THE MEDICAL DOCTORS PRESCRIPTION ONLY AGENDA

‘THE MEDICAL DOCTOR’S PRESCRIPTION ONLY’ AGENDA

(Sole drug prescription power to the medical doctor)  -  A giant stride that would positively transform the Nigerian medical system and stop the tragedy and calamity that has befallen the health and life span of Nigerians.

                                                             -By: DR. OKHUELEIGBE M. O.

 

INTRODUCTION / CURRENT SITUATION:

It is a beautifully interesting thing to realize the great blessings that has been bestowed upon us both in talent, knowledge, human and natural resources. But the irony of this realization is that despite these vast amount of great endowments, the average life span of a Nigerian in the past few years has been about 46.94 years in recent times –a level that is far below the world average of 67.2 years and that of other developed countries such as USA (78.15 years), Monaco-89.73 years, United Kingdom (80.05years), Japan -82.25 years, Germany -80.07 years, Canada -81.38 years and even others like Indian (69.89 years) ,Ghana (59.85 years), Cameroon (53.69years) and more like Mexico (76.51 years), Egypt (72.12 years), and Spain (81.17years) and European Union (78.82 years).

Currently, the average Nigerian believes that the medical system of Nigeria is bad. The top government officials (who even have the power to change this), doctors and other medical workers (who have the knowledge for this changed) and others (who have the financial power to change this) are not excluded.

This is evident by the fact that they almost always would travel overseas for the medical care that they may need from time to time. The surprising thing is that quite a number of times they get treated by Nigerian doctors resident in some of these “great” countries where they travel to. Yet it has not been realized - where, what and how we have gone wrong. Is it that our doctors are bad and suddenly become good when they cross our boarders or the air and sun that comes into the Nigerian atmosphere have some adverse effects on the performers of our doctors or what exactly?

Almost 50% of Nigerian doctors travel overseas making those countries greater with their brains, talents and efforts. Some may even go there to work as nurses and do other lower jobs – just to leave this nation. Yet we quickly conclude that they are looking for “greener pastures” as if we were cursed that our pasture can never be green – more so, close to over 70% of Nigerians who can afford very good health care  travel overseas and carry our Nigerian foreign exchange out and thus reducing our economic power. I don’t put the blame on them. Therefore, even the few doctors in Nigeria who are making effort to make progress do not get adequate patronage to support the development they are attempting – these doctors are not to be blamed.

Most of the government hospitals have minimal development - may be because there is usually no personal interest or commitment in it. Yet these hospital are crowded with patients; making health care very poor. Yet there may be doctors – usually not enough for the patients. Equipments and materials are almost always not enough – but the innocent patients may be unaware of this.

Many doctors and other workers “fight” seriously to get into these government hospitals because that is where they may be sure of little daily bread. So many doctors resign from private hospitals daily because the private hospitals may not be able to offer what the government is paying. Though they are almost always immediately replaced, the efficiency of the private hospitals is adversely affected – neither the doctor nor the private hospital should be blamed.

It is alarming to realize that there are so many doctors out there that are still feeding from their mothers’ pots. So, who will blame them if they choose to travel overseas? Yet there are so many places where there are no doctors, but no doctor goes there because patronage is not guaranteed. A careful study of this complex situation tells us that we have gone wrong somewhere.

The patronage at the private hospital have gone so low that a number of them have gone into some unprofessional “sharp” practices to make ends meet and they do everything to protect themselves. Yet is difficult to blame them. Something is wrong somewhere.

It is unfortunate that most times, the patient that finally get to the doctor for treatment is the one that has been mismanaged by other persons who are not doctors and of course not trained in the art of making the right diagnosis and instituting the properly required treatment which require adequate knowledge of basic medical sciences, pathology, pharmacology and other clinical sciences.

