I sat at the rear and watched with amazement as all the honourable members of Delta State House of Assembly Committee on Health spoke in defence of the submission of the commissioner for health, Dr. Ononye Mordi. One after the other, they gave reasons why the local community nursing and midwifery programme, a programme initiated by the Nursing and Midwifery Council of Nigeria (NMCN) must be operational in Delta. This is despite the fact that the nurses gave great reasons why the programme should be aborted as not suitable for a high profile state as Delta.
As one who has been following the development for a period of time, I can conveniently write on the issues at stake. As a practising journalist in Delta for 13 years, I know the importance of professionalism. As at present, the Nigerian Union of Journalists (NUJ) in Delta state is wielding out unprofessional journalists from the union. Although the union cannot stop them from practising since they are employed by different media organisations or they are self-employed, they cannot be members of the NUJ. This is peculiar to the media industry. Though the media industry has some level of freedom for whoever has a flair for writing and can practice without being member of the union, it is not so with other professions.
If there is compromise in any sector of the economy in the employment of practitioners, it should not be in the health sector because the sector is very significant in the sense that it deals with human life. Any unguarded mistake made by the person in charge leads to automatic death. And life has no duplicate. That is why there is extreme care in the education of persons who must work in the health sector because of its importance to life. Not everybody is fit to be in that sector. If you are not fit, you are not fit. If you are fit you are fit. It does not need negotiation. If anybody bribes his way into the health sector, there will be harvest of deaths in the field. With its importance to life, quacks are not needed in the health sector.
We’ve been told stories of doctors who, after carrying out surgical operations, abandon surgical knives in the body of their patients and such patients begin to bleed unaware that an unqualified doctor abandons a knife after completing the process. Yes, they call them doctors but they are poorly trained and the compromised process allows them into the medical field. This is one reason why only few medical personnel graduate from the medical school because of the rigour they must go through to maintain their status as doctors. Many fail along the way and they are thrown out of the school and only few struggle to the end. One hundred students may start the medicine and surgery department in year one. At the end of the class, may be 40, 50, 60 who will graduate. The fake ones have been removed.
The nursing profession is not different from that. Nurses and doctors work together in the hospitals to ensure the well being of their patients. If a nurse is not well trained, there is the tendency of adding to the problem of her patients in the hospital and complicating the work of the doctor. This is why I was baffled when the lawmakers were defending the initiative and the proposal for the training of community nursing and midwives in Delta state. Although I’m neither a medical doctor nor do I have experience in any aspect of medicine, with my knowledge of professionalism from my media experience, the health sector should not be run with poorly trained personnel.
The community nursing as we are made to understand will be low cadre nurses who will be trained for two years instead of the regular three years programme in the school of nursing and midwifery which we understand do not have enough facilities for the regular students. Teachers are not enough to train the regular students and now an additional burden is being added to a system which has already been overstretched.
One needs to ask some salient questions. Will the state government provide more facilities to accommodate this set of students? Will the state government employ more health teachers in addition to the ones who are teaching the regular students? Do the schools have enough laboratories for practical sessions for the regular students which can also accommodate the community nursing without stress and strain? These are questions that the authorities need provide answers to as the students are coming into the schools.
There are some institutions that employ part time teachers for lecturing. These may work for some courses but not so with the medicals. Part time lecturers are after their money and not what the students will benefit from the lectures. In most institutions, students are crowded in classes while the teachers struggle their way into the classes. One wonders whether students can benefit from such classes. These are issues that lead to poor graduates from the higher institutions.
When I heard the nurses making presentations as to why the community nursing and midwifery programme should be abolished in Delta, I knew they were talking with professional experience, the need to save the profession from quackery and most importantly, the need not to jeopardise the health of Deltans and other residents in the state. The committee members hinged their support for the programme on the fact that the programme emanated from the Nursing and Midwifery Council of Nigeria (NMCN). Agreed, but the nurses argued that the programme is actually meant for states which do not have enough nurses to cater for the health needs of their people and most especially Northern states.
With this submission, Delta has already trained nurses from which the government can employ as many as the system wants to fill the gaps in the sector. There is therefore no need training lower cadre nurses for the health system in the state. On the argument of whether the qualified nurses will accept low pay which the government is proposing for the lower cadre nurses, that argument does not hold water. The issue under review is the health of people and not animals. Delta state government cannot hide under low salary payment to employ low cadre nurses for the health sector. The health sector is too significant for the economy for government to employ poorly trained personnel for the system. That will amount to sacrificing quality for quantity and end result is always disastrous.
From the submissions made by the proponents of programme, I understand that the participating students will be drawn from each of the political wards. This could be interpreted as an attempt to politicise the training of the community nurses. If not, why selecting the trainees from the political wards? Deltans are keenly watching where the entire scenario is heading. I understand that some persons were trained some time ago but it yielded no result. I will advice we face reality on this all-important health policy and make our health facilities habitable for both patients and health workers.
Delta state is not a poor state. The facts are in the public domain. Delta has one of the highest allocations from the federation accounts allocation committee. There are poorer states in Nigeria but not Delta state. With the federal allocation and the internally generated revenue, Delta can conveniently pay full salary of all sectors of workers in the state. So, this flimsy excuse does not come to play. If money cannot be spent on anything else, definitely it should be spent on the health of the people of Delta state. This is because this sector takes care of the manpower that generates the money for the state.
Another argument put forward was that the state governor, Dr. Ifeanyi Okowa, has given his signature for the programme. That is immaterial. There are many programmes President Muhammadu Buhari signed at the federal level but with heavy criticism and protests from the Nigerian people, Buhari had not option but to abandon the programme for the sake of Nigerians. Yes, it is possible that the governor may have signed without understanding the full details of the programme presented to him by the commissioner for health. The fears expressed by the nurses may not have been presented to him by the commissioner.
If it is established that health workers do not stay at the work place, questions need be asked to find out their reasons. Probable reasons could be lack of basic amenities such as water, electricity, motorable roads, accommodation, and others. For instance, we can make a comparison between health workers in Shell assisted facilities in the state and those in normal facilities, we can conclude why such nurses act the way they act.
While in the hall, I heard that there are about 425 primary health facilities and 402 nurses in Delta state. This shows a heavy shortage of manpower in the sector. But the committee members told the nurses that anywhere these community nurses will be posted to, qualified nurses will be there to monitor their activities. While this is true, there are still some questions to be answered. I understand that medical personnel work on shifts. A situation where there are 425 primary health facilities with only 402 nurses, how will the shift be possible when there are even some centres with no nurse attached to them? And those centres with only one nurse, will that nurse not go on shift? Will she run 24 hours non-stop and abandon her family so as to monitor a quack nurse? These are issues that must be looked into.
I will also like to mention that like a tripod, every profession is made up of the regulatory body, the union and the professionals. Any attempt to wither the strength of one and render it impotent tantamount to breaking one leg of the tripod and it could spell doom for that profession. The health commissioner had on several occasions allegedly said that NANNM members should not interfere in the decision of the ministry of health. It must be emphasised that the greatest welfare any association can give to her members is to gate keep the profession and create space for her members.
Delta state government cannot delve into programmes arbitrarily. The benefits of the programmes must be looked into. The quality of personnel is also very important. The life and health of Deltans should be given the highest priority in the choice of personnel to man the health institutions. We cannot sacrifice quality for quantity under the guise of paying low wage. The state is not poor, not at all. It is therefore important that government should have a second look at the community nursing and midwifery programme before the programme commences. After all, I’m also a Deltan. And I have right to air my opinion.
THIS OPINION ARTICLE WAS WRITTEN BY AUSTIN OYIBODE FROM ASABA