STAKEHOLDERS

2. NMA Relationship with States, Affiliates and Regulatory bodies ByProf. O. A. Atoyebi, MB. BS, (Honours), FMCS, FWACS, FACS COLLEGE REGISTRARNational Postgraduate Medical College of Nigeria

3. STAKEHOLDERS Stakeholders in an organization, venture or activity are those who stand to benefit and contribute to its well-being. The term also includes those whose interests are jeopardised by the existence of the organization, venture or activity and hostile to it.

4. ORIGIN OF NMA • Origin dates back to 1951, when the British Medical Association tried to form a branch here • On January 12, 1951,there was a meeting where it was agreed to form such a branch. • Professor O. A. Ajose was elected President and Dr. Brian S. Jones, Honorary Secretary. • Dr. M. A. Majekodunmi succeeded Dr. Jones as Honorary Secretary in December, 1951. The former was later appointed Federal Minister of Health, a post he held from 1961 to 1966.

5. Initial Problems • First Dr. Jones unsuccessful 8-month attempt to form divisions in the West, East and North • Most members were Government Officials who would not therefore accept offices. • Assistance sought from Government with regard to the formation of a division in the North because of the long distance and poor transport services met with a refusal. • There was Government hostility as the association was described as "unofficial”

6. Initial Problems (cont’d) • Historic Annual General Meeting held at the General Hospital Lagos in March 1952 revealed some of the problems: • disagreement with members over non-payment of subscriptions • disagreement with Government over the role that should be played by its officials • remuneration to be paid to doctors in its employment.

7. Initial Problems (cont’d) • Lack of unity of purpose among the divisions of the country also created problems. • For instance Dr. Hadden from the North announced that Northern members dissociated themselves from the branch when the Association refused to be used by Government to get its civil service members to obey the regulations governing private practice. • decided for this reason to hold the next Annual General Meeting outside Lagos.

8. Nigerian Medical Association • At the Annual General Meeting of 1960, members decided that the British Medical Association branch had matured into the Nigeria Medical Association. • By 1962, the Nigeria Medical Association had obtained Government recognition • It was registered under the Land Perpetual Act and Certificate of Incorporation (31st July, 1962). • After 1963, the association gradually developed from being an oligarchy into a more democratic organization. • The divisions formed in 1958 in the East, West, North and Lagos had grown into branches. The Eastern branch proved the most virile while Lagos had virile moments. The West state branch became the best organized and has often proved the most militant.

9. Clashes with Government • Minor Clashes from 1954 till 1974 • Significant Clashes in 1974/75 • Major Crisis in 1985 with Buhari/Idiagbon regime • Proscription of NMA/NARD • Deproscription in 1986 • Medical and Dental Practitioners Decree 23 of 1987

10. NMA FROM 1987 • By Decree 23 of 1987 (Now Medical and Dental Practitioners Act Cap M8, Laws of the Federation of Nigeria 2004): • Any medical or dental practitioner registered by the Medical and dental Council of Nigeria shall have a right of membership of the NMA on payment of the annual practising fee

11. What is an organizational structure? An Organizational Structure is a description of the arrangement, organization, makeup or composition of the staff or members of the organization The structure is indicative of: ❐ How an organization functions and is managed. ❐ How information flows and is processed within an organization. ❐ How flexible or responsive the organization is.

12. STRUCTURE • National Body • President and National Officers • National Executive Council • 37 Branches (States and FCT) • Chairman and State officers • State Executive Council • Affiliate bodies

13. Composition of NEC • (i) All the National Officers of the Association as in Article 12 (1) above. • (ii) The Chairman and the Secretary of each State branch. • (iii) Immediate Past President of the Association. • (iv) Immediate Past Secretary-General of the Association. • (v) One Representative of each affiliated Organization as defined in Article 7 (8) (f).

14. Composition of NEC (cont’d) • (vi) Chairmen of Standing Committees provided the Chairman of the NDC shall not be a member. • (vii) Chairmen of Ad Hoc Committees or bodies shall be co-opted as provided for in 14(5). • (viii) Chairman or Registrar of MDCN • (ix) President or Registrar of the NPMCN • (x) President or Secretary-General of CMA, CAMAS, WMA or the rep if any of them is a Nigerian. • (xiii) Assistant Secretaries-General shall be non-voting co-opted members of NEC.

16. STATE BRANCHES • Members of the Association practising and/or resident in any State of Nigeria shall have the right to constitute themselves into a State branch of the Association. • A State branch shall be bound by the provisions of the Constitution of the Association and shall have the right to make Rules and Regulations to regulate its functions provided such Rules and Regulations are not in conflict with the Constitution.

