‘How Nigeria can utilize radiography to improve healthcare delivery’
Daniel Okpla Onaji is a specialist radiographer and chief executive officer of New Page Healthcare Solutions Group, Abuja. He practiced for 16 years in the United Kingdom before returning to Nigeria. In this interview, he spoke about the low use of radiography, the rivalry between medical doctors and lessons from the United Kingdom’s health system, among others.
From your experience in the United Kingdom, what major lessons do you think Nigeria can adopt to improve her health system?
In order to bring sanity to the health sector, governments must do the right thing. They must summon courage to be neutral so that everyone can get what they deserve. They should pay people for the work they do and not the title they flaunt around. There is pay parity in the United Kingdom amongst the newly employed doctor and that of a radiographer which is just 1,000 difference. Here ,the Nigerian Medical Association (NMA) is talking about relativism.
Also in the UK, during the course of your programme, you can grow to become a specialist radiographer. A radiographer in the UK trains only for four years while the doctor trains for six years but with minimal pay difference.
Looking at career progression you can become a specialist radiographer and a doctor become a specialist doctor who earns about 36,000 and a specialist radiographers earns 30,000 thereby encouraging learning and expertise.
But in Nigeria, the gap is so wide in the beginning, middle and at the last.
The chief executives of any hospital in the UK can be anybody - a radiographer, physiotherapist and so on - but in Nigeria they chase you away.
In addition, corruption and impunity are also the problem of the Nigerian system because everybody wants to head a department so that they can buy equipment.
I worked in a hospital in Birmingham where we acquired six Magnetic Resonance Imaging (MRI) machines and I wasn’t given a penny but in Nigeria for one MRI machine everybody would get their own share of the purchase.
Another example we can learn from the UK is paying people what they earn and paying them per hour. In my case, I was working as a middle radiographer and I was doing overtime and I was earning so much more than the head of my department but that cannot happen in Nigeria. Does your expertise matter to the patient’s outcomes and how they feel? And these are ways you can use to checkmate sanity and Nigeria can learn because people need to be paid for what they do and for the hours of time they spend at work and not because they have master degree, PhDs or because they are called doctors or pharmacists.
Do you think radiographers should have separate departments in hospitals?
I don’t think that radiographers should have a separate, special department. If you say special department are you saying autonomy for radiographers as professionals? Yes, with autonomy radiographers can be trained, respected and allowed to improve the patient care and to have that independence.
For example again, radiographers in the UK are always in their offices reporting their film but in Nigeria the radiologist is seen taking the kits to CT scanner rooms so when there is an emergency we have to go and look for a radiologist who is head of department and has locked up the machines and in the MRI room which is the duty of radiographers.
We also have a situation in Nigeria where the radiologist buys the equipment and does all manner of mistakes because radiographers are the ones that operate the machines and are the best people to maintain and operate the machines.
What is your advice on quacks masquerading as radiographers or medical imaging scientists?
Quackery is a serious issue that should be fought. In the UK, the regulatory agencies know where everyone is and you cannot change your address jobwise without informing the body about your relocation.
The regulatory body, Radiographers Registration Board of Nigeria, must wake up to enforce law and order because that is their primary responsibility.
In what ways can Nigeria harness the field of radiography to increase her health indices?
Radiography has lot of benefits in healthcare , for example, if you look at the whole scope of practice, healthcare all over the world has shifted from curative to preventive care. Preventive care means you have to use diagnostic tools to screen the population. For example, we were involved in the launching of the national cancer control plan and it is a shame that we are talking about cancer control plan in this country and we don’t have radiotherapy centres.
The greatest weapon we can deploy against cancer is screening but you discover that the equipment is not available here.
We do not have linear accelerator in the therapy centres in this country and taking cancer for example the greatest weapon you can deploy against cancer is screening.
You must have mammography, linear accelerators which is the equipment for radiotherapy for cancer treatment and I am not quite sure how many cancer treatment centres we have in Nigeria while in the UK every county has the best number of mammography, linear accelerators either in fixed building or mobile one which they take round with them.
They also have screening protocol in which it is compulsory for every woman to conduct screening when they are age 40 whether you have lump or not.
In Birmingham, there are five international hospitals and in each of these hospitals there are a minimum of four MRI scanners but in Abuja we are likely to have 1.2 MRIs scanners and if you want result, it would not come from a government hospital but private hospitals. Meanwhile, the population of Abuja is probably four times that of Birmingham which has 12-15 MRI centres compared to Abuja. This tells us where we are in terms of Nigeria utilizing radiography to improve its healthcare.
