Healthcare industry is staffed with several professional groups and non-professional intellectuals. Each of the employees, from clinical to financial, to engineering, to technical, to managerial/administrative will have the competence, commitment, qualification, experience, skills and aptitude to lead and achieve significant success within the healthcare organisations. However they would require sufficient and appropriate support, training and mentoring to be successful. The ill-developed culture that only a section of the workforce, especially the clinicians among all the people employed in healthcare institutions across the country should be heading every unit, department, the wider healthcare institutions, is purely out of misinformation and lack of knowledge.

I am an advocate of removing healthcare inequalities across Nigeria, and with a promise from the political establishment that NHIS is here to address that social injustice, there is a need for a shift in the paradigm for managing and delivering healthcare services across the country. Even if the scheme should be allowed time to report success, it is imperative that proactive actions should be taken in changing the organisational and management structure in order to bring in the most qualified, skilled, experienced and competent managers from all categories of training and management background.

The country needs people that will think about best ways to bridge the gap between ordinary members of the public and their government. It is on this relationship that even the low income earner would be motivated to contribute whatever they can afford into the financial base of the industry. It must be clear that the success of NHIS cannot be assessed mainly by those in paid employment who are privileged to have a job against the interest of the majority of the population who are not connected to any system of government or guaranteed any social right/justice by the political institution in the country. Among these people are the elderly, those unemployed and their families, the disabled, mentally ill and others with limited cognitive abilities.

The issue here is can a trained manager who drives for financial viability also wear a human face to realise social goal for the ordinary society? The answer is in the relationship the organisation is able to build across the funding government, support by the community and the wider society, including the umbilical cord linked to external interest. Any great management consultant with innovation and creativity for relationship building, quality assurance processes, proactive delivery and financial accountability will balance productivity with social responsibilities for the weak and vulnerable. Developing and delivering healthcare system and services for easy accessibility for the entire population is not a myth. It is easily realisable if those with political power will have the political will to shift the paradigm and consider putting square pegs in square holes. If change could happen in USA with a historical shift of power, and Obama, an African-American becomes the President of the most powerful country in the world, there is no reason why, the status quo in the leadership of Nigeria's healthcare industry should subsist. This is the time for a radical re-organisation of the healthcare institutions in the respective States across the country. It is the time to open the door of management positions to those that have interest in management or wish to develop their career in corporate management of health service institutions.

In shifting the paradigm of leadership and management of public healthcare services, the following steps should be considered.

* Decentralize organisational structure, so that leadership of healthcare institutions does not have to be run from headquarters of Health Management Boards which is the status quo in all the states of the federation. Each Health Centre, District Hospital, Teaching Hospital, etc should have their respective management team headed by a Chief Executive Officer (CEO). The idea of having a Chief Medical Director as the title of the position blots out a need to consider health care services with a holistic management approach as medical view overshadows issues of human resources, training and development, financial management and accountability, customer care services, image marketing and promotion, services review and development, non-medical research initiatives, partnership working, inter-professional co-operation and collaboration, setting organisational standard and building organisational culture for growth and profitability.

* In view of the above, it is important to introduce quality assurance in the interest of patients' safety that would create competences framework for all clinicians. In the event that a clinician, (doctors, nurses, physiotherapist, occupational or speech therapist, pharmacists, dieticians etc) decides to take up management post, which is not connected to their clinical practice, they should not be allowed back to their clinical roles if out of practice for more than 12 months. They should undertake a 'return-to-practice programme for update of skills and assessment of their practice competences. It has to be borne in mind that clinical skills needs to be regularly kept up-to-date as advancement goes like speed of time which does not wait for anyone.

* Eliminate inter-professional rivalry by opening and broadening knowledge base where pride does not get in the way of learning from each other and everyone will have the opportunity to contribute significantly into activities that provides the best care for the patients, service users/customers

* Place emphasis on training and continuing professional development for all the categories of employees. Career progression should be dependent on the amount of training, experience and skills acquired and not on the culture of promotion by a discretion of some power from above who has no knowledge of what it takes to deliver quality standard on a particular job. The current situation is a system of mass promotion at periodic intervals, which means people just sit and wait for the time to come without any need for creative and innovative endeavour that could improve quality of life and care for the patients / service users.

* Translate rhetoric to realities in order to introduce accountability from line management, to corporate executives and to the elected political personalities. This will give voice to the ordinary person and empower the patients / service users to demand for authoritative value in the course of their experience of using healthcare services. This will bring about the change in attitude of clinical and non-clinical staff, and a new understanding of their position as people paid to serve the society and not tower over the vulnerable people on the basis of their specialised knowledge.