The situation in Nigeria today is such that if a person has a health complain, he tries to treat himself; if no response, his parents or friends will try; if no success, the chemist man will try; if no success, the nurse would try; if no success the laboratory scientist would try whom in recent times personally or through some of their employed O’ level holders would conduct tests (not even requested for by a doctor) and go ahead  to make drug prescription, give injections and sometimes transfuse blood (practices that are very dangerous to the patient); if no success, the pharmacist would try; if no success the patient will finally seek for a doctor’s attention. Of course by this time only few patients get to the doctor and usually their cases would have been very bad, but because the doctor gets few patients, he may get tempted to holding unto the patient whether or not he can help. He may then do some sharp practices to get some money before pushing to the right person. By the time patient gets to the right person (doctor) or co-operation of doctors, the patient might have become unredeemable. Of course, even this right person may also do some sharp practices since very few patients get to him. Obviously, these doctors are not to be blamed completely since the system of the nation has allowed the above sequence which reduces their patronage and they also required funds to run their lives, families and hospital if any. This system also makes it impossible for them to get enough funds for required equipments and research. It also discourages the doctors from telling the patient  details of the condition and treatment (drugs and otherwise) as this would make him to keep having the patient as a customer because if  the patient know details, next time he will go to the chemist or pharmacy for the drugs.

This poor patronage also makes the number of standard private hospitals and number of doctors they employ to be few. Unemployment is further created for doctors who would have been of help in enhancing our health system. This unemployment and how doctors are handled in Nigeria further make our doctors travel out of Nigeria- with brain drain out of Nigeria.  Time will not be enough to elaborate on this ugly situation of our medical system.

 

THE AGENDA

Having observed the tragedy of the Nigerian Medical System and using my God- giving talents and those of other persons to study the situation, I am glad to say that “ALL HOPE IS NOT LOST”. This has led to the initiation and proposal of this great and very hopeful agenda – “THE MEDICAL DOCTOR’S PRESCRIPTION ONLY” AGENDA (MDPO agenda ) - for the benefit of general Nigerian System, the Nigerian Medical system and all Nigerians in general.

What is the MDPO agenda all about: wait a minute!

It says that ‘a law should be made stating that from a particular date onward no drug whatsoever shall be sold, bought, used or obtained by any means whatsoever from any place whatsoever-whether chemist, pharmacy, medical establishment, or otherwise –by a patient or person in Nigeria without a written prescription from a medical doctor or dentist registered to practice by Nigerian Medical and Dental Council except a registered dealer (wholesaler or retailer) who MUST ONLY dispense following a written prescription by a registered medical doctor .’

By so doing, we shall redeem the medical system of Nigeria from the impending calamity that would have befallen it. Medical services would become more marketable and improved; the life span of Nigerians shall increase.

GENERAL ADVANTAGES:

General advantages are that - since for any drug to be obtained by patient, it must be prescribed, it means that wherever humans are, medical services would be marketable, thus doctors would spread all over and those who travelled out of Nigeria could return instead of doing dirty jobs overseas and eventually, the life span would increase. It would also prevent undue adverse drug effects and subsequent morbidity and mortality caused by self medication and drugs being prescribed by chemist men, laboratory scientist and technicians, nurses, pharmacists and other persons not trained for the job or art of diagnosis and prescription of drugs.

 

POINTS PEOPLE MAY PUSH AGAINST IT AND THEIR QUICK DISMISSAL.

 

Having discussed this agenda in different fora, certain points have become frequent from persons including medical personnel but brief explanations have countered all of them and convinced them.

1. Our people are poor and would not have money to see doctor.

   Dismissal: no matter how poor we may be, if there is adequate private and public health insurance scheme that have different packages including premium of as low as two hundred naira (N200) monthly (may be for prescription only) it will become affordable. Moreover, the poverty per se is in the mind mainly, not just absence of funds. Many of them would rather buy clothes, land and other luxury than pay for health.  When they develop problems from attempts of treatment from non doctors, they eventually pay more directly or indirectly for it. When there is morbidity and mortality, they spend much more for admissions and premature burial resulting from this.

   Moreover, when MDPO agenda is made, there will be so much market that unnecessary increase in prices with hope of meeting up with wage bill and utility bills will not be necessary. So, prices will be low for the standard services being rendered. There is more to write but no enough time. All things put together, poverty is not actually a hindrance. After all, the poverty we perceive could also have been caused by non productivity due to inadequate diagnosis and the treatment of medical conditions of the populace. Moreover, with this more health insurance companies and policies will spring up. Details are written below.

   Let’s remember that even poorer nations are practicing this.

2. There are so many places without doctors.

   Dismissal:When MDPO agenda is operational, the doctors both young and old that are crowding the urban areas will start going to the rural areas since they are sure of being patronized. More doctors would also come back to Nigeria before the expected date, making it possible to treat everyone.