In terms of what radiography can deliver to our healthcare we are a million miles away from the benefits of radiology in Nigeria because government doesn’t see healthcare as a priority and is not investing in it.
Again, radiography skill is not at its best in Nigeria. Most Nigerians in diaspora are happy to come back to Nigeria but they look at the challenges, the level of scope of practices you have, you can’t see any platform to practice it here; as an international radiographer, you come to Nigeria you cannot see anywhere to practice.
The tool of effective treatment of patients is energy and unless Nigeria prioritizes healthcare and gives radiography its rightful place, we will continue to struggle in the healthcare statistics.
What is your take on the rivalry in the health sector especially between medical doctors and other allied health professionals?
Healthcare is about the patient and should not be about the doctors or other health workers. Putting the patient’s care at the heart of the service that we are delivering will resolve most of the arguments. In the UK for example, you can hardly hear of this rivalry. This I will say stems from the fact that, we have government, ministers and officials who are afraid of doing the right thing either because they pay allegiance to their colleagues or it favours them to do the wrong thing because we have a general problem in the Nigerian society which is impunity. The culture of impunity seems to have been institutionalised and people carry on as if there are no rules and regulations guiding the practice or the patients do not matter.
The cause of rivalry in the Nigerian Medical Association (NMA) is the ego that stands especially in the Nigerian Association of Resident Doctors (NARD) who over the years see other healthcare workers as sub-servants in the health sector. Healthcare is about team work and the most important person in the health sector is the patient.
We know that doctors do great jobs and they should be respected for that but not for them to feel that every other person is not important. They should understand that healthcare is a package - the cleaner delivers a lot to the patients in the hospital, the dietician delivers a lot, and the radiographer produces great images without which the best surgeon cannot do his job.
Again, the rivalry comes from the fact that the doctors have formed a cult over the years as they are ministers for Health, minister of State for Health, heads of all the departments in the Federal Ministry of Health and head of all the parastatals in Nigeria, hence the existence of the rivalry in these positions. In the UK for instance, the heads of 90 percent of health offices are non-doctors and nurses. Nurses have larger share in the heads of hospitals in Canada, Norway, USA and other places in Europe but the reverse is the case in Nigeria because everywhere you go it’s all about the doctor.
We recognise their importance when it comes to taking clinical decisions but there is more to do in the hospital than taking clinical decisions of our patients.
What is your take on the issue raised during the recently called off JOHESU strike as regard parity, with JOHESU demanding adjustment of CONHESS and NMA insisting on relativity?
The best way to deal with this argument is to bring empirical evidence. I don’t want to repeat arguments that most people have already and that is that there are lots of adjustments to the salaries of the doctors that has not been reflected over the years while members of JOHESU have worked under the system and their salaries have not been reviewed.
Overtime and in other climes, people deserve a living wage and I think that’s what JOHESU is demanding for. A radiographer for instance trains for a period of five years, one year internship and one year NYSC which is seven years in total while the doctors train for six years, one year houseman ship and one year NYSC which is eight years - that is one year difference. But when people talk about pay parity for example a new intake doctor would enter as comms2 which is grade level 12 and a radiographer enters on grade level 10 and would take four to five years for a radiographer to move from level 10 to 12.
If you look at the scale or the ratio of progression in terms of salaries, a medical doctor would be earning close to N350,000 whereas a newly trained radiographer would be earning about N160,000 which is the current structure and JOHESU is asking for a little adjustment in the structure of payment. The issue of parity is an enemy language but unfortunately the Ministry of Health represented by the minister of Health, Prof Isaac Adewole, seems to be throwing that away which means, its a conspiracy and part of the discrimination against other health workers which is the bane of the crisis in the health sector.
Now, nobody is asking for the same structure of salary with that of a doctor, because even in the UK it is not the same thing but recently there was a pay increase of up to 29 percent given by the UK NHS and its starting by 24.7 percent and going to 29 percent by 2020. That is the way they have phased the salary increment.
All am saying is that other healthcare workers, that is the cleaners and potters got 27.5 percent increment and the last salary increment the doctors received by the British Medical Association was in 2015 and that was a work increment by one percent because the doctors are earning so much already.
Here the NMA is a judge in its own way and seem to be too concerned with what workers get and also determines how much other healthcare workers get which is not fairness or equity.