17. Discipline of a State Branch • 7. (a) The NEC shall have the right by a 3/4 majority to discipline a State or FCT Abuja branch for whatever cause. (b) An appeal shall be made in writing by the branch within three months of the NEC decision through the President and/or Secretary-General to the ADM. An appeal to the ADM shall succeed if the appeal is upheld by 2/3 majority of delegates present at the ADM. The decision of the ADM shall be final • (Article 5 Section 7)

18. State Branch in Default of Elections • 9. The NEC shall have power to dissolve any State or FCT branch Executive Council which fails to conduct an Annual General Meeting and/or elections of the officers of the State or FCT branch within 3 months after the ADM. • 10. On dissolution of the State or FCT branch Executive Council, by NEC, it shall appoint a caretaker committee to conduct an Annual General Meeting and/or election of the State branch officers within three months of its appointment. • 11. All the provisions of this Constitution that apply to the State branches shall apply to the Federal Capital Territory (FCT) branch.

19. Relationship of National with State NMA • A branch cannot exist without the trunk! • Subordinate cannot override the head • Many discordant tunes over the years • Past incidences • WAY FORWARD

20. AFFILIATE GROUPS • In addition to branches, any group of doctors with special interests can form special professional groups in affiliation with the Association. • Such affiliated professional groups shall also be bound by the Constitution of the Association but shall also have the right to make Rules and Regulations governing their functions provided such Rules and Regulations are not in conflict with the Constitution of the Association.

21. Affiliate bodies • AGPMPN • NDA • MDCAN • NARD • NADUHS • NAGG-MDP • MWAN

22. Affiliation • (ii) Any professional group wishing to be affiliated shall submit an application to that effect to the NEC which will consider the Rules and Regulations of the group and by 2/3 majority decision recommend the group to the ADM for affiliation. • The ADM shall approve the recommendation of the NEC by 2/3 majority of delegates present at the ADM if so satisfied. (iii) Upon affiliation, such a group shall resolve to be bound by the NMA Constitution and thereafter be entitled to be represented at the ADM by 2 delegates.

23. Affiliate Bodies • Relationship • Different from States branches • Problematic sometimes

24. Regulatory bodies • MDCN • NPMCN

25. Establishment of Nigerian Medical Council • Indigenous statutory regulatory body was strongly supported by the first Nigerian Inspector of Medical Services, Sir Samuel Manuwa, following the agitation of the Nigerian Medical Association • Thus parliament passed the Medical Practitioners and Dentists Act in December 1963, through a bill initiated by Dr. M. A. Majekodunmi, former Secretary of the NMA. • This law established the Nigeria Medical Council as the first regulatory body for medicine and dentistry in Nigeria, similar to the the GMC, established in England by the Medical Act since 1858.

26. Establishment of the Medical and Dental Council of Nigeria - 1988 • In 1988, the Nigerian Medical Council gave way to the Medical and Dental Council of Nigeria, which was established by Decree No. 23 (now Cap M8 LFN 2004). • The Decree was amended in 1992. • Its membership comprised of a chairman to be appointed by the President of the Federal Republic of Nigeria and other members which included Chief Medical Officers (or by whatever name called) of all the states of Nigeria, representatives of the Federal Ministry of Health, eleven representatives of the Nigerian Medical Association, whose nominees must include two representatives of the Nigerian Dental Association and other professional stakeholders.

27. The Council shall have responsibility for :- • (a) determining the standards of knowledge and skill to be attained by persons seeking to become members of the medical or dental profession and reviewing those standards from time to time as circumstances may permit; • (b) Securing in accordance with the provisions of this Act, the establishment and maintenance of registers of persons entitled to practice as members of the medical or dental profession and the publication from time to time of lists ofthose persons;

28. Council’s responsibility (CONT’D) • (c) Reviewing and preparing from time to time, a statement as to the code of conduct which the Council considers desirable for the practice of the professions in Nigeria • (d) supervising and controlling the practice of homeopathy and other forms of alternative medicine; (1992 No. 78)

29. Council’s responsibility (CONT’D) • (e) making regulations for the operation of clinical laboratory practical in the field of Pathology which includes Histoopathology, Forensic Pathology, Autopsy and Cytology, Clinical Cytogenetics, Haematology, Medical Micro-biology andMedical Parasitology, Chemical Pathology, Clinical Chemistry, Immunology and Medical Virology, and (1991 No. 78) • (f) performing the other functions conferred on the Council by this Act.

