PROFESSIONAL ETHICS

INTRODUCTION
The history of medical ethics is considerable. In the West, it began with a
remarkable growth of literature bearing on the department (the way in which a
person behaves) of physicians in the late 16 th century. By the mid-19th century,
these concerns with medical morality developed into a movement in the west to
codify (to arrange laws, rules, into a system) medical morality, resulting in a
number a formal articulations of norms for the appropriate behaviour of
physicians. Though the accent was often on general moral concerns, many of the
early codes of medical ethics explicitly recognize themselves as codes of
etiquette.

REPUTATION is what people say about you, but your name is not what you are
called. It is what you answer to. If the Community Health Practitioner is a tribe,
then its elders must define conditions of its association. What does it mean to be
a member of this tribe? When other national or professional groups define
themselves, they project the optimal model. When the English send an
ambassador to Nigeria, then send a tall handsome gentleman who went to
Oxford University and not a football thug. The ambassador talks of Shakespeare
and not of the knife criminals who roam some part of that nation’s capital.

Religion is indeed a source of moral authority but in fact, ethics has no necessary
connection with any particular religion or with religion in general. Just as there
is no necessary relationship between intelligence and morality, there is no
inevitable connection between degree of religiosity and sensitivity to others.
“Religious” steal, kill and commit adultery, but they find a way to rationalize and
compartmentalize their behaviour in order to maintain their “religious” self-
image.

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Both “ethics” and ‘morality’ have their roots in a word for ‘customs’, the former
being a derivative of the Greek term from which we get ‘ethoa’, and the latter
front the Latin root that gives us ‘mores’, a word still used sometimes to
describe the customs of a people. They are terms often used as if they have no
relationship to one another. What is clear and simple is that both have to do
with the concepts of good and bad.

Morality is used to refer to what we would call moral conduct or standards.

Ethics is used to refer to the formal study of those standards or conduct, it is
possible to say, that, ‘morality is ethics in action’. Ethics itself is a word used to
refer to the set of rules, principles or ways of thinking that guide, or authority to
guide, the actions of a particular group, and sometimes it stands for the
systematic study of reasoning about how we ought to act.

Integrity is a concept of consistency of actions, values, methods, measures,

principles, expectations and outcome. In western ethics, integrity is regarded as
the quality of having an intuitive sense of honesty and truthfulness in regard to
the motivations for one’s actions. Integrity can be regarded as the opposite of
hypocrisy in that it regards internal consistency as a virtue.

The Federal Government of Nigeria in 1973 realized that Health Care Service in
the Federation is meager and that up to two-thirds of the population particularly
in the rural areas were not receiving medical care. Therefore, a new type of
health care system called Basic Health Services Scheme was introduced in 1974
in order to create a service whereby health care would be taken to the doorsteps
of the people particularly in the rural communities. For this reason, a new cadre

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of staff was created. These would receive a special training and be based in the
community in order to make such health care delivery possible.

The new cadre of staff then created were designated thus:

PHCT  Primary Health Care Tutor
CHO  Community Health Officer
CHEW  Community Health Extension Worker
JCHEW  Junior Community Health Extension Worker

Because these cadres of staff have common interest and unique problems, it
becomes absolutely necessary that they should be merged under one
professional body, and that this professional body be guided and bound by a
constitution.

BACKGROUND INFORMATION OF COMMUNITY HEALTH

Primary health care is an integral part of health care services. It is a discipline
among other disciplines that constitute the field of health care services. Its goals
are health care for people in the community which formed about 70% of
population, through health preventive, promotive and rehabilitative measures.

Primary health care is a bedrock of health services which is specially concerned

with the strategy for helping and empowered the community to make use of
available resources and utilization of health care services.

CONCEPT OF COMMUNITY HEALTH PRACTICE

Community health emanated from public health, which is the science and art of
preventing disease, prolonging life and promoting health and well being through
organized community effort for the sanitation of the environment, the control of

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communicable infections, the organization of medical and health services for the
early diagnosis and prevention of disease. The education of the individual’s
personal health and the development of the social machinery to ensure that
everyone has a standard of living adequately for the maintenance or
improvement of health.

However, community health is the part of medicine which concerned with the
health of the whole population and the prevention of diseases from which it
suffers. Therefore, community health practice make use of assessment of health
needs of a population groups, determination of resources available for meeting
the health needs, and evaluation of health programmes in the community.

DEFINITION OF PROFESSION
Profession is a type of job that needs special training or skills especially one that
needs a high level of education.

PROFESSIONAL ETHICS
Professional ethics is the rules of conduct in the practice of the specific
profession.

There are sets of commonly held behavioural/norms made up by the

professional body known as professional ethics. All the norms have been
codified in each profession code of professional responsibility. Whether codified
or not, these norms ideally represent the guidelines for people to adhere to in
conducting themselves as professionals. In the process of breaking the rules or
code of conduct, disciplinary measures are taken against such professionals.

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ETIQUETTE
Etiquette are conventions or rules of correct or polite social behaviour, usually
unwritten regarding the behaviour of members of a profession toward each
other and the public. Etiquette is generally regarded as the rule that need to be
observed in any given circumstances.

It is also the formal rules of correct or polite behaviour in a society or among

members of a particular profession.

CHARACTERISTICS OF PROFESSIONALISM
(1) A prescribed period of specialized training in academic and practical
contents, including fieldworks, which must not be less than one academic
year (invariably 12 months minimum).
(2) Approved training programme by the certifying body.
(3) Unique essential social services to be performed by the professionals.
Uniqueness in the sense that no other profession has been providing such
services in a technical or professional sense.
(4) A technical formulated academic and professional competence programme
in terms of knowledge and skills required for effective performance.
(5) A set of professional code of ethics for the practitioners.
(6) A self-governing organization/association of the practitioners.

