Hospital Head Position, Nomenclature, And Qualifications: A Quick Take On The Deluge Of Other Health Professionals’ Rejoinders

The bar needs to be raised far above that! If certain Professors will argue in the century of the lord the 21st that Master’s and Ph.D. holders in general management-related fields, health/hospital management-related fields are not qualified to hold distinctively “executive” positions in the hospital or health institutions because they do not possess first degrees in medicine and/or dental surgery, must those disagreeing with clearly superior arguments also dance naked in the market square?

It is of note that of ALL the rejoinders seen by this writer, only that of the ACAPN [Association of Clinical and Academic Physiotherapists of Nigeria] was specific with JUST two examples of the W.H.O head being a “Biologist” and a past European Respiratory Society head being a Physiotherapist. 

Also, the AHAPN [Association of Hospital and Administrative Pharmacists of Nigeria] made some references to some specific countries but in a general sense without any specificity in the cases being referred to.

The PSN [Pharmaceutical Society of Nigeria] with six pages of her rejoinder gave just one sentence example of the same W.H.O head having a bias in “microbiology”.

Imagine, six pages!

ACAPN referred to a Health Economist who did well as a health minister in Nigeria while the PSN went ballistic on Olukoye Ransome Kuti who brought the Decree 10 of 1985 to the health sector. 

What about citing the specific examples of the present and past Secretaries (Ministers) of Health in the US and UK and the Ministers of Health in Canada?

One of the last three secretaries of health in the UK studied PPE, one economics and politics, while one studied history and law; two were even former bankers.

Of the last three Secretaries of Health in the US, law, economics and government are their foundations while law practice and economics dominate.

The last three ministers of health in Canada studied social works, public administration, and economics. What happened to examples like these not being cited in the rejoinders? 

Gosh!

The inherent message and the emphases from the rejoinders largely seem to be that “it is only the medical doctors that have been enjoying being the head of the hospitals in Nigeria.”

No! Far from it! 

That shouldn’t be!

The issue is about global best practices! It is about merit, not “privilege by induction!” 

Medical doctors can also be the heads of the hospitals just like other health professionals can; the interested ones (Physicians) who get the positions MUST get them based on merit!

That is the crux of the matter! Just like the health professionals who acquire qualifications in law to be able to stand in courts for prosecution or defense and those who acquire qualifications in engineering to be able to practice as biomedical engineers, ALL those with management/administrative qualifications “MUST” be able to attain the top “administrative/management” positions in any health institutions without any restrictions based solely on the kind of first degree possessed.

Globally, it is known that there are two criteria required for management positions, especially when it is about top management positions – qualifications and cognate experience.

Anyone vying for the position of the head of the hospital must have “relevant” qualifications and what are those relevant qualifications?

Is it an MBA? Is it a MiM? Is it a Master’s in Health Administration, MHA? Is it a Master’s in Medical Management, MMM? Is it a Master’s in Hospital Administration? Or is it that the applicant must have at least a Master’s degree which “must” be one of the aforementioned administrative/management qualifications or simply in Administration/Management?

This is what the discussions should be centered on concerning academic qualifications in this circumstance. The first degree matters less in this circumstance — top-level management. At least based on known global best practices principles.

Administration/Management is about the ability to make efficient and productive use of both human and material resources.

The issue is about global best practices! It is about merit, not “privilege by induction!” 

Why are there no recommendations on the specificities of what the requisite administrative/management academic qualifications should be?

A good number of the health professionals who presently head hospitals in Nigeria are associate members of professional management bodies, who were awarded those titles for recognition (of the management associations) basis and not primarily based on the merit of the awardees — a good number of the top-level recipients of these awards do not have the actual academic or experience requirements! 

What happened to cite cases in this area in the rejoinders?

Cognate experience in management is critical in being handed top-level management jobs globally but how many of the positions — the CMD and CMAC jobs — in contention are being held by those with relevant and adequate cognate experience in management or administration? 

Completing professional training is not tantamount to being qualified administrators or managers, especially when it involves human resources.

These are the areas one expects the rejoinders to emphasize, but it has not been a satisfactory read all along, in all honesty.

The rejoinders are seemingly not dealing directly enough with the issues that have raised the present dust if they are dealing with them at all. Why?

More, when talking about the head of hospitals, what are the possible or available options? Is it the C.E.O path or the Clinical path (Medical Director and/or Head)?

The first path has more to do with human and other material resources management while the second path has more to do with the management of “disease conditions.” Interestingly, both positions can co-exist side by side in the same organization. 

Even though the C.E.O is higher by ranking, the Clinical Head in many, if not in most cases earns higher than the C.E.O because of the perks of clinical practice. 

There are examples from other countries that can be cited to buttress the points being made. 

If nurses largely hold the headship of many clinics/hospitals in the US as stated by AHAPN, why not point out specific examples? 

In the US, Regina Cunningham is the C.E.O of the Hospital of the University of Pennsylvania. That hospital has more than 800-bed spaces.

Regina is a nurse; the hospital is a residency training hospital!

In South Africa, Wits University is in the top 251- 300 global ranking and 2nd in Africa according to the Times Higher Education ranking for 2022. It is the 428th top-ranked university globally and 3rd in Africa according to the QS global ranking for 2022.

The most popular university, arguably, among Nigerians trooping to Canada for studies today is globally ranked 601- 800 by the T.H.E ranking and 751- 800 by the QS university ranking for 2022.

Wits University has Nobel Laureate (Sydney Brenner) in Physiology and two of the teaching hospitals of Wits University have had a CEO with Physiotherapy Background. 

The present CEO of the Charlotte Maxeke Johannesburg Academic Hospital (Wits University) has a Master’s degree in Physiotherapy and Public Health for Hospital Managers. Her name is Gladys Bogoshi!

Currently, there is an ongoing volcanic eruption in the form of health professionals’ emigration to greener pastures — the top destination is the UK. The body in charge of the public healthcare employment and services in England is the NHS. Guess what, the head (CEO) of the NHS in England is Amanda Pritchard. 

You know what? She studied Modern History at her first (and only) degree level! Yes, you read that right! 

South Africa has two paths to hospital headship: clinical headship or C.E.O headship.

Even as a medical doctor, you can choose the administrative path, with requisite administrative qualifications, even though the C.E.O may be superior but still earns less than the Clinical head.

So, the call for a reform in the process of appointing hospital heads in Nigeria is a heroic one because Nigeria is deeply dead in the woods! It should not be where merit reigns! 

What happened to verifiable specific examples like these?

Other Health Professionals keep making the issues seem as if they are being denied part of the largesse.

No! Not at all.

The bar needs to be raised far above that! If certain Professors will argue in the century of the lord the 21st that Master’s and Ph.D. holders in general management-related fields, health/hospital management-related fields are not qualified to hold distinctively “executive” positions in the hospital or health institutions because they do not possess first degrees in medicine and/or dental surgery, must those disagreeing with clearly superior arguments also dance naked in the market square?

No, else they become members of the village masquerades too!  

In fact, in Nigeria’s teaching hospitals the position of a C.E.O can be created while the position of the CMAC can be modified to become the hospital’s clinical head position with the CMD position being abolished while the Director of Administration is retained.

The CMAC position should be reserved strictly for ALL the purely CLINICAL health professionals i.e the clinicians who manage or directly handle clients on the wards. The CMAC is a “leadership” position on patient handling NOT a leadership position on what exact treatment a patient must get as the various health professionals will handle that independently. The involved managing teams can decide who leads based on the patient’s medical needs.

As it affects the headship of the health institutions, so does it affect the other/allied health professionals’ units and departments.

Come to think of it, what are the directors of Nursing services, Physiotherapy, Pharmacy, Laboratory Science, Social works, Dietetics, etc. directing in the real sense of it?

Are they not health professionals who were trained and are in practice to deal with patients?

Look at the present circumstances where we now have up to a quarter of the number of the clinical staff of some departments being on the Assistant Director and above levels. Seriously?

The “directorate” cadre in terms of nomenclature is administrative but today with the proliferation of the Assistant, Deputy, and Director levels, one often wonders what administrative duties, other than clinical duties, exist in Pharmacy, Radiography, Nursing, Physiotherapy, Dietetics, etc. that cannot be handled by the human resources management department that requires Assistants and Deputies to the Directors in the clinical professions. 

ALL the “director-attached/suffixed” name positions of the various departments or units that are not under the Human Resources/Administration departments should be abolished and replaced with the position of “Chiefs” after a restructured ladder of cadres (schemes of service) for the health professionals.

The chiefs will then be the new level 17 occupants. At least, that would ensure that ALL the health professionals still attain the zenith of their careers if they meet the promotion requirements.

The solutions to be proffered at this stage by the rejoinders should not just be rebuttals or going venomous on the physicians.

They have to be solutions that go beyond professional rivalries. Good gracious! That’s where the exhibition of higher maturity levels comes in for Christ’s sake! Not simply pouring expletives

There is an absolute need to think out of the box in this inter-professional politics!

It is about the good and future of the health sector in the country, and for the sake of national interest, and should neither be about the size of the salaries to be earned nor the positional appellations to be earned!

Things should be better, please!

#SimpleIyare Musings…


This article was published with the permission of the author. All inquiries can be directed to the author [contact details found below in the “Author Box”.]

Slight edits have been made that in no way compromised the message of this essay.


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