3. Health Insurance Organizations are only in the cities.

   Dismissal: when MDPO agenda is signed into law, health insurance organizations would expand into the rural areas since they would be sure that more people will get interested in their services so as to mitigate whatever they may be charged in the hospitals or by a doctor. Of course, the employment of marketers to go to rural areas and subsequent residing of those marketers there would improve employment and development in the rural areas.

4. How can you enforce it?

Dismissal:    given a period of time for people to adjust and prepare well,  a combined efforts of a paid NMA task force, lawyers, police (including CID), good Nigerian citizens and other persons including pharmaceutical council, patent medicine dealers, Medical and Dental Council of Nigerians and individual doctors (especially when taking history) will ensure that this is followed. Details would be discussed later.

 

PECULIAR ADVANTAGES TO DIFFERENT GROUPS AND AREAS OF THE NATION – NIGERIA

1. Life span:     since a doctor is the first care giver to attend to patients complains, proper diagnosis is arrived early and adequate treatment instituted early. So undue morbidity and mortality is avoided.
2. Medical system:      since the services of doctors become marketable, there is enough money for training of staff and doctors, equipments and medical research, innovations; there is enough money and need to employ more doctors and pay them well reducing unemployment in medical profession. There is increased confidence and ability to obtain bank loans for hospital development. Thus, there would be rapid sustained development of our medical system. Doctors would no longer have much (if any) reason not tell a patient details of his/her condition, treatment and the drugs prescribed.
3. Medical Doctors: there will be increased employment for doctors. Doctors will no longer do “just anything” to get into governments hospital in order to get CONMESS or good salary, since they can get something similar or ever more being employed by private establishment. Doctor not employed could even see patients, make diagnosis and prescribe in his/her home and still get paid. Many of the private practitioners would no longer sweat so much for less or little pay.
4. Nigerian Medical Association (NMA): The success of this MDPO agenda will make the AGPNP and privately practicing doctors feel belonged to the NMA family, and would no longer see it as if they are being left aside having successfully achieved CONMESS or good salaries for government employed doctors. This is because this agenda would also benefit all doctors.
5.  General population: The right diagnosis is reached early. Since there would be improved health care, there would be improved state of health and increased life span for general population. There would also be better productivity due to good health; there would also be development and provision of many EMPLOYMENT OPPORTUNITIES.
6. Rural   development: The extension of standard hospital (possibly built with loans and other supports), doctors, and health insurance organization workers, workers of the hospital and other attracted persons and establishments to the rural areas leads to rural developments.
7. Health insurance companies:  the MDPO would make people see more reasons to patronize health insurance companies. These companies will also by this means expand into rural areas; with different packages and more employment, they get more clients.
8. Youth Employment: with expansion of health insurance companies and hospitals and also companies attracted by these, more youths will be employed thus creating employment.
9. New establishments:  with this MDPO agenda, so many new establishments will come up within a very short time including hospitals.
10. Hospital Development/ Equipments:            due to improved marketability of medical services, there will be funds to developed hospitals both in infrastructure and equipments. Banks and other financial bodies would easily offer financial aids for this.
11. Laboratory Scientist:  their market would improve since the doctors would likely request a wide range of relevant investigations. This will also enhance their proficiency- unlike the common current situation of a very narrow range of investigations (PCV, RVS, MP and widal test) especially in private labs, where they mostly run test and make prescriptions. More jobs shall be created also.
12. Pharmacists:  there would be increased market for them as the doctors would likely prescribe various numbers of drugs in combination based on the pathology(ies) observed. There would be increased employment for them in well developed hospitals. This MDPO will also reduce the undue stress on them by patients requesting prescription, thereby giving them chance to go into analysis and formulation of drugs which is a major aspect of their profession, instead of just “drug dispensers” as it commonly is today.
13. Nurses:   there will be more employment opportunities with good salaries since there will be more well-developed hospitals which will require more nurses due to larger patronage.
14. Administrative staff:    due to complexity of the new hospitals, there will be more administrative workers employed.
15. Chemist Men / Women: their chances of giving wrong drugs out are markedly reduced since that is done only by prescription. There will also be increased range of drugs they can sell since the doctors usually would combine a number of drugs.