GUIDING PRINCIPLES OF PROFESSIONAL ETHICS

The formulation of a professional ethics is based on the following principles:
(1)It must aim at rendering efficient service even where and when patient/
client may not be able to pay for the service.
(2)It must be clearly spelt out and specific.

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(3)It must not be used to regulate the private lives of its members; rather it
must have bearing strictly on the efficient performance of professional
duties.
(4)It prescribes adequate penalty for contravention of any of the code of ethics.
(5)It protects and promotes members’ professional integrity against
unwarranted criticisms, and defends members’ professional conduct in the
context of the code.
(6)The goal must have professional efficiency.

REASONS FOR TEACHING PROFESSIONAL ETHICS IN COMMUNITY HEALTH

(1) Every established profession has a set of code of ethics which guides and
guard its modus operandi commonly known as professional ethics. The
code is normally formulated, interpreted and enforced by the association.
(2) It serves as a guide to the newly initiated members of the profession as to
the rights, obligation, privileges and responsibilities. Ethics is essentially
social responsibility.
(3) It also serves as a guide to laymen for understanding community health
professional conduct.
(4) It is professional etiquette that regulates conduct among professional
members as well as between them and their clients in the performance of
their duties.
(5) Code of conduct is not a public law, its criteria and goal are like good law
and it is tenable at the court of law.
(6) It has the force of law for the erring officer if he is found guilty of
professional misconduct by professional association.

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MORALITY
Morality is the quality of being right or wrong behaviour in relation to accepted
moral standard of a particular system.

CONCEPT OF MORALITY AND CHARACTERISTICS OF MORAL

Morality is the basis of ethics. Moral is the rules about what is right or wrong that
a person believes and uses in his life. A free and rational being is a moral being.
Man by nature is a moral being. This means that man is subject to moral laws and
is morally responsible for anything he does.

Moral is related to the principles of good and evil or right and wrong. It is
conforming to what is considered by society to be good, right or proper. It is also
considered in terms of psychological effect rather than outward appearance.

TYPES OF THINKING THAT RELATE TO MORALITY

There are three types of thinking that relate to morality in one form or another.
These are:
(1) Descriptive empirical inquiry/scientific thinking: This type of thinking
can be employed by anthropologists, historians, sociologists and
psychologists. The goal is to describe or explain the phenomena or morality
or work out a theory of human nature which based on ethical nature.
(2) Normative thinking: This is what we do when we ask or consider what is
right, good or obligatory. It is a kind of normative judgement which gives
reasons for a certain judgement.
(3) Analytical critical or meta-ethical thinking: This asks or tries to answer
logical or semantical questions like “what is the use of expression ‘right or
good’?” “How can ethical and moral judgement be established and justified?”
“What is the nature of morality?”

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INDISCIPLINE
INDISCIPLINE simply means lack of discipline. DISCIPLINE is the readiness or
ability to respect authority and observe conventional or established laws of a
society or an organisation. Discipline implies self control, restaurant, respect for
self and respect for others as well as sacrifice, perseverance, tolerance and
recognition of human society.

However, discipline is to train or force (oneself or others) to behave in an

ordered and control way. Therefore, when an individual or a group of people are
not trained, not orderly and behave in an uncontrolled way, that is indiscipline.
The lack of indiscipline in our public and private lives is largely responsible for
the failure of our national efforts at development and it affects our health care
delivery system.

TYPES OF INDISCIPLINE
 Abuse of public property
 Political intolerance
 Vandalisation of public property.
 Electoral fraud.
 Pilferage in the health facility etc.

CAUSES/FACTORS ASSOCIATED FOR INDISCIPLINE

 Ignorance
 Greed
 Public aggrandizement
 Public/society opinion
 Political instability etc.

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SOLUTION TO PROBLEMS OF INDISCIPLINE
(A) The first solution to indiscipline is the provisions of legal system which will:
(1) define indiscipline,
(2) making such conduct as an offence,
(3) stipulating punishment and mechanism for the enforcement of such
provisions.
(B) The second solution is enlightenment campaigns.
(C) Incorporation of ethics into school curriculum

MALPRACTICE
Malpractice is improper, careless or illegal professional conducts.

EXAMINATION MALPRACTICE
Examination malpractice is the exhibition of unacceptable and illegal behaviour
by a person or persons prior to the conduct of an examination, during the
examination and after the examination results unduly.

TYPES OF EXAMINATION MALPRACTICE

Examination malpractice is of three dimensions. They are:
(1) Pre-examination malpractice – This involves students having access to
examination question papers before examination.
(2) Examination malpractice includes all forms of cheating during the
examination.
(3) Post examination malpractice relates to inflation of marks and changing
examination on grades of students.

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OTHER TYPES OF EXAMINATION MALPRACTICE
(1) Communication in the examination hall with interest to exchanging
information relevant to the examination.
(2) Consulting materials outside the examination hall in the course of
examination.
(3) Bringing into the examination hall and using materials relevant to the
examination except those authorised by the examiners.
(4) Writing an examination on behalf of a candidate or procuring someone to
write examination for another student that is impersonation.
(5) Communication through exchange of answer scripts, question papers or
any other materials.
(6) Destroying possible evidence for an examination malpractice case.

FACTORS RESPONSIBLE FOR EXAMINATION MALPRACTICE

(1) Lack of seriousness in academic work by some students.
(2) The quest for paper qualification.
(3) Fear or failure in examination.
(4) Love for material gain on the part of some students.
(5) Need to meet parents’ high expectation.
(6) Inadequate motivation for teachers.
(7) Lack of adequate teaching facilities.
(8) Poor teaching.
(9) The need to enable the status of the institution.

