…as she launches an online book on Nigerian healthcare problems, effects and solutions
By Ebun Sessou
D r. Ola Brown is a physician, a trainee helicopter pilot, and an entrepreneur who founded West Africa’s first indigenous air ambulance service, the Flying Doctors Nigeria.
The Flying Doctors Nigeria saves hundreds of lives across the region every year especially in the oil and gas industry, rendering medical evacuation services.
Recently, she produced an online book, ‘Fixing Healthcare in Nigeria’, which can now be freely downloaded by anyone. In this interview, Brown X-rays five pillars mitigating against the healthcare sector in Nigeria and proffers solutions which she believes would bring about robust and efficient healthcare service in the country.
What inspired your thoughts on this topic?
It was a mixture of two things. When I was younger, my focus was on business and making sure that the business expands but as I grew older, I became worried about the number of children that die on a daily basis. I was distressed by the rate of maternal mortality in the country and I thought that there was a role for ordinary citizens to make suggestion and contribute to policy that can change the sad story.
So, I decided to pen down my thoughts, catalog my observations for the past few years, catalog some of the statistics and also make people start thinking more about healthcare. Everybody recognises banking or power reforms but people do not pay so much attention to healthcare. They do not give the same energy to healthcare and this is something that I am passionate about. So, the book is the combination of all my thoughts about healthcare system in Nigeria.
What actually was the focus when you were putting your thoughts in this book?
I think everyone somehow has been affected over the past decades by the healthcare sector and I believe as a physician and entrepreneur that healthcare is one of the most important investments any country can make. It is an important focus for any leadership either in public or private sector. We can see this in different countries around the world that have achieved greater developments because healthcare has been a major focus for them. For us to achieve the Nigerian dream of a wealthy and healthy Nigeria, we must focus on the healthcare system and that was why I decided to pen down some thoughts.
The first question is where do we go from here? The book focuses on policy suggestions and with my experience for the past ten years, one of the policy suggestions I think if we are able to implement it will really change the narrative of healthcare in Nigeria and by changing that narrative, we can have a wealthier, healthier Nigeria, we can spearhead the economy growth and diversify away from oil and healthcare can be an industry like the United State of America.
What is view about fixing healthcare in Nigeria and the prescription for improvement as stated in your online book?
With my years of experience working within Nigeria’s healthcare system, I felt I had to offer some practical solutions to the problems that are holding us back. While our challenges are more economical than they are clinical, I think much can be accomplished through organizational restructuring, task shifting, and a re-prioritization of public and primary healthcare services.
But let me also say that I don’t minimize the need for additional funding and I suggest several paths that need to be explored in order to upgrade financing of healthcare.
It’s my hope that my book will get the discussion going and also propel leadership to look at some new ways to approach healthcare delivery in Nigeria.
I started the book by talking about the state of healthcare in Nigeria. According to the World Health Organisation, WHO, Nigeria is ranked 187 in healthcare system in the world out of 190 countries; which suggests that it is one of the five worst healthcare systems in the world. I also talked about some other problems in the healthcare system. I compared the number of children that died in Nigeria to other developing countries and noticed that the number of children that died is more than the highest compared to any other country in the world.
Look at some of those indicators including the maternal mortality,neo-natal mortality, among others and see what policy interventions we can make to turn the story around and change the narrative of healthcare in Nigeria.
The book looks at the current healthcare system in Nigeria from several points of view. It also examines how some commercial enterprises have achieved success in Nigeria and suggests that those in charge of delivering healthcare adopt some of the ideas that have proven to be successful in private enterprise.
The Five Pillars
These are the five things we can do as a nation and the five policy suggestions I think we can make and implement as a nation that would change healthcare narrative in Nigeria.
These pillars include: Expansion of Primary Healthcare, Centralization of Tertiary Care, Focus on Maternal and Child Care,Sustainable Healthcare Financing and Task Shifting.
