Secretary, Dr. Jimoh Hassan, in a communique they jointly appended to after an emergency State Executive Council meeting held at the Lagos State University Teaching Hospital, Ikeja, last week gave a seven-day ultimatum to both medical directors to reverse their decisions.

In the communique, the association highlighted its position, saying the establishment of a consultant cadre for pharmacists is a dangerous move with no clinical value, which could unsettle patient care and professional harmony.

The affected institutions are the Federal Medical Centre (FMC), Ebute Metta, headed by Dr. Adedamola Dada, and the Federal Neuropsychiatric Hospital, Yaba, whose CMD is Dr. Olugbenga Owoeye.

The council voiced serious concern and disappointment over what it saw as a unilateral and ill-advised decision that violated the NMA’s earlier warnings. According to the communiqué, the cadre could not offer contributions to direct patient care,  infringed on established medical protocols, and potentially endanger the peace and stability of health service delivery by allowing for industrial disharmony.

“In addition, the SEC instructed the SOC to write to the Federal Ministry of Health and other relevant stakeholders, outlining the potential dangers the new cadre poses to patient care,” the communique read in part.

The council also enjoined  the NMA to start  a national-level discussion and take decisive steps to prevent what it described as a “dangerous precedent” from taking root.

Old Contentions

It would be recalled that similar fights had erupted between the two professions in the past, and there seems to be no end in sight. In those fights, the NMA is always the protagonist in a bid to protect its privileges and dominance in the medical profession. The first of such fights began in the 1990s, when Prince Julius Adelusi-Adeluyi, a renowned pharmacist, was appointed Minister of Health. The NMA rejected the appointment and fought to the very end. Since then, he remains the only pharmacist ever to occupy the position. Then, another fight erupted over the appointment of pharmacists as chief medical directors of teaching hospitals. NMA also vehemently objected to it, and so it has been. In the present controversy, nobody knows how it will play out yet.

But in a swift reaction,

The Pharmaceutical Society of Nigeria (PSN) Lagos State branch last week took a swipe at  the NMA Lagos chapter’s attempt to scuttle the federal government’s appointment of Consultant Pharmacists in Federal Health Institutions in the state to task, saying it was biting more than it could chew.

PSN Lagos Chairman, Babayemi Oyekunle, while responding  to NMA recent communiqué signed by the NMA Lagos chapter rejecting the appointment of Consultant Pharmacists into federal health institutions in the state, and calling for a “reversal of the appointment irrespective of its legality,” including a warning that its members in the two affected federal health institutions in Lagos State would embark on a warning strike; said the action of the physicians body was a “hostile and monarchical attempts to undermine the implementation of the Consultant Pharmacist Cadre approved by the government.’’

He  declared that  NMA Lagos State had  instructed  its leadership to write to the Federal Ministry of Health on the  apparent  danger of the Consultant Cadre in Pharmacy, while a “clear and strong warning was issued to all other Medical Directors and Chief Medical Directors contemplating the implementation of Consultant Pharmacist Cadre in their institutions” to stop.

Oyekunle  said the NMA Lagos action was nothing but  a “vintage epitome of monarchical antiquity,”  adding  that “its uncouth statements are unduly aggressive and hostile and amount to a declaration of war.

“We wonder where the NMA Lagos derives the authority to issue “Clear and strong warnings” to Medical Directors and Chief Medical Directors, who are government appointees that are bound by circulars of government in the spirit of existing Public Service Rules (PSR),’’ he queried.

Referencing standard practices that obtain in other climes including the U.K where pharmacists have been designated Consultants in the National Health Services, USA, Canada, Australia, Poland , South Africa, Ghana and Sierra Leone where Consultant Cadre has been the norm in the health system for decades without a disruption to the communality of the focus of health professionals, which is patient care, the PSN declared as inconceivable “that NMA believes that only physicians should specialize and be rewarded while skills acquisition must remain a taboo to other health professionals contrary to international best practices.’’

Another Threat

The PSN, Lagos State Chapter, has petitioned the state government to expedite the implementation of the consultant pharmacist cadre, warning that inaction could exacerbate the ongoing strike by health workers in the state.

This appeal comes as health workers, represented by the Joint Health Sector Unions (JOHESU), embarked on a three-day warning strike in Lagos.

In a letter addressed to the Head of Service of Lagos State, PSN, Lagos State Chairman, Pharm. Babayemi Oyekunle highlighted the ‘unending delays’ in formalizing the consultant pharmacist cadre through an official circular.

Oyekunle in a letter titled, “The Beat Goes On In The Health Sector In Lagos State,” emphasized that this demand is critical and was previously agreed upon during discussions with Governor Babajide Sanwo-Olu during his campaign.

The PSN noted that the establishment of the pharmacist consultant cadre was initially approved by the National Council on Establishment (NCE) in 2011. The pharmacist consultant cadre was reaffirmed in 2021, underscoring the importance of timely implementation for the benefit of healthcare delivery in the state, according to PSN.

“This cadre has since been adopted in several states, including Edo, Osun, Oyo, Ondo, Niger, and Kwara, as well as by federal health institutions.

“Notably, over 250 Consultant Pharmacists have recently been appointed at the federal level, with the University College Hospital (UCH), Ibadan, leading with over 30 appointments,” it noted.

He pointed to the earlier use of the title ‘Controller of Pharmaceutical Services’ in place of the more appropriate ‘Director.’

According to Oyekunle, this issue was only rectified following intervention from the Ministry of Establishment, highlighting the ongoing challenges faced by pharmacists in maintaining their professional titles within the state’s healthcare framework.

“In all the negotiations dating back to 2018 when JOHESU/Assembly of Healthcare Professional Associations (AHPA) engaged the former governor, Akinwumi Ambode administration to contemporary times when National Union of Allied Health Professionals (NUAHP)/JOHESU negotiated with the Sanwo-Olu administration, we demanded specifically for a Consultant Cadre and not a Specialist Cadre.

Pharmacist Ajoke Adedayo told Business Hallmark that “it’s unfortunate that the Nigerian Medical Association still lives in the past, it’s also unfortunate that the idea or perception of doctors as superior to pharmacists has no basis in facts, it’s one of the bequeath of years of discrimination against pharmacy. I think the federal government will go the whole hog in implementation of the consultant cadre for pharmacists, it should not succumb to the pressure from doctors.”

Nwankwo Chukwueke, a medical doctor, told this medium that “We, the medical doctors, have made our points clear to the Lagos State government. The two federal health institutions where the consultant cadre for pharmacists has been implemented must walk back on the implementation, else we will embark on strikes. We will start with a warning strike,” he said.