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IMMORAL EFFECT OF EXAMINATION MALPRACTICE AND HEALTH CARE
DELIVERY
 Professionals in the health sector should be persons of high skilled and
competent to render health care.
 When persons find their way by hook or crook into the health sector, they
become quacks and providing inadequate and ineffective health care
delivery.

SOLUTION TO EXAMINATION MALPRACTICE

 Legislation
 Enlightenment campaign
 Workshops, seminars on examination malpractice.

PURPOSE OF ETHICAL CODE OF CONDUCT FOR PRACTITIONERS

(1) To make the practitioners keep abreast of the ethical and quasi-legal
requirements of the profession and to keep them constantly on their guard.
(2) To ensure that a set of definite and well articulated code of ethics is made
available as a point of reference and to serve as a way of life to all
practitioners.
(3) To preserve and uphold the professional integrity and good image of
practitioners.
(4) To serve as a Mobile Companion to all practitioners in order to stress the
overwhelming importance of the professional and facilitating harmonious
interpersonal relationships.
(5) To publicise the relevant information on the ethical code of conduct for all
professionals, because ignorance shall not plead for justice by contravening
any of the ethical imperatives.

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(6) To serve as guiding standards and constant reminder to the practitioner
working relationship with
(a) their professional colleagues
(b) their clients/patients
(c) the general public, community leaders, etc.
(7) To serve as a constant reminder to the professional of their rights,
privileges and responsibilities. It also focuses on the welfare of the
members in this regard.
(8) To let clients and general public know and appreciate the roles and
limitations of the profession.

LIMITATION OF THE PRACTITIONERS

Community Health Practitioners should be adhered to the use of standing orders,
unless there is a valid medical reason to deviate from them. These standing orders
present as much as possible, the best treatment for each condition listed in the
standing orders. As a result of many years of field testing, they are practical and
relevant to the setting in which community health practitioners operate.

Therefore, by strictly adhering to the standing orders, the practitioner is acting

under the authority and legal auspices of the physician at all times. In any
complicated or life-threatening problem, where the standing orders specify that
the patient is referred  either to the next level referral centre or the hospital as
appropriate.

However, all the practitioners must understand their limit and scope and ensure
that all the conditions that are not covered by the standing orders should not be
attempted but referred to higher level, and all the cases referred by the standing
orders should also be referred as well.

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COMMUNITY HEALTH PRACTITIONERS REGISTRATION BOARD OF NIGERIA
(CHPRBN), DECREE (ACT) 61 OF 1992
The Community Health Practitioners Registration Board of Nigeria was signed to
law on 24th November, 1992 as Decree 61 of 1992 to take charge of the following:
(a) Determining what standards knowledge and skill are to be attained by
person seeking to become members of the community health and improving
those standards from time to time as circumstances may permit.
(b) Board accesses and accredits community health courses in institutions in
College/School of Health Technology/School of Hygiene and Community
Health Training institutions.
(c) Securing and maintenance of registered members under this decree as
members of the profession and publication from time to time the lists of
the members.
(d) Conducting examinations in the profession and awarding certificate to
successful candidates as appropriate.
(e) There shall be establishment of a disciplinary committee to be known as
“The Community Health Practitioners Disciplinary Committee”, which shall
be charged with the duty of considering and determining any case referred
to it by the investigating panel (session 21 of Decree 61 of 1992).

CONCLUSION
There is a lot of public interest in professional ethics especially in these days
when our society is in dire need of moral regeneration. We must necessarily
examine our attitude and behaviour towards our immediate environment and
the way and manner in which we conduct our personal and professional lives.
Ethics is about moral principles and rules of conduct. It is about doing the right
things and preventing the wrong things.

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CODE OF CONDUCT FOR COMMUNITY HEALTH PRACTITIONERS IN NIGERIA
Community Health Practitioners Registration Board of Nigeria (CHPRBN)
established by (Decree) Act 61 of 1992 has the responsibility among others to
monitor, prescribe and maintain ethical standards in the profession of
community health. The law empowers the Board to register persons who had
attended approved courses of training and acquired sufficient knowledge and
skills for the practice of the profession of community health. Therefore, because
of the moral obligation towards society, there is every discipline and integrity.

CODE OF PROFESSIONAL CONDUCT, ETHICS AND ETIQUETTE FOR

COMMUNITY HEALTH PRACTITIONERS

RULE 1: EXPLANATION OF TERMS

CLIENT: A client is a person who is healthy and comes for further health
services, receive a commodity, health education, medical advice and care.

CODE OF PROFESSIONAL CONDUCT: Are the collection of Rules, Laws and

Standards that guide and control the behaviour of the profession.

COMMUNITY HEALTH: Is the branch of medicine concerned with the total

health of the individual, the families, the group, the community, the nation and
the world at large.

COMMUNITY HEALTH PRACTITIONER: A Community Health Practitioner is a

specially trained professional who provides promotive, preventive, curative and
rehabilitative health activities and services to the people where they live and
work. The main focus of the health practitioner is to promote good health,
prevent disease and treat disease.

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ETHICS: Is a system (a written document or rules) observed with a very high
standard of respect (by a profession) which guides and controls the moral
behaviour and manifests in the character and mind.

ETIQUETTE: Means mode of manners, behaviour and actions which are

expected of a professional under certain conditions/circumstances and are
observed by all in the profession.

MEDICAL ETHICS: Medical ethics is the code of moral and social behaviour in
relationship to medical profession and the patient entrusted to your care.

PATIENT: A patient is a person who is suffering from a disease and is under

medical or surgical treatment and care.

PROFESSION: A profession is an occupation which demands a high standard of

education as well as high code of conduct, and ethics and etiquette.

VALUES: Values are effective disposition towards a person, an object or an idea

and represent a way of life. Values are qualities a person has learned to believe
are important and worthwhile; they are individual or collective conception that
produces behaviour which could be emotional, judgemental and symbolic.
Professional code of conduct and ethics produce values for the profession.

RULE 2: DEFINITION OF A PRACTICING COMMUNITY HEALTH

PRACTITIONER
(i) A Community Health Practitioner is a specially trained professional who
provides promotive, preventive, curative and rehabilitative health activities
and services to the people where they live and work. The main focus of the
health practitioner is to promote good health, prevent diseases and treat
diseases.

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(ii) A Community Health Practitioner practicing anywhere in Nigeria shall
uphold and comply with the code of professional conduct, ethics and
etiquette as prescribed.
(iii) A Community Health Practitioner shall be:
(a) Registered with the Community Health Practitioners Registration
Board of Nigeria (CHPRBN).
(b) A holder of a current license to practice.
(c) Shall be an active member of National Association of Community
Health Practitioners as contained in the constitution of NACHPN (Rule
3 Subsection 1).

RULE 3: THE RIGHTS OF THE PRACTICING COMMUNITY HEALTH

PRACTITIONER
The following are the Rights and Guidelines which shall ensure that there is
improved health service by a community health practitioner to the members of
the community in the health facility and in the community:
(a) Practicing in accordance with the scope, which is legally permissible for
specific practice.
(b) Proper orientation and goal-directed in-service education in respect of the
modes and methods of treatment and procedures relevant to her working
situation.
(c) Negotiation with the employer for such continuing professional education.
(d) Advocacy for protection of patients and personnel for whom he/she has
accepted responsibility.
(e) Equal and full participation in such policy determination, planning and
decision-making as may concern the treatment and care of the patient.

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(f) A safe working environment, which is equipped with at least minimum
physical, material and personal requirements.
(g) Refusing to carry out a task reasonably regarded as outside the scope of
his/her practice and for which he/she has insufficient training or for which
he/she has insufficient knowledge or skill.
(h) Withholding participation in unethical practice.
(i) Obtaining written policy guidelines and prescriptions concerning the
management of his/her working environment.
(j) Refusing to implement a prescription or to participate in activities, which
according to his/her professional knowledge and judgement, are not in the
interest of the patient.
(k) Disclosure to him/her the diagnosis of patients for whom he/she accepts
responsibility.
(l) A working environment, which is free of threats, intimidation or
interference.
(m) A medical support of referral system to handle emergency situations
effectively.
(n) A manageable workload so that adequate standards of health care can be
maintained.
(o) Wages commensurate to health services rendered.

RULE 4: THE RIGHTS OF A CLIENT/PATIENT

A Community Health Practitioner shall be conversant with the Rights of the
client/patient to enable him/her deliver quality health services to the members
of the community. The rights of a client/patient include the following:
(a) Right of consideration and respect, privacy and confidentiality.

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(b) Unconditioned acceptance as a human being.
(c) Receiving health care in accordance with his/her specific needs.
(d) Informed, voluntary decision-making, regarding consent and refusal of
treatment.
(e) Confirmation of identity for purposes of diagnosis, care and treatment and
correct labeling of his/her:
(i) person
(ii) possession
(iii) specimens for investigation purpose like blood sample etc.
(iv) records including monitoring records and reports.
(v) His/her body in the case of death.
(vi) reasonable expectation regarding his/her treatment.
(vii) protection against cross-infection and communicable diseases
(viii) receive prescribed treatment
(ix) die with dignity.

RULE 5: DUTIES OF THE COMMUNITY HEALTH PRACTITIONER

Community Health Practice is dominated by good decision-making and skillful
services. The duties encompass the total wellbeing of man. The Community
Health Practitioner’s duties include:
 caring for the sick and injured considering the resources of the patient, his
family and environment and the services available, incorporating personal
needs to his/her recovery and rehabilitation in accordance to the findings
and actions of the Standing Orders.
 Helping the individual and the family to take positive action in relief of
illness and improvement of his/her individual family and community needs.

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 Training others to function as members of the health team.
 Adopting community health services to correspond with responsible
planning, authoritatic in emergencies, like disaster, outbreaks, and wars.
 Evaluating and conducting research to improve healthcare and adequately
meet society’s needs.
 Sharing with others in the dissemination of health information to
individuals and in the community.

RULE 6: CODE OF CONDUCT FOR COMMUNITY HEALTH PRACTITIONER

(a) Set a high standard: A community health practitioner shall set a high
standard and not allow himself/herself to receive gifts, favours, or
hospitality from a client/patient, or relatives of a client/patient who is to be
or who has been in his or her care.
(b) Intra-professional obligation: A community health practitioner shall
maintain friendly relations with colleagues and be respectful to the senior
colleagues.
(c) Use of Standing Orders: A community health practitioner must use
his/her Standing Orders and other medical equipments in arriving at any
diagnosis and management of his/her patient.
(d) Maintenance of Two-Way Referral System: A community health
practitioner shall maintain the referral system by referring cases beyond
his/her job description to the appropriate level.
(e) Administering of Treatment: A community health practitioner shall not
administer any treatment on a patient without the consent of the patient or
his/her relation in case of unconscious or a patient who cannot speak for
himself/herself.

