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Fix our poor health system, stakeholders task new Minister

By Chioma Obinna & Gabriel Olawale

AS the new Minister of Health gets set to take over affairs of the apex health ministry, Nigerians are anxiously waiting for a vibrant health system that will address the many challenges hindering access to qualitative and affordable healthcare.

It would be recalled that the last dispensation was marred with allegations and counter-allegations over the only olive branch – the National Health Insurance Scheme –  that would have guaranteed the much-awaited Universal Health Coverage, UHC, for all Nigerians.

Stakeholders in the sector are tasking the incoming administration to bring the UHC dream to fruition. Good Health Weekly spoke to major players in the sector. Excerpts:

L-R: Dr Casmir Ifeanyi, National Publicity Secretary, Association of Medical Laboratory Scientists of Nigeria, AMLSN; Dr Francis Faduyile, President Nigeria Medical Association, NMA and Dr Jimmy Arigbabuwo, National President, Health Care Providers Association of Nigeria, HCPAN

New Minister should synergise with state Commissioners of Health on PHC —Dr Francis Faduyile, President, NMA

The Primary Healthcare Centres, PHCs, and secondary healthcare facilities are under the state government control which is supervised by the commissioner for health, so the Minister should be able to work with Commissioners for Health in the States to strengthen service delivery. It is when that is done we can believe that healthcare management and services will be available to majority of people in the country.

The Ministry should look at the operation of the PHCs because that is where we have information that will determine intervention and implementation.

With their collaboration, they can put a lot of pressure on the Governor and the National Council of Health to mobilise resources at the primary and secondary levels of healthcare.

Its common knowledge that out-of-pocket expenditure for healthcare cannot give proper and quality service to our people; the Minister should pursue the agenda of increased enrollment into National Health Insurance Scheme and make sure most state health schemes are established as well as community health insurance schemes.

It’s through these we can have pool of funds that will help patients who go to hospital for qualitative care without any obstacles.

From this pool of funds, we can use part of it to provide drugs and equipment that will serve the populace. If possible, the Minister should make the Scheme mandatory for all Nigerians so that everybody can enroll and enjoy the benefits of the improvement in service delivery.

The Minister should also prevail on his counterparts at the Federal Executive Council, especially Mr President so that they can have appropriate budgeting for health.

It will be recalled that all African Heads of States agreed in 2001 that a minimum of 15 percent be budgeted for health, because they realised that health is wealth. Unfortunately, Nigeria has been largely under 5 percent, we expect the Minister to push for increase in budgetary allocation for health.

It’s through this, that we can take care of hospital environment, purchase modern equipment and make sure that all the consumables and necessary ingredients for proper health services are in place.

The Minister should ensure  harmony among health workers which is a major cause of distraction that contributes to poor healthcare outcome we have seen.

Our Federal labs not suitable for accreditation —Dr. Casmir Ifeanyi, National Publicity Secretary, AMLSN

The Minister should first put his house in order and carry out some housekeeping activities which must be all-inclusive. Before now, what we had at the Federal Ministry of  Health was  “Ministry of Doctors” where all other healthcare professions are not catered for and integrated.

The Minister must pursue an agenda that reflects the core clinical services. Basically, there are four core areas in healthcare service delivery. It’s important to note that whoever is coming as Minister is inheriting a chaotic health system. Nigeria’s healthcare system is chequered. If you look at the global rating, we are 188th out of 192 countries and also 52nd out of 54 countries in Africa. This rating is based on health indices. So it has been an all-time low for the Nigeria healthcare sector.

READ ALSO: FG urged to increase coverage of kidney treatment in NHIS

Why is it low? It’s simply because we have a very weak system. And why is it so? The bedrock of every National health system is a strengthened medical laboratory service structure. But as we speak today, medical laboratory service in Nigeria is very weak because most of the recommendations in the National Medical Laboratory Science Policy 2007 have not been implemented.

If implemented, there will be a coordinating centre as in other countries where there is direction and leadership.

The Minister should see to the establishment of the Department of Medical Laboratory Services in the Federal Ministry of Health to help coordinate laboratory activities across the country.

The last time any Nigerian laboratory was awarded accreditation was courtesy of implementing partners that supported the country with programmes in HIV, malaria, and tuberculosis.

Some of these implementing partners are pulling out, and when they do, our laboratory services will be worse for it. So the new Minister should provide support for strengthening laboratories across the country.

Presently, we have about 52 Federal Teaching Hospitals and 22 Federal Medical Centres in the country. None of these facilities have any form of accreditation and the global rating of laboratories is based on the kind of rating they have.

