By Chioma Obinna

Nigeria’s healthcare system has continued to earn the embarrassing distinction of ranking 187 out of 190 countries in the world by the World Health Organisation. This, according to stakeholders, has shown the dire situation within the system. Sunday Vanguard spoke to a former President of the Nigeria Medical Association, NMA, and current Vice President, Commonwealth Medical Association, Dr Osahon Enabulele, on the challenges in the health sector. Osahon, who is also the Chief Consultant Family Physician and Head of Department of Family Medicine, University Teaching Hospital Benin, UBTH, describes the country’s health situation as an unpleasant story.

Are there truly challenges in the health sector that need to be urgently addressed?

There are challenges that have significantly conspired against Nigeria’s healthcare delivery system and the health sector. Leveraging on my practice as a medical doctor, my experience as a health and civil rights activist, my involvement in the processes that led to the enactment of the National Health Act, and importantly, my practical experience in health sector leadership at local, state, national and international levels, there are challenges and burning enough to warrant the urgent attention of all stakeholders, including all state and non-state actors at local, state and national levels. For instance, poor governance and political commitment to the health of citizens remains one fundamental undermining factor that has led to the sorry state of Nigeria’s healthcare delivery system.

Dr Enabulele

Poor governance and political commitment, which largely results from a poor understanding of the economic importance of health and health care by most political and public officers at all levels of government, can be seen in poor budgeting for health. The poor understanding of the nexus between health and the economic prosperity and productivity of nation-states partly explains why, 17 years after Nigeria hosted the Abuja 2001 Summit of African Heads of Government which declared that African Governments should allocate a minimum of 15% of their budgets (at local, state and national levels) to the health sector, the Nigerian government (aside from a few state governments) has never attained even half of the African benchmark on budgeting for health.

Allocation to health at the federal level from 2009 to date shows an average allocation to the health sector of less than 6%.   The situation is even worse now in the current dispensation, and much worse at the state and local government levels where the aggregate sectoral allocation to the health sector ranges from 1-3%. Another evidence of poor political commitment to Nigeria’s healthcare delivery system is the poor utilization of health care facilities in Nigeria by the nation’s political leaders and public office holders.

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Rather than utilize health facilities they claim to have constructed in their communities and therefore inspire citizens within their jurisdiction to do same, most of Nigeria’s political and public office holders, including Mr. President and state governors, take delight in frequently travelling abroad for medical care under government sponsorship and at the expense of taxpayers. This bugbear of outward medical tourism, characterized by frequent medical travels, which are sometimes for very basic medical conditions and procedures, has done incalculable harm to Nigeria’s healthcare delivery system, with a humongous capital flight out of Nigeria, to the tune of well over $1 billion (as at 2013), with the Indian economy and hospitals securing over 50% of this capital outflow.

In the course of my duties as Vice President of the Commonwealth Medical Association, I once met a prominent Nigerian political leader in a foreign hospital in one of the Commonwealth countries. When I engaged him to find out why he was yet to be seen on that day by the doctors, I found out that all he simply came for was a basic medical check-up, which he gleefully stated was a regular routine for him. That, to me, was a huge shame and blackmail of our Nigerian state. During my tenure as President of the Nigerian Medical Association, our executive committee mounted an aggressive campaign to halt the abysmal trend of outward medical tourism. This campaign included engagements with foreign high commissions and the National Assembly.

This singular action was meant to send a strong message to our legislators, political leaders and top public office holders that their health conditions could be satisfactorily managed here in Nigeria by the available medical experts, and, therefore, that there was no need for them to travel several kilometres abroad, sometimes at great risks, just to conduct health check-up, or seek medical care for conditions that could be easily and effectively managed in Nigeria. Honestly, there is a litany of medical experts dotting the health landscape of Nigeria who can carry out such health checks and other medical interventions. The effective management of Governor Idris Wada’s fractured limb by a hospital in Nigeria, following a traumatic road traffic accident, is a testimony of the great possibilities in Nigeria’s healthcare sector.

The country’s health system (all levels and tiers, both public and private) should be strengthened, to enable it deliver quality, efficient and effective healthcare services. There is a need for balanced investment in curative and preventive medicine. Since Nigeria’s political independence from her colonial overlords, the performance of her healthcare delivery system has remained unpleasant due to several conspiring factors and challenges. However, with the successful berthing of the National Health Act, Nigeria now has a historic significant opportunity to improve her healthcare delivery system and attain Universal Health Coverage predicated on the constitutional imperatives of social justice, equity and egalitarianism. The National Health Act, NHA, gives a legal seal to the Public-Private-Partnership policy enunciated by the National Council on Health in 2006. Specifically, it prescribes in Section governments, will abandon the era of paying lip service to the health sector, and translate their widely circulated promises (including the promise to allocate 15% of the national budget to the health sector within the first year of Buhari’s tenure) on health into practical reality.

On National Health Insurance Scheme

There is the urgent need for a holistic and comprehensive overhaul of the scheme, with a progressive review of the mode of appointment of the Executive Secretary and managers of the ccheme, in a way that allows for a transparent, fair, just and meritorious consideration and selection of would-be managers. The scheme is too critical and important to the lives of Nigerians to be left to undue manipulative political interests. The selection process must, therefore, be cleansed of all political, religious, nepotistic, ethnic, and clannish propensities and interests. There is the need to make the subscription to the NHIS mandatory, as provided for in the amendment to the extant NHIS Act. This will help to pool more funds into the scheme, with better cost sharing and financial risk-protection for a greater population of Nigerians, particularly the vulnerable, the poor and low-income earners.

On the Boards of health agencies

The frequent and indiscriminate dissolution of health professional regulatory councils, like the Medical and Dental Council of Nigeria (MDCN), should be stopped. Government only recently inaugurated the Governing Council of MDCN and other health professional councils that were dissolved by this government over three years ago.

On rivalry in the health sector

It is perhaps one of the evils that have afflicted Nigeria’s public health sector for over a decade now. I prefer to call it inter-professional beauty contest; what some might call inter-professional rivalry amongst the various health professionals. This unfortunate evil debacle, which is virtually non-existent in the private health sector, is traceable to a beauty contest with medical doctors/physicians for turf of operation, professional power and status, relevance, economic rewards, authority and leadership. This intriguing phenomenon, which could have been easily nipped in the bud through the implementation of basic de-politicized administrative mechanisms, was allowed to blossom until then-President Goodluck Ebele Jonathan when he declared an emergency with the setting up of the Alhaji Yayale-Ahmed Committee of Experts on Inter-professional Harmony in the Public Health Sector.

While it is sad that after spending huge resources to travel round African, European and American countries in search of solutions to the inter-professional beauty contest, the submitted report of the Alh. Yayale Ahmed-led 11-member Committee of Experts is currently gathering dust on the shelves in Aso Rock Villa, due to government’s failure to implement the committee’s recommendations, particularly as it concerns job roles and job description.   I am appealing to President Muhammadu Buhari to dust up the report of the Yayale Ahmed committee of experts, and implement the recommendations aimed at resolving inter-professional rivalry in Nigeria’s public health sector.

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