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(f) Prompt attention: A community health practitioner shall ensure the safety
of his/her patient whether the relatives are around or not and use
whatever means at his/her disposal to preserve life while awaiting relation
arrival and assistance.
(g) Giving of evidence: A community health practitioner shall say what
he/she knows is true when giving evidence as an expert witness.
(h) Use of uniform: A community health practitioner must always appear in
his/her uniform once on duty except during emergency and call duty which
is outside official working hours.
(i) Anti-professional behaviours: A community health practitioner shall be
members of the National Association of Community Health Practitioners of
Nigeria being the only legally recognized body to assist the Board in
ensuring professional sanity and dignity in the country. Any Community
Health Practitioner that does not belong to the Association would not be
recognized by the Board.
(j) Absenteeism: A Community Health Practitioner should not absent
himself/herself from duty without permission.

RULE 7: THE COMMUNITY HEALTH PRACTITIONER AND CLIENT/PATIENT

RELATIONSHIP
The Community Health Practitioner shall maintain cordial relationship with the
client/patient in the following ways. The Community Health Practitioner shall:
(i) Respect a client/patient irrespective of his/her rank, religion, culture,
severity of the condition.
(ii) Use of professional skill and The Standing Orders as a guide to manage
the client.

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(iii) Maintain absolute confidentiality on information concerning the client/
patient, which has been revealed to him/her.
(iv) Provide adequate client/patient care regardless of social status, age and
ethnicity.
(v) Share information concerning clients using critical judgement.
(vi) Be honest in personal and professional activities with the clients.
(vii) Be an adviser to the client instead of a decision maker.
(viii) Give quality care to the clients.
(ix) Explain all procedures to be carried out on the client and make sure he
understands and give consent.
(x) Be aware of the dangers of each procedure to be carried out on a client
and prepare for treatment.
(xi) Where necessary, refer immediately, and not to delay.

RULE 8: GENERAL WORK ETHICS OF A COMMUNITY HEALTH

PRACTITIONER
Possession of positive personality traits gradually develops into habits and skills
which help the Community Health Practitioner to become proficient in health
care delivery. These basic habits and skills required; usually contribute to the
success in the health practice. These traits include the following:

The Community Health Practitioner shall:

(i) Act with sense of maturity: Personal and professional skills contribute
to the achievement of maturity. Maturity is an achievement which is not
dependent on age but on several aspects of personality of many skills
such as the practice of positive habits, attitudes and skills contribute to
maturity.

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(ii) Develop the sense of self-motivation have the willingness to learn new
ideas, duties and procedures, especially a willingness to learn about the
communities; being served by the health facility. Being alert when in the
health facility and in the community enables the health practitioner to
observe and understand problems that need to be solved and to
anticipate the client/patient’s or community needs.
(iii) Be accurate in all activities an error in health practice even when minor
could have a lasting effect on the individual, family or the community. All
data, information, education, introduction of health activities and
programmes, should be as accurate as humanity possible.
(iv) Practice thoroughness provides a careful and complete attention to all
details of all information and health activities provided. This involves the
ability to; listen attentively, take ample notes and pay attention to the
who, when, why, where and how answers and verify information given to
you by the client/patient and/or by the relation.
(v) Practice dependability, that is involving other specialists in health
practice and communicate willingly to work as a team member. The
dependable health practitioner; ask questions and repeats instructions to
avoid mistakes, ask for assistance with unfamiliar tasks from other
colleagues and health practitioners, and take complete data.
(vi) Be flexible, that is, respond calmly to even last minute activities, avoid
being under pressure and handle complex situations with calm. Develop
the ability to implement new ideas, and, good suggestions with self-
confidence are a mark of flexibility.
(vii) Have good judgement use the knowledge, experience and logic to assess
all aspects of a situation; to enable for a sound decision. It inspires the
confidence of clients/patients and members of the community.

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(viii) Be honest: express in words and actions the trust given by a client/
patient; at all times and in all situations. The trustworthy health
practitioner understands the serious nature of the patient’s condition and
the confidentiality involved in dealing with the clients/patients. Do not
reveal any of a patient’s data, any conversations or any details; which
must always remain confidential. Honesty is central to integrity and this
is necessary to effectively represent the profession.
(ix) Have initiatives: There are routine and guided duties of a health
practitioner, however, there comes sometimes where positive actions
should be taken outside the routine duties; this is where good initiative
becomes important. The ability to move forward and to resolve issues by
using one’s initiative is a valuable skill in health practice.
(x) Possess the ability to problem-solving: analyzing a situation, asking for
advice and planning out the steps needed to accomplish a health
programme and acting wisely demonstrates the ability to solve problems
effectively. The result is achieving the goals set in improving the health
status of the community, like planning for a successful outreach
immunization programme, planning for controlling an epidemic.
(xi) Be punctual: Being there on time, allow the health practitioner to
organize tasks, furthermore, be punctual for all meetings with the
members of the community or other organizations. This allows maturity
and responsibility.
(xii) Possess the attitude of efficiency: An efficient health practitioner plans
the day’s work in advance, makes plans for completion of jobs and
assemble materials and resources necessary to complete tasks.

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(xiii) Be a member of the team: Have a positive attitude of a team player, be
generous with time and provide help, where necessary. Part of being a
good team player involves simple courtesies like personal activities in the
health facility and in the country.
(xiv) Be tactful: Work with people in ways that show signs of sensitivity to
their possible problems and work towards achieving the goal of solving
the problems smoothly and without being offensive. Tactful manners and
speech create goodwill with clients/patients and with other staff
members.
(xv) Be assertive: Accurate, dependable and honest, who understands and
perform tasks with intelligence and good judgement, is confident and do
step forward to make a point in a positive manner. He/she contribute
positively to a more efficient, more cordial working environment. It is
quite unlike aggressiveness which is hostile and overbearing.
(xvi) Be a member of the professional association: Being a member of the
professional association i.e. NACHPN.