16.  Lawyers: since the sole right and power of health care is handed to doctor(s), lawyer(s) can then reach out and handle any doctor(s) who decide(s) to toil with health of Nigerians or do “sharp” practices or incorrect practices.
17. National Economy:  the national economy will improve since most of the money taken overseas for health care will no longer be taken out. Hence, improving our economy and foreign exchange. Thus, everyone benefits at the end of the day.
18. Standard Of Living:  since there is improved health, employment, new establishment(s), improved economy, there will be more development and improved standard of living.
19. Effects on Nigerian Doctors in Diaspora:      with a functioning MDPO agenda, Nigerians doctors in Diaspora will be encouraged to come back home, where they will use their knowledge and finances in developing the medical system and Nigerian system in general.
20. Industrial Strike Actions:  with well developed medical systems and decentralized authorities over different well-developed hospitals (including private, corporate and government-owned), more needs of the different groups of staff would almost always be meant. Also, authorities would struggle to satisfy their workers since the workers have so many other alternatives of where to go and what to do. Furthermore, over ambitious, irrational and grandiose demands being consistently made by different groups of workers in health institutions would reduce since there are more places and they have the right and opportunities to go elsewhere and anywhere. These would eventually reduce or eliminate the number of incessant industrial strike actions, by different subgroups of workers in the medical system, which usually cause massive loss of lives and further reduction in the average life expectancy of a Nigerian. Let’s remember that anyone may be affected by this death as we have seen in the past – the workers, innocent Nigerians or even those in authority including government officials and relations of any of these groups.                                              Even when industrial strike actions occur, only the hospital involved would suffer much. There may not be massive loss of lives from diseases and injuries since there would be good alternatives for patients. Thus the public and innocent Nigerians would be spared of the rot. Authorities would thus do everything to prevent such losses to their establishment.
21. Complicated Medical Conditions:   Since a trained and qualified medical doctor is the first to attend to a patient’s complain, early diagnosis, appropriate treatment and referral if necessary is done. So, we would have fewer complicated medical conditions leading to fewer hospital admissions. Thus the patient saves more money. This would also lead to more available healthy productive persons in the economy and thus economic growth.
22. Residency Training Programme:    with more well-developed hospitals, many more private hospitals would be engaged in and be accredited for residency training programme in various specialties. This will markedly reduce the back log of doctors looking for spaces in Nigeria to do their residency training. The end result would be improved employment for resident doctors and eventual marked increase in number of specialist doctors in Nigeria which will further enhance the health system.
23. Housemanship and Internship:    with more developed hospitals, there would be enough spaces for housemanship doctors and other medically related interns. This would reduce the back log and undue delays some persons experience between graduation from school and getting a place for internship.
24. Pharmaceutical analysis laboratories:   with well developed medical systems, it would be possible to have pharmaceutical analysis laboratories where hospitals and other drug dealers send samples of procured drugs for analysis. Such centres could even be privately owned. This would help to check presence of fake and substandard drugs at the grass root levels and enhance the work of NAFDAC. Such would also provide more jobs for the teaming population of pharmacists we have.
25. Medical Research and Innovations: since doctors always get various complains from the public and follow up the cases, the outcome of the various treatment modalities and conditions are known and recorded within the medical system. The accidental discoveries are also recorded. Innovations by one professional or the other also get to be recorded. With this vast amount of records in the medical system, enough data will be available for medical research and innovations.
26. Drug Resistance: this policy would reduce the development of organisms resistant to drugs and also reduce undue drug tolerance since the use of unnecessary drugs and inadequate doses of drugs would be prevented by this setting.
27. Complications from Self Medication: This policy would prevent most of the complications people develop from use of drugs without doctor’s prescription.
28. Standard of Medical Practice: with all the advantages put together, the standard of medical practice in Nigeria would improve significantly.
29. Effect on training of Medical Students and that of other medically related student(paramedics): absence of strikes leads to continuous flow of activities with standard  and quick completion of training as and when due. 