30. Major functions of Council: • To ensure that medical, dental and alternative medicine training in Nigeria meet international standards. • To ensure that practicing professionals provide health care of international standards by adopting a culture of continuous learning and skills acquisition as provided for in the Code of Medical Ethics in Nigeria. • To ensure that practitioners maintain the highest ethical standards in their practice. • To maintain registers of medical, dental and alternative medicine practitioners, which should be published regularly. • Regulation of Clinical laboratory practice.

31. NMA Constitution: Article 17 • 1. The Council shall have power to elect all the Representatives of the Association on the Medical and Dental Council of Nigeria in accordance with such procedures as may be laid down from time to time by the ADM of the Association.

32. Relationship of NMA with MDCN • NMA representatives are on MDCN – 11 (9 + 2) • MDCN representatives are onNMA NEC – 2 (Chairman and Registrar) • NMA Members on MDCN, though 11 out of over 60 members, constitute the backbone of MDCN – vibrancy • NMA independent of Government control

33. MDCN Act M8, LFN 2004 • (3) At any time while the office of chairman is vacant or the chairman is, in the opinion of the Council, permanently or temporarily unable to perform thefunctions of his office, the vice-chairman shall perform those functions and reference in this Schedule to the chairman shall be construed accordingly. • 4. (1) Subject to the provisions of any standing orders of the Council, the Council shall meet whenever it is summoned by the Chairman and if the chairman is required so to do by notice given to him by not less than six other members, he shall summon a meeting of the Council to be held within fourteen day from the date on which the notice is given.

34. MDCN Dissolution ??? • Was MDCN dissolved? • MDCN Rep is here to educate us! • Where is the instrument that dissolved the Council despite “perpetual succession and common seal? • Why has 6 of NMA members not taken action?

35. NPMCN • The National Postgraduate Medical College of Nigeria was established by Law in 1979, now Cap. N59 Laws of the Federation of Nigeria 2004, as a body corporate with perpetual succession and a common seal. As the body at the Apex of Medical Education in Nigeria,

36. Postgraduate Medical Education • Professor Mabayoje as Registrar of the Council ensured that due attention was given to postgraduate training in order to produce specialists and teachers for the medical schools. • Boards were set up specifically in the specialties of Medicine, Surgery, Obstetrics and Gynaecology, Paediatrics and Public Health, to draw up the curriculum and regulations for postgraduate training and examination • The proposals were given legal backing by the Decree No. 44 of 1969. This decree, which was by and large was an amendment of the 1963 Act, empowered NMC to conduct postgraduate examination of candidate in various specialized branches of Medicine, Surgery, Midwifery and Dental Surgery

37. Evolution of National Medical College • The Nigerian Medical Association, at its Annual General Meeting in 1971, commended the efforts of the Nigerian Medical Council for fashioning a functional postgraduate medical programme for doctors and dentists in the country; it was nevertheless argued that the Council, which is the statutory body that assesses and registers medical qualifications, should not be a training and examining body. • It was on the basis of this argument that Professor E. Adeyemo Elebute tabled a resolution praying the Nigerian Medical Council to set up a separate body which would conduct postgraduate training and examinations in Nigeria. This resolution was unanimously carried. • The Council accepted the prayer.

38. Separation from the NMC • Physical separation of the Fellowship Programme from the Nigerian Medical Council started when the “Joint Boards” was set up and given a separate office within the office of the Council at Alaka in Surulere, Lagos. • In 1979, the College of Medicine of the University of Lagos offered the “Joint Boards” some rooms within its premises at Idi Araba, Lagos. It was at this site that the “Joint Boards” metamorphosed into the College by Decree 67 of 1979. • The College later moved to a rented but bigger apartment on Apapa Road, Ebute Metta, Lagos, before finally relocating to its permanent site at Ijanikin, along the Lagos-Badagry expressway in Lagos.

39. Relationship of NMA with MDCN • NPMCN representatives are on NMA NEC – 2 (President and Registrar) • All except 3 members of NPMCN Council (total 25) are NMA • NMA is thus a major stakeholder. • Only advocacy can help, cannot CONTROL

40. CONCLUSION • Many thanks to NOC for organising the Retreat • This type of Retreat should be every 2 years • Many come to leadership position without being aware of the relationships just discussed. • Information is power.

41. Leonardo da Vinci's "rule" – Branch/Trunk

42. Leonardo da Vinci 500 years ago! • Enunciated a simple yet startling relationship that always holds between the size of a tree's trunk and sizes of its branches. • Da Vinci wrote in his notebook that "all the branches of a tree at every stage of its height when put together are equal in thickness to the trunk." In other words, if a tree’s branches were folded upward and squeezed together, the tree would look like one big trunk with the same thickness from top to bottom.

43. THANK YOU