RULE 9: ETIQUETTES TO BE OBSERVED BY A COMMUNITY HEALTH

PRACTITIONER
The Community Health Practitioner shall:
(i) have a generally positive attitude towards work with a cheerful
personality. Most of the clients/patients value the positive personality
from the health care provider.
(ii) offer explanation to patients on charges for services in an honest manner;
(iii) have a genuine desire to help people: this is expressed in the way the
health practitioner communicates with people through speech and body

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 language. These allays worry and anxiety common in patients/clients
who come into the health facility for management advice;
(iv) be warm and attentive: this helps to reassure the client/patient and is
a signal of desire to help;
(v) listening with attention: communicates acceptance of the person;
(vi) have a pleasant facial expression and being cheerful: a natural smile
and a relaxed rather than a rigid body posture are all body language
signs that express openness and acceptance; in addition to the
professional skills, a pleasant and friendly attitude, is an asset in any
career. In health practice, this lifts the patient’s spirit and help build
goodwill between the client/patient and the health practitioner;
(vii) provide appropriate privacy to his/her clients/patients;
(viii) have empathy: always give unconditional positive regard to his/her
patients and express appropriate empathy for their condition;
(ix) have good and positive health habits which is shown in the physical
energy output by the health practitioner when moving, talking and
communicating; in the alertness and clarity of eyes, and even in the
shine of hair. Habits that promote good health, are essential into
maintaining a positive image such as general cleanliness with good
overall appearance;
(x) establish a good interpersonal relationship with the client/patient
for effective interpersonal relationship: it is the responsibility of the
health provider to make clients/patients feel they are important and
that enough time is available to them for good health care. As a health
practitioner, remain calm, reassuring and pleasant to everyone;

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(xi) show appropriate courtesy to clients/patients at all times and under
any circumstances;
(xii) treat all clients/patients with the same amount of sympathy,
concern and attention. Everyone (client/patient) is an important
visitor to the health practitioner;
(xiii) avoid over familiarity through less formal tone: this will make
client/patient feel more comfortable;
(xiv) address all client/patients formally: such as Mr., Mrs., Alhaji, Alhaja,
Mallam, Chief, Dr., Miss, Ms., Rev., Madam, Sir, or call appropriately
according to the accepted tradition, and so on. Calmly repeat
instructions to an uncooperative patient to prevent having to redo or
recall a procedure or task;
(xv) avoid smoking and drinking alcohol in the health facility
environment. If smoking and alcohol drinking must be carried out, it
should be outside the health facility environment;
(xvi) be at liberty to take prompt steps: to protect yourself from aggressive
or dubious patients who are out there to deceive or manipulate the
health practitioner;
(xvii) dress decently always: whether at work or out of work;
(xviii) avoid engaging in marketing: advertising or selling of items while on
duty;
(xix) consider junior colleagues as brothers/sisters and strive to be a
good example, give good advice and guidance at all times;
(xx) do not fight with colleagues or clients/patients, or their relations as
fighting is an unethical action;

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 (xxi) avoid gossips, character assassination (defamation) of colleagues,
patients and relations;
(xxii) avoid pilfering or stealing health facility property, like drugs,
equipment, instruments etc.

RULE 10: THE COMMUNITY HEALTH PRACTITIONER AND HIS/HER

PROFESSION RELATIONSHIP
The following are the behaviours and attitude expected of a community health
practitioner towards his/her profession. The community health practitioner shall:
(i) maintain competence by continual learning and executing responsibilities
with a strict focus on health ethics.
(ii) act through a professional organization, participate in establishing and
maintaining equitable and economic working condition.
(iii) in accepting and delegating responsibility, put into consideration the
individual’s competence.
(iv) play a major role in determining and implementing desirable standards of
health care.
(v) be active as a professional in developing care of professional knowledge
and should have the ability to impact the same into others.

RULE 11: THE COMMUNITY HEALTH PRACTITIONER AND HIS/HER

COLLEAGUES RELATIONSHIP
The Community Health Practitioner shall:
(i) be honest in his/her professional discussion with colleagues like during
report writing;
(ii) trust his/her colleagues to elicit cooperation;
(iii) have respect for the contribution of others;

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(iv) take appropriate action to safeguard the client/patient when his/her care
is endangered by a co-worker or others.

RULE 12: THE COMMUNITY HEALTH PRACTITIONER AND HIS/HER

EMPLOYER RELATIONSHIP
The Community Health Practitioner shall:
(i) cooperate with his/her employer in carrying out care to the best interest of
the management of the health facility and the clients. Follow the employer’s
policy guidelines;
(ii) make suggestions to the employers on issues that will help in sound policy
formulation;
(iii) be honest in carrying out all duties;
(iv) have trust on his/her employer that wages, promises made will be fulfilled;
and
(v) use dialogue to settle any grievance against employer.

RULE 13: THE RELATIONSHIP BETWEEN THE COMMUNITY HEALTH

PRACTITIONER AND THE MEMBERS OF THE COMMUNITY
The relationship between the community health worker and the members of the
community shall be that of mutual understanding. The Community Health
Practitioner shall:
(i) listen, learn and understand the members of the community;
(ii) talk, discuss and decide with the members of the community;
(iii) encourage, organize members of the community to participate, encourage
them to take up healthy behaviours and habits;
(iv) be involved and actively participate in the community development
activities.

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RULE 14: RULES AND REGULATIONS OF COMMUNITY HEALTH PRACTICE
A Community Health Practitioner:
(i) Must always bear in mind the obligation of preserving human life, where
he/she fails and the patient suffers as a result, he/she may be sued for
negligence.

(ii) Must give emergency care as a humanitarian duty unless he/she is

assured that someone is available to give such care; however, where there
are two or more urgent cases with only one Community Health
Practitioner available and the patient dies while waiting for his/her turn;
the Community Health Practitioner cannot be liable for negligence for not
given him/her priority.

