Long before President Goodluck Jonathan fired resident doctors last week, the Nigeria Society of Physiotherapy (NSP) had on different platforms condemned the strike embarked on since July 1, 2014 by the Nigerian Medical Association (NMA).
Physiotherapists argue that the NMA is not a registered trade union, does not have the legitimacy to negotiate on industrial issues nor go on strike, more so when there is a court order restricting its member from industrial action.
The agitation is spearheaded by NSP President, Taiwo Oyewumi, who is Assistant Director at the University of Benin Teaching Hospital where he heads the physiotherapy department, and a fellow of the National Postgraduate Physiotherapy College, where he was appointed a consultant in neuro-physiotherapy.
Oyewumi, in this interview with Assistant Business Editor, KELECHI MGBOJI, urges those who lost relatives hospitalised before the industrial unrest to sue the resident doctors to court. Excerpts:
Evaluation of health workers in 2007
Taiwo Oyewumi
In 2007, the government produced a White Paper on job evaluation in the health sector. It set up a committee that went round the country’s hospitals and the job factor in terms of knowledge, energy expenditure, and generally the evaluation was based on what you do and what you are worth as a health worker.
They found that physiotherapists were highly rated. In fact, what dropped physiotherapists below some specialty in medicine was that at the time there was no model for specialist training, and the number of years of qualification that was five against six of medical doctors.
Otherwise, if those things were in place then as they are today, physiotherapists would have been the first among all other healthcare professionals in job evaluation. In both job hazards and other related areas physiotherapists are on top when compared with doctors, laboratory scientists, pharmacists, and others.
But we are not demanding that physiotherapist job hazards should be higher than any others. What we are advocating is that the job hazard should be equal.
The disparity we have is absurd. How can somebody who just has a difference of one year in training be employed at the entry level of Grade Level 12, and another gets entry level of Grade Level 9? What we are saying is that this disparity should stop, and there must be fair play and equity.
Implication of disparity in placement of health workers
The implication is huge. It means that some cadres of workers will never get beyond level 12. Nurses, for instance, they terminate at Grade Level 12 if the nurse does not have a degree. So, there are some cadres of workers that can never go beyond Grade Level 12.
And doctors are being placed where some other professionals cannot get to as entry point and they are still asking to be moved to Grade Level 13 or 14 as entry point.
The margin is too wide. Let the government go back to the job evaluation report by the committee it set up in 2007. That document provides for relativity in salary.
It appears the NMA does not understand this or it knows what it is doing; because at every point doctors are negotiating for change in salary, and once that is given they ask for another because they want to maintain that wide gap.
There is a dynamic of change in all professions. The way physiotherapy practice was a few years ago is not how it is today. We now have certified specialty physiotherapy. We have fellows of the Post Graduate College, we have doctor of physiotherapy.
Is it not proper that these professionals who have put in several years of training should still be remunerated the way they were remunerated some decades ago? That is what we want our colleagues to understand, that things have changed and we have to adapt to changing realities.
Clamour for surgeon general
The position of surgeon general which doctors are clamouring for and some other demands that are not under the purview of Mr president for approval beat the imagination. It is only in the military in climes where the position is being used. The position is below that of the minister of state for health.
If we create the position of surgeon general in Nigerian system, he will be fourth in ranking and that will amount to wastage of resources and duplication of functions of the minister of health and the minister of state for health.
Recall that the National Assembly (NASS) threw off the proposal for surgeon general and the proposal suffered a similar fate at the national conference. It is our position in NSP that we do not need the post of surgeon general.
The NMA has to adapt to evolving changes in the health sector. Things are changing for the better, and there is no way they can relegate other professional groups to the background.
Oversight by the House of Reps
Key inputs that will be of greater benefit to Nigerians have been restored in the National Health Bill (NHB) by the House of Representatives. It was read in the House a few weeks ago.
If not for the Lower Chamber of the National Assembly, the bill would have favoured doctors whose members largely constituted the Senate Committee on Health; 90 per cent of the composition is medical doctors. So, whatever they come up with favours medical doctors.
That is what we have seen in the NHB. But thank God for the House of Representatives.
We have presented our position to the House of Representatives. And we have feelers that those provisions that were left out initially have been taken into consideration. Of course, both Houses of the National Assembly must agree before the bill is passed into law.
It is incredible that in the initial bill passed upheld by the Senate, there was no single place where physiotherapy is mentioned. That portends danger to the health of this nation.
Prosecute doctors for patients’ death during strike
The NSP will like to draw the attention of the government and the people of Nigeria that the strike embarked upon by members of the NMA is illegal. The NSP has on different platforms condemned it. We view the strike as unjustifiable and illegitimate.
The NMA is not a registered trade union hence it does not have the legitimacy to negotiate on industrial issues nor embark on industrial action, more so when there is a court order in place, restricting its members.
The NMA is not greater than the law of the land and should be called to order with immediate effect by the relevant law enforcement agents as their current action is in violation of the law of the land.
Relatives of casualties in hospitals where NMA withdrew services of their members should take legal action against the doctors.
Marginalisation of other health professionals
At the beginning, the entry level for medical doctors, physiotherapists, pharmacists, laboratory scientists was the same at grade level but differences in the step until (former Health Minister, the late) Olikoye Ransome-Kuti gave a super salary scale, otherwise called MFS, to the medical doctors. And that was when crisis and acrimony started in the health sector.
The imbalance in remuneration which Ransome-Kuti created has been sustained to date. And that is why we have medical doctors arrogate everything in the sector to themselves. Successive health ministers were medical doctors and they perpetuated the imbalance.
We cannot continue like that because the medical profession is a team; it is like human body and once any part of the human body is cut off, the body can no longer function properly.
Maximising physiotherapy
Physiotherapists work not only in hospital settings but also in sports centres, health promotion industry, and in schools as teachers and researchers. There are physiotherapists who set up private clinics, and some consult in hospitals, NGOs (non governmental organisations) and other organisations.
There are physiotherapists who are professors in universities and some who are researchers, so they work in various settings not only in hospitals.
Nigerians lack information about the role physiotherapists play in the healthcare profession.
Physiotherapy is the art and science of helping people to move and function properly throughout their lives. That means, physiotherapy is required from cradle to grave.
Physiotherapists specialise in different areas like medicine, orthopaedics, paediatrics, women health, sports medicine, ergonomics, et cetera.
There is so much physiotherapy can offer Nigerians but because it is not being practised as first contact practice, whereby clients and patients can access physiotherapy directly, it has limited the service offerings.
In the United States of America, for instance, 50 per cent or more of the population has embraced first contact physiotherapy. That is the direction the professional practice is moving.
What physiotherapists on first contact offer patients
In all areas of physiotherapy on first contact – with patients having neck pain, low back pain, even patients who have had stroke, been earlier managed and can go to physiotherapist on first contact – what we do is, after we have assessed the patient, we make referral if what the patient requires is not within our competence.
But patients can access physiotherapist directly and the physiotherapist can investigate and diagnose the challenge the patient has. If there is need for referral such patients will be referred to other experts.
We have lots of areas to contribute to healthcare promotion for preventive, rehabilitation and curative medicine. So we urge Nigerians to embrace physiotherapy, engage physiotherapists on first contact practice.
People with problem of overweight and obesity, require physiotherapy. Those with arthritis require physiotherapy. People who are in certain work, ergonomic issues require physiotherapy. Sportsmen and women who may suffer certain degrees of injury, pain or strain, require physiotherapy.
Even patients with certain heart condition require a physiotherapist who is core specialist in physical activity, exercise testing and prescription. Exercise is like drug and when a patient takes an overdose, underdose or inappropriate drugs, there will be problem.
That is why the exercise applied in physiotherapy is therapeutic exercises. They are for treatment and not just any form of exercises. So Nigerians have a lot to benefit either before they suffer any kind of ailment or while they are suffering an ailment, and need our intervention for rehabilitation.
A stroke patient, for instance, needs to be rejuvenated back into society. Physiotherapists have the wherewithal and technical know-how to offer qualitative healthcare services.