Expansion of the Primary Healthcare; as explained in my book by giving a successful account of how healthcare system in Nigeria should be handled by telling the Dangote’s story. Dangote’s Obajana factory is one of the most advanced and largest cement factories in Africa. Much of the company’s success is due to its ability to reduce its costs while at the same time increasing its output. Central to this is Dangote’s massive network of small distributors spread out through Nigeria’s communities.
Dangote was able to decentralize systems to the problems found in the Chinese cement industry where large centralized plants are located far from where the cement is actually used. I see a parallel with healthcare in Nigeria, which I believe is overly dependent on large centralized hospitals and has too few decentralized primary care units.
I also believe we need to innovate our systems and our way of thinking. Along with making primary care and public health our highest priorities, we need to leverage technologies like tel-medicine and shift the handling of tasks that require less training away from our physicians. Primary healthcare should be the central nervous system and focus of any healthcare system so that most of the regular problems that people have could be solved on the next street. It is only when the problem is serious that you can visit the tertiary hospitals. An example of a country that has successfully achieved this is Costarica. Their life expectancy is better than that of America. They made it possible for majority of people to be able to access healthcare system cheaply and conveniently within their communities.
Task Shifting: Explains how that we have fewer healthcare practitioners than it is in the other developing countries. Our challenge is to do more with less and if we can allow the community health pharmacists and medical scientists, nurses to do things that are supposed to be done by doctors. There is need to train more people in the medical profession because there are a lot of non-specialist things that we can train people to do without necessarily looking for a doctor to do some medical jobs.
The third pillar is the focus on Child and Maternal Mortality; more children die in Nigeria every year than almost anywhere in the world. And I think that ignoring such a disaster is bad for our healthcare system and the country. The third focus suggests how to give our children the best healthcare.
The fourth was Sustainable Healthcare Financing; I took a deep dive into the budget in this chapter and I found out that huge percentage of this budget is used to pay back debt while the remaining is used to pay salaries. And we only have small amount dedicated to health. So, in order for us to sustainably finance healthcare, there is need for restructuring on how to manage our finances. Healthcare is expensive. The budget for healthcare in different countries is huge compared to what is obtainable in Nigeria. Unless, we change our style of managing our finances, we will not have enough money to dedicate to healthcare. One of the things I suggested in the book is that we can raise finance for health internally and that can be with the NCC and the telephone providers network. We need to stay alive to be educated, to go to work or invest.
On the fifth pillar which talked about Centralization of Tertiary Care, it explains the Soludo’s Energy. When Charles Soludo assumed office, he had a presidential mandate to restructure the banking sector. He collapsed the banks to a few banks in the country and made the banking sector more robust, stronger and feasible. Therefore, the government should know how to reduce the number of hospitals and not increase them. We are always building underfunded hospitals. Number of hospitals should be reduced such that the ones left would be stronger and better. The outcome of patients that are treated in a specialist centre is better than patients treated in a non-specialist centre. How can Medical Tourism in Nigeria be curbed?
I do not think, we can stop medical tourism but what we can do is to provide the best healthcare to the major populace. The leadership of this country should concentrate on how people would access efficient healthcare service at its cheapest cost. We are not taking care of the basics and that is why we are having challenges.
Does your book address the issue of inaccessibility of primary healthcare in the riverine areas by women?
This is an incredible point for me and that is why one of the pillars of the book talked about children. There is a woman and child health pillar paying particular attention to the health of woman and the child. More mothers die in the process of pregnancy and childbirth. And if you compare the statistics to Afghanistan, Yemen, Congo and areas where there had been active civil war, we will still find out that the numbers are comparable.
One of the key focus is healthcare accessibility and affordability. I have been to some rievrine areas in Delta State. It took us 45 minutes by boat but when we got there, Coca Cola company was there, there was also a political office there. Therefore, the question is: why it so difficult for primary healthcare centres to be in these places? And that is why we need real focus on expansion of primary healthcare which can solve 90 percent of healthcare problems in this country, especially in communities.
The summary is that we should apply the same energy applied to banking, manufacturing and power to healthcare in Nigeria.