By Doris Obinna
The Association of Community Pharmacists of Nigeria (ACPN) has countered recent assertions made by the Nigerian Association of Resident Doctors (NARD), calling for urgent reforms to end the physician monopoly in the nation’s health institutions.
In a clash with NARD over hospital leadership, the ACPN argues that physician dominance in the administration of Federal Health Institutions (FHIs) has led to a systemic collapse of efficiency, transparency, and innovation in Nigeria’s healthcare delivery.
In a statement signed by National Chairman Pharm Ambrose Ezeh, reacting to NARD’s claim that physician-led hospitals yield better patient outcomes and that doctors do not interfere in other health professions, the ACPN asserts that healthcare administration is ideally a standalone profession best handled by trained administrators.
The group points out that until 1985, Nigerian hospitals were led by professional administrators, contributing to efficiency and professionalism. This changed with Decree 10 of 1985, engineered by the late Prof Olikoye Ransome-Kuti and then-military leader General Ibrahim Babangida, which enabled physicians to dominate hospital leadership roles.
The ACPN states that physician-led hospital management has been overwhelmingly negative, accusing doctors in administrative positions of dismantling civil service norms and entrenching corruption. It highlights the monopolisation of key leadership positions, such as Chief Medical Directors (CMDs) and their deputies, even in non-clinical areas like catering and energy.
The association notes that physicians control procurement processes, including pharmaceuticals and hospital equipment, leading to massive inefficiencies and corruption. It references the Independent Corrupt Practices and Other Related Offences Commission (ICPC), which described Nigeria’s health sector as the most corrupt segment of the national economy. The ACPN cites cases of former physician-ministers and hospital CEOs dismissed or prosecuted for corruption, including the alleged embezzlement of COVID-19 funds by the CEO of Federal Medical Centre (FMC) Owo.
On leadership competency, the ACPN argues that physicians often lack the business, management, and communication skills needed to run hospitals effectively, resulting in abandoned modern equipment, poor health insurance coverage under the National Health Insurance Authority (NHIA), and deteriorating health indicators. It recalls that NHIA coverage increased significantly under professional administrators but declined under physician-CEOs.
The ACPN criticises the physician-led model for prioritising curative treatments over preventive healthcare, noting that malaria treatment remains largely curative while preventive strategies like environmental management are neglected. This, they argue, prioritises physician interests over public health.
Responding to NARD’s claim of non-interference, the ACPN points to disputes over the Consultant Pharmacist Cadre, accusing physician-led bodies of resisting policy advancements for non-physicians, including adjustments to the Consolidated Health Salary Structure (CONHESS) and appointments of non-physicians as health ministers or commissioners.
Recalling the 1993 appointment of Pharm Prince Julius Adelusi-Adeluyi as Minister of Health, the ACPN notes resistance from the Nigerian Medical Association (NMA). It claims such resistance persists, creating barriers to appointing non-physicians to senior health roles.
The ACPN urges Nigeria to adopt global best practices in health sector governance, advocating for holistic reforms to decentralise physician control and empower other health professionals. It calls for reinstating professional health administrators, reforming institutional structures, and prioritising equitable participation across all health professions.