August 4, 2019

More investments, implementation of policies area needed — Enabulele, ex-NMA President

Africa bears 25 per cent of global disease burden, says CMA President

*Dr. Osahon Enabulele, NMA President

By Chioma Obinna

A former President of Nigerian Medical Association, NMA, Osahon Enabulele and the only African on the Executive Committee of the World Medical Association, in this interview, demand an improved political commitment to the health of all Nigerians. He also speaks on other issues in the sector and on NHIS.


*Dr. Osahon Enabulele, NMA President

Suggest way the health sector can fare better in the next four years?

The tenure of the immediate past Minister of Health was a mixed bag. Just as there were some positive developments that took place, there were other areas that were left unattended to, such that on an average scale, one may be tempted to say the health sector could have fared better than it did under the former Minister of Health. For instance, the areas were gains were recorded include the formal establishment of the National Centre for Disease Control, NCDC, and increased emphasis on infectious disease control and management. Another positive development was the increased focus on Primary Health Care, PHC, and the much-expected implementation of the Basic Healthcare Provision Fund, which is a key provision of the National Health Act targeted at expanding healthcare services at the primary and secondary levels of care.

Another positive development was the establishment of a state-of-the-art National Cancer Treatment Centre in Lagos.

However, there were lots of other areas where the country failed. For instance, there was no serious advancement in Universal Health Coverage, UHC, with Nigeria’s UHC coverage level remaining one of the worst in the entire world.

Also, the challenge of funding of healthcare delivery, human resource for health, and brain drain syndrome remained largely unaddressed. Indeed, the brain drain phenomenon took a further dive over the last couple of years. This was neither helped by the denial of this stark reality by some officers of government nor the ridiculous advice by some government functionaries that medical practitioners should rather take to other professions and vocations.

There was also unsatisfactory enforcement of quality standards, with quackery in the health sector assuming monstrous proportions in the last couple of years. Importantly, not much was done to give expression to section 46 of the National Health Act, a situation that largely made it impossible to stem the tide of medical tourism. These, among other areas, received little or no attention during the last dispensation.

How can the challenges you highlighted be addressed?

There are several areas that need to be addressed. We are expecting an improved political commitment to the health of all Nigerians, through greater investments and implementation of initiatives, programmes and projects that will promote the health of Nigerians. Importantly, there is a need for greater commitment to the social determinants of health by the government at all levels.

The components of the national health system, including physician-led primary health care, need to be strengthened.

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Health Insurance Scheme

The government should commit itself to the transparent operationalisation of the provisions of the National Health Act, particularly as it concerns access to healthcare by Nigerians, transparent and sincere implementation of the BHC, development of a human resource for health, provision of the certificate of standards, elimination of quackery and enforcement of quality standards.

Again, the incoming minister should focus on the National Health Insurance Scheme, NHIS. The scheme needs to be urgently reformed to enable it to deliver on its core mandate. In the same vein, the ongoing effort to review the NHIS Act needs to be brought to completion to make for mandatory subscription to the scheme, and thus expand the possibility of Nigeria achieving universal health coverage.

Brain drain

There is an urgent need to address brain drain syndrome in the health sector through the development of an efficient, focused, holistic and strategic human resource for the health development plan. They should strengthen the Residency Training Programme and ensure enforcement of the provisions of the Medical Residency Training Act.

There is a need for strict regulation of the health sector and the strengthening of the health regulatory agencies and bodies to enforce quality standards to eliminate quackery.

Importantly, the extent drug prescription and distribution policies and laws need to be strictly enforced.

What strategies are you proposing?

The government should upscale its investment in the health sector, through proper budgeting for health and adequate releases as and when due. Indeed, they must work hard to give expression to the 2001 Abuja Declaration of African Heads of Government to commit a minimum of 15 per cent of the national budget to the health sector.

The Universal Health Coverage must be taken more seriously with better monitoring, evaluation and oversight by the National Health Insurance Scheme (NHIS) management for better delivery on their mandate. Indeed, the NHIS Management must be given a realistic target on UHC coverage levels, with efforts intensified to make it mandatory for Nigerians to subscribe to the NHIS scheme.

Again, while the management of some health institutions and hospitals, including Federal Tertiary/Teaching Hospitals have striven hard to improve their infrastructure, processes and practices, what is undeniable is the fact that most health institutions, health facilities and hospitals in Nigeria, are in need of rejuvenation, rehabilitation and upgrade.

There, is, therefore, a great need for health facilities and hospitals across the country to be upgraded, with merit enthroned in the determination of the leadership of these hospitals and not the common resort to some primordial considerations.

In this regard, government at all levels should be encouraged to appropriately invest in health institutions in their jurisdictions with a commitment to sustained maintenance of those facilities. There is also a need to ensure judicious utilisation of funds invested in these health institutions by appointed managers.

For the federal health institutions, it will be rewarding if the government through the new minister reviews the current practice of two-term tenures for Chief Medical Directors/Medical Directors. It is time for the government to introduce a five-year single term currently being practised in universities. This will help to address some of the nepotistic and bitter struggles for the leadership positions of these institutions. That is in addition to creating an opportunity for fresh managerial ideas to be brought on board. I expect the Minister or President Buhari to introduce this paradigm shift in the tenure of Chief Executives of Federal Tertiary and Teaching Hospitals.

Additionally, the selection process should be made more transparent, inclusive and participatory.

Medical Tourism

The minister should ensure that government functionaries show good example and leadership in efforts to reduce outward medical tourism. In this regard, they should commit themselves to NHIS  and the utilisation of health facilities that abound in Nigeria, as well as strict adherence to Section 46 of the National Health Act.

Though it may be difficult to eliminate industrial actions in the health sector, not only because of Nigeria’s level of socio-economic development but because of the poor attitude of most governments and managers of health institutions to the welfare and interests of health workers. The minister should ensure that the government puts in place a more proactive and responsive conflict resolution mechanism to address potential areas of conflict and demands of health workers at the budding stage before it transforms into a conflagration. Additionally, the government and its functionaries should be sincere in its engagement with workers and fulfil all collective bargaining agreements. A situation where some state governments in Nigeria still owe medical doctors and other health workers months of unpaid salaries is shameful, condemnable. Such a situation is a catalyst for sustained industrial actions.

While the government drives the implementation of its bourgeois policy of ‘No Work No Pay,’ it must also accept the policy of ‘No Pay No Work’.

Cancer management and treatment

Obtaining proper treatment for cancer condition has been a real challenge for patients in Nigeria, and one of the reasons for patients are opting for foreign medical care. I still have vivid recollections of the traumatic experiences of my father went through in the course of seeking treatment for his medical condition. It was horrible. Therefore, the reality of the cancer epidemic and the non-availability of adequate numbers of functional cancer treatment centres demand the quick resolution of government at all levels.

While it is commendable that a new cancer treatment centre was established in Lagos, there a need for the minister to do much more to satisfactorily address the huge deficit in the number of functional cancer treatment centres in Nigeria. The government can upscale this to at least one per region, and gradually to many more facilities in Nigeria. They must not only provide enough to cater for the teeming population of cancer patients, but they must also build into their procurement policies effective, efficient and sustainable maintenance policy frameworks to prevent the usual experience of frequent breakdown of these facilities in institutions where they may be available.

State governments and other investors should support efforts at expanding the number of cancer treatment centres in Nigeria and ensