Lower Middle Income Countries (LMICs) are experiencing a health workforce crisis. In the Nigerian context, one of the underlying problems is disharmony and unhealthy rivalry among health professionals and this has contributed to the dysfunction of the health system. Yet, effective teamwork among health professionals is recognised as an essential tool for patient-centred health service delivery, and the process of providing health care is interdisciplinary requiring health professionals to work in teams. A lack of teamwork leads to poor coordination of patient care, poor utilization of care, patient dissatisfaction, medical errors and patient mortality.
The key drivers of disharmony and unhealthy rivalry among health professionals in Nigeria include among others, the struggle for the most important profession in health care, with some health professionals claiming superiority over others; the struggle for leadership positions; and the disparity in remuneration of health workers. The problem has been allowed to fester for decades without adequate intervention by policy makers and the government.
Over the years, medical doctors have laid claim to the leadership of Federal and State Ministries of Health, as well as other health institutions/agencies, and it is believed that the status of consultant is the exclusive preserve of doctors which non-medical health professionals cannot aspire to. Furthermore, evidence suggests that there is wide disparity in the remuneration of health workers of the same grade level across the federal, state and local governments, as well as in the remuneration of health workers of different professions. In addition to this, there is a widespread belief among other health professionals, that the Nigerian health system is designed to favour medical doctors, who due to their perceived autonomy and authority over other health professionals continue to dominate. The Joint Health Sector Union (JOHESU) was set up to challenge this dominance.
The medical, non-medical health professional dichotomy has been a major hindrance to the effective delivery of health services and the development of the health system and health services are often disrupted as a result of this battle for supremacy. This affects poor and vulnerable populations who must rely on public health facilities, the most, as the unaffordability of private health care services means that such people cannot access healthcare when public health facilities are shut down. Those that seek care either engage in self-medication or patronize traditional healers and alternative medicine dealers, and many have died as a result of this.
Efforts to reduce health inequalities and improve health outcomes must prioritise addressing the drivers of disharmony and unhealthy rivalry among health workers and preventing the strikes that are due to this petty rivalry among health professionals.First, equal opportunities to leadership positions must be provided for all qualified professionals, medical or non-medical and the pay and remuneration gap must be closed or at least reduced significantly. Second, the notion that medicine is the most important profession in health care must be changed; behavioural change communication efforts should focus on the key message that all professional groups are important in the delivery of health care services. Making these key two changes would be a first good step to addressing the issue.
A strong health workforce is critical in accelerating progress towards Universal Health Coverage (UHC) as a target of SDGs (Sustainable Development Goals) and increasing equity in access to quality health care services without financial hardship. This is of particular importance for the almost 70 per cent of the Nigerian population who live below the poverty line and suffer inequitable access to health care services. The SDGs focus on ensuring that no one is left behind and a strong health workforce that is able to work together to deliver patient-centred health care is one way of ensuring this.
It is myopic for some health professionals to claim superiority over other health professionals, since doctors, nurses, midwives, pharmacists, physiotherapists, laboratory scientists, community health workers, health economists, public health specialists and health managers all have a stake in addressing the health challenges Nigeria faces. A united health workforce is critical to strengthening the Nigerian health system which has over the decades been weakened considerably.