(iii) Must use his/her Standing Orders and other medical equipment in
arriving at any diagnosis and management of his/her patient where he
fails and the patient suffers as a result, he/she may be sued for
negligence.

(iv) Maintenance of Two-Way Referral System: A Community Health

Practitioner shall maintain the referral system by referring all cases
beyond his/her job description to the appropriate level. However, if a
Community Health Practitioner fails to refer and the patient suffers any
injury he/she may be sued for negligence and the practitioner will face
disciplinary action.

(v) Shall preserve absolute secrecy on all he/she knows about a patient even
after the patient has died.

(vi) Shall not advertise himself/herself as better than his/her professional

colleague whether directly or indirectly for the purpose of obtaining

30
 patient or promoting his professional advantage. Press statement must be
avoided, however, becomes inevitable, anonymousity should be observed
and praise showering shunned.

(vii) Shall not be involved in malpractice especially sales of Government or any

public property, drugs, materials etc., misappropriation of funds under
his/her care or obtain money by false pretence, fraud, forgery, theft
and/or share fees of which the patient is not aware of. Also a Community
Health Practitioner convicted of criminal deception may face disciplinary
proceedings if such will bring the profession to ridicule, scandal or public
odium (a feeling of hatred).

(viii) Shall not disclose voluntarily without the consent of the patient
preferably written consent any information, which he/she has obtained
from the patient and/or client in the course of his/her professional
relationship with the patient and/or client. These information include
criminal abortion, venereal diseases, HIV/AIDS infections, concealed
birth, attempted suicide, etc. Not even the State has the right to demand
such information except under the direction of a Presiding Judge. This
excludes patients presenting themselves for examination for an insurance
policy, because it is implied that he/she has consented to the disclosure of
the findings to the insurance company. Nevertheless, the community
health practitioner should only report the conditions and findings and
should not give any opinion as to whether or not any abnormality or
disease is caused by misconduct. Apart from this, professional secret must
be maintained and not given even to husband, wife /or brother or sister
or in-laws etc.

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(ix) Shall not commit adultery, fornication or have any improper conduct with
any person who has come to seek medical attention from him/her
whether as a precondition for treatment or after treatment. If discovered,
such person apart from being subject to civil proceedings by the relatives
of the victim also has to face disciplinary action. Any finding of fact in this
respect by a High Court or any other recognized legal institutions
presiding is inclusive evidence before the Disciplinary Committee.

(x) Being under the influence of drinks or drugs: A Community Health

Practitioner is expected to be a role model, decent and respected person
in society. And so must not give in to excessive drinking or abuse of drugs.
And a Community Health Practitioner who treats a patient under the
influence of drugs or drinks, whether the patient suffers any injury or not,
will face disciplinary action. And where the patient suffers any injury he
may be sued for negligence.

(xi) Drug abuse: A Community Health Practitioner shall not under any
circumstance do, authorize to be done anything that would weaken the
physical and mental alertness of a human being except for the prevention
and treatment of a disease even though asked of him/her.

(xii) Procurement of abortion: A Community Health Practitioner shall not

procure abortion in whatever form be it asked of him/her for the purpose
of saving life because it is not within his/her job specification and
description.

(xiii) Giving of false information: A Community Health Practitioner shall not

give any false information concerning a patient even though he has
physically seen the patient to protect him/her (e.g. issuance of Sick

32
 Certificate, Birth Certificate, etc.). And shall never give a certificate to
someone he/she has not seen.

RULE 15: THE COMMUNITY HEALTH PRACTITIONER AND THE LEGAL

LIABILITY
Any person who commits an act contrary to the lay-down rules of the profession
must face the punishment commensurate to the offence of his/her actions or
compensates the aggrieved party. For a Community Health Practitioner to be
liable for an act, the following must be established:
(i) The health practitioner must have acted illegally, and not have been in a
state of unconsciousness like being in a state of sleepwalking. The act may
be omission or commission.
(ii) It must be proved that it was the health worker’s conduct that caused the
harmful consequence. Like, a cross infection in the health facility.
(iii) The conduct must be wrongful and unlawful, and therefore unreasonable
in the eyes of the society.
(iv) Intention and negligence must be clearly established.
(v) There must be damage or prejudice resulting from the act.
(vi) He must have made wrong assessment of the patient without using the
Standing Orders.
Any negligence and/or violation of any of the above code of conduct shall be
reported to the Disciplinary Committee by either a fellow practitioner or any
member of the public. And upon any report the Investigation Panel will carry
out its function as assigned to it in Section 21 Subsection 3a-b of Act (Decree) 61
of 1992 based on the directive of the Disciplinary Committee.

After the necessary investigation, the Disciplinary Committee shall perform its
function as contained in Section 21 Subsection 1 and give punishment in

33
consonance with Section 23 subsection 2a-e of Act (Decree) 61 of 1992 if such a
report is confirmed or found to be an act of indiscipline and an unethical
behaviour.

JOB DESCRIPTION FOR COMMUNITY HEALTH EXTENSION WORKERS

Job Summary

The Community Health Extension Worker (CHEW) is a member of the Health

Team for Primary Health Care (PHC). The Community Health Extension Worker
will spend 50% of his time on community based functions and 50% in the clinic.
He/she has the responsibility of supervising the Junior Community Health
Extension Workers (JCHEWs), the Community Health Extension Worker in-
training, the Volunteer Village Health Workers and Traditional Birth Attendants.
He/she is to be supervised by the Community Health Officer (CHO).

Job Title: Community Health Extension Worker.

Location of the Job: LGA PCH Department/Community.