Many of these laboratories are not even available for periodic regulation, inspection and advocacy visit by the Medical Laboratory Council of Nigeria which is the flagship agency for regulation of medical laboratories in Nigeria for facilities and personnel.

As we speak, most Tertiary health institutions in the country are yet to mainstream quality management system. So long as we do not have quality management in our hospitals, they will not in any way be prepared for accreditation and the quality of services there will remain low.

The new Health Minister should give full support for full-scale implementation of quality management system, and compliance with ISO standard 18579 which is global standard for medical laboratory.

Nigeria is the 4th leading country in the importation of laboratory equipment and consumables, followed closely by South Africa, which simply means that more than 90 percent of what we utilise to provide medical laboratory testing is all imported.

The Minister should drive a process that will encourage local content, local production of these materials. We have a lot of human resources for the production some of these kits and reagents. We need to understand that importation has negative impact on our foreign exchange and also turn our country into a dumping ground.

It’s disheartening that various substandard products find their way into Nigeria, because the testing laboratory at Yaba, Lagos, which former Minister of Health, Prof. Onyebuchi, facilitated, is yet to be put into full function.

That facility supposed to certify medical laboratory reagents and kits in the country. The new Minister has to put life into it. When that happens, we will be able to address fake reagents, If that does not happen, we cannot guarantee the quality of tests from laboratories in the country.

The Medical laboratory scientists of Nigeria has obtained over 16 national industrial judgments stipulating that medical laboratory is different from medicine and directing management of various Tertiary health institutions and Federal Medical Centres, that a full department of medical laboratory service be established, but it has not been implemented.

We expect 25%  reduction of our poor health indices within 2 years –  Dr. Jimmy Arigbabuwo, HCPAN,

 The Healthcare Providers Association of Nigeria, HCPAN, expects a Minister of Health that will serve as a rallying point for all stakeholders in the Federal Ministry of Health, and in Nigeria as a whole.  We need fusion.  We desire unity. We cherish fair play and coalition of our various groups and appendages.

We need a good and sound manager of human and material resources with evidence of ability to give listening ears to our plight as Nigerians.

Beyond credentials of professional competencies, we need as a matter of necessity without prejudice, a highly fortified character in political engineering and navigation.

This is a very key requirement.  This is a non-negotiable credential to fuse the various diverse groups in the health sector to greatly minimise if not totally eliminate our age-long inter- and intra-professional rivalries, discord,  acrimony,  and crises that have always thrown the Nigerian health sector into unending and perennial discord.

This has always been described in some quarters as “irreconcilable differences” and “cold war.” What this has brought to the Health Sector is retrogression, stagnation, motion without movement etc. It has eroded patient- centered practices, especially openly demonstrated in Public Health Institutions.

We expect a charismatic leader, someone who has the credentials of relative global acceptability by the various critical stakeholders in the health sector across the six geopolitical regions of the country.

We need a highly detribalised Nigerian who is tested and proven in political galvanization of people and groups.  We need a character that is not controversial.

We expect a reduction of at least 25 percent in our very poor indices of Health care within first two years in office. Zero tolerance for creating discord in the sector so that we do not keep on dissipating energy in managing crisis.

It is not a requirement for expertise in brain surgery or antecedents of managing retinal detachment.  People are on ground to do all of these.  Directors are on ground in the Ministry. What we need is coalitionsof human and material resources with ability to win the heart of Mr President for political will.

We expect a shrewd manager who will not embrace wastage as usual. But who will also not sponsor hypocrisy. We expect someone even who has learned over the years to know what the market women and the poor lots require. We expect a good driver of managed care and health Insurance

We need the Minister to push for better budgetary allocation to health. The most educated President in the world is from Africa. We expect a Minister who will encourage Public Private Partnership, PPP, so that we can carry all stakeholders along nationwide.

We need a total healthcare person— Pharm Gbenga Olubowale, Former Chairman, PSN Lagos

Our message to the new Minister and Mr President. We hope he will appoint a Minister for Health and not a Minister for medical doctors, because that is why we have not made progress to date.

We need someone who is nationalistic and is seen as a total healthcare person.  It doesnt matter who is there as long as it is in the interest of all. Healthcare is teamwork. This has brought disharmony and we want to move forward.

Our health indices is abysmally poor, we need someone with proper knowledge that can deploy this knowledge to the advantage of all Nigerians not just to the select few.

So the new Minister should improve the nation’s health indicators through better collaboration among the healthcare team that will guarantee better outcomes to all Nigerians.

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