MAJOR CHALLENGES THAT WOULD BE HANDLED FOR THE POLICY TO SUCCEED

1. Political Will Power:  A major problem for any policy is the political will power. Recall that “where there is a will, there is a way.” When leaders both at the level of the government who have the political power and at the level of the Nigerian Medical Association who have the power of the knowledge of this, power of the unity of the association and industrial union power are willing, then this will be possible. The NMA (because her members are much knowledgeable of the necessity of this) may need to work on the government of the day to improve their political will for this policy.
2. Tradition And Resistance To Change:People generally like to follow a pattern which they have followed over a long time and would resist any attempt to change the existing tradition especially if they perceive any form of inconvenience that may initially occur in it no matter how good the end result is expected  to be. Let’s remember that any form of change whether physical or otherwise requires some inconvenience and “a price is paid for every rise’’; “no gain without some pain”.     This resistance can be handled by adequate publicity, public enlightenment and orientation before full effect of this policy. This would increase the percentage of the populace that desire it and reduce those who want to resist it.
3. Protest by People: Sometimes when good policies are made for a better system and better future, some people usually would lose because the existence of the problem has been a source of gain to such persons. Usually, there is tendency of such persons or groups to start protesting the change or instigate people, groups or unions to protest such good policies for their own selfish interest.  Some may even go ahead to sponsor such protest and will only show the populace how the policy would inconvenience them but play down or mask the ways the policy would benefit the system and future. However, with the presence of the political will power and adequate enlightenment and also gradual transition into this policy(may be over a period of about 18 months), the extent of protest against this policy will be reduced as more people would know the long term benefits and so dissuade others who may want to protest. The will of those in power will also help to resist any form of protest. At the end of the day, every one would gain though few may suffer some initial inconveniences just like what happens during road expansions in major cities.

HOW TO MAKE THIS POLICY

A bill concerning MDPO agenda should be presented to law makers by the president of Federal Republic of Nigeria, the NMA and some members of the senate, and the House of Representatives. After the bill have been passed; the Nigerian president should sign it into law giving Nigerians about eighteen months to make all necessary adjustments, such as health insurance, relocation and redistribution of doctors, and return of some doctors in Diaspora. After which the law start being enforced.

HOW TO PROSECUTE/ ENFORCE THE POLICY:

Having signed the bill into law, wide spread campaign should be made by the government, National Orientation Agency, Nigerian Medical Association(NMA) at all levels (even down to the LGA and ward levels), traditional rulers, school teachers, religious leaders both by banner, mass communication media, direct communication and otherwise, within the eighteen months and even beyond. At the arrival of the said date, I suggest that NMA should set up a task force (which is paid to do the job) that would strategize to catch patent medicine dealers, pharmacists, laboratory scientists, nurses and others that may default or give drugs without written doctor’s prescription. The police, most especially CID, would also help to catch offenders and close such shops. The lawyer would also help to enhance and bring offenders to justice.

A useful thing will be that all doctors should have a customized prescription booklet that would bear his details including name and registration number which if forged would be a serious crime.

CLARION CALL / CONCLUSION

I wish to call on President of Federal Republic of Nigeria, Senators, House of Representative members, all State Law makers, Nigerian Medical Association, all doctors, all health personnel, Nigerians generally and in a special way, all Nigerian elites to continually reinitiate, propel and support the “medical doctors prescription only” (MDPO) agenda until it comes to materialize – having considered the above advantages and much more that time will not allow me to mention. Good governance, among other things, also involves making and enforcing good policies.

It is important to realize that most countries with well developed medical system, where Nigerians even go for treatment, got there by this means. This is the way we will encourage private sectors to develop the medical system. Such countries include India, USA, England, Germany, e.t.c. Cameron, Benin Republic, Ghana which are 3rdworld nations have borrowed the same leaves and are now on the parts of progress.

I wish to humbly and sincerely apologies to those who may feel offended about this agenda or this write-up for any reason whatsoever. Please do not be offended. Yet a fact must be said, ‘we all have to realize and push this agenda until it succeeds. Then we can say we have done greatly well to develop medical system in Nigeria. For indeed, Nigeria is the only country we can truly call our own.’

I would not hesitate to be in any fora or media in which I am able to be; in order to defend and elaborate on this ‘medical doctor’s prescriptions only (MDPO)’ agenda.

 All correspondence, criticisms, corrections, enquiries should be sent to [email protected] or +234-8039218261. Anyone wishing to sponsor or assist in spread of this agenda or this publication, or wish to be specially involved in the continuous re-initiation and realizing of this agenda may also contact [email protected]  or +234-8039218261. For I know; and it is true that ‘life is worth living only to the extent to which it is used for the service of humanity to the glory of God Almighty’. So, let’s achieve this.

Thanks.

 

DR. OKHUELEIGBE M. O.

Secretary, Nigerian Medical Association (NMA), Imo State.

June, 2014.

 

 

Copyright© 2012:   Dr. Okhueleigbe M. O.

 

First publication:-  23/08/2012.

Second publication:-  June, 2014