Personal Qualification:
(i) Physically and mentally fit.
(ii) Able to communicate and work well with people in the community.
(iii) Able to guide, supervise and give good leadership to his subordinates.
(iv) Be willing to live and work in the community.
(v) Mature, approachable, friendly and honest.
(vi) Able to work independently when necessary and make good judgment.

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Community Based Functions
1. Explain to the community, the Primary Health Care approach of the
Nigerian Health System and his role as a member of the health team to link
the community with health care system.
2. Carry out community mobilization for health action.
3. Guide and support the Volunteer Village Health Workers (VVHWs)/
Traditional Birth attendants (TBAs) and Junior Community Health
Extension Workers to initiate preliminary contact with the leaders.
4. Familiarise self with target population and health services within the
community.
5. Follow-up and provide support for the initial contact made by the
Volunteer Village Health Workers/Traditional Birth Attendants of Junior
Community Health Extension Workers with the Community Leaders.
6. Initiate the formation and facilitate the effective functioning of the
Development Committees.
7. Attend Community Development Committees meeting in rotation at least 2
times in a year.
8. Participate in, and supervise Primary Health Care house numbering and
placement of home-based records.
9. Update house numbering and placement of Home-Based Records during
home visits, and through reports and records from Junior Community
Health Extension Workers and Volunteer Village Health Workers/
Traditional Birth Attendants.
10. Initiate and work with the community and other health workers to carry
out community diagnosis and continuous health needs assessment of the
Community (Health needs include areas related to provision of good roads,

35
 good water supply, education, agriculture, nutritional problems, HIV/AIDS,
poverty eradication, etc.).
11. Initiate the work with the community and other health workers to carry
out general community survey, social and cultural characteristics of the
community.
12. Work with other health workers and the community to identify major
health problems of the community, including HIV/AIDS, Teenage
Pregnancies, Juvenile delinquency, problems of the Elderly, Gender
inequality, etc.
13. Teach the Junior Community Health Extension Workers simple methods of
data collection and analysis.
14. Participate in the analysis of data collected.
15. Initiate and/or work with his supervising officer and community members to:
(a) Prioritise health problems.
(b) Plan solutions to identified health needs.
(c) Identify available resources to solve the health problems.
(d) Set coverage objectives (targets).
(e) Identify workable interventions.
16. Prepare and/or assist the supervising officers in preparing budget for
implementation of plans.
17. Prepare a schedule of activities for the delivery of services to tackle the
priority health problems.
18. Work with Supervising Officer, Junior Community Health Extension
Workers, Volunteer Village Health Workers/Traditional Birth Attendants
and Community members to carry out plans.
19. Develop a monthly work plan with the approval of Supervising Officers.

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20. Develop a monthly work plan with the approval of Supervising Officers.
21. Coordinate the work plan of the Junior Community Health Extension
Workers and the Volunteer Village Health Workers/Traditional Birth
Attendants.
22. Manage Junior Community Health Extension Workers and the Volunteer
Village Health Workers/Traditional Birth Attendants referrals and ‘At-Risk’
cases within the community using Standing Orders.
23. Support Junior Community Health Extension Workers and the Volunteer
Village Health Workers/Traditional Birth Attendants efforts on health
education, and initiate periodic health education campaigns within the
community.
24. Supervise activities of the Junior Community Health Extension Workers
and the Volunteer Village Health Workers/Traditional Birth Attendants
and give feedback.
25. Assess the accomplishment of set coverage objectives (targets) by Junior
Community Health Extension Workers and the Volunteer Village Health
Workers/Traditional Birth Attendants.
26. Collect and collate records collected by Junior Community Health
Extension Workers and the Volunteer Village Health Workers/Traditional
Birth Attendants and forward these to the Supervising Officer.
27. Supervise the operation of the Essential Drug System and the Drug
Revolving Fund.
28. Keep accurate records of activities and health problems as required within
the area of coverage.
29. Analyse and summarise data collected and present in simple graphic form.

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30. Compile monthly returns and reports, and send to the supervising officer
and the Community Development Committee.
31. Update from Volunteer Village Health Workers/Traditional Birth
Attendants records, information on births, deaths and new entrants into
the community.
32. Decide, in consultation with Community Health Officer where available,
when there is need for more pre-packaged drugs.
33. Maintain a roster for regular servicing of equipment, if Community Health
Officer is not available.
34. Constantly monitor staff and vehicle movements, if Community Health
Officer is not available.
35. Maintain a roster decided upon with Volunteer Village Health Workers
(VVHWs)/Traditional Birth Attendants (TBAs) for meetings, and inform
the community.
36. Carry out all other duties assigned to him by his Supervising Officer.

Clinical Based Functions

1. Provide integrated Primary Health Care Services.
2. Organize and run integrated Primary Health Care Services where
Community Health Officer is not available. These services are listed in the
Nigeria National Health Plan and include:
(a) Health Education concerning prevention and control of prevailing
health problems.
(b) Promotion of water supply and basic sanitation.

38
 (c) Maternal and Child Health, including reproductive health e.g. provide
ante-natal care and delivery of normal pregnancy, postnatal care and
specified reproductive health services.
(d) Provide immunization services.
(e) Manage logistics and cold chain system.
(f) Carry out sterilization of equipment according to established protocol.
(g) Treat common conditions and injuries.
(h) Perform of simple laboratory test and examination e.g. haemoglobin
estimation, stool and urine testing, etc.
(i) Keep and check that clinic equipment are safe and in good working
order.
(j) Promote mental and dental health.

3. Collect and collate monitoring and evaluation data for the National Health
Management Information system (NHMIS) from the Community and Health
Facility and forward to the Ward level.

4. Carry out with Community Health Officer (where applicable) the day-to-day
administration of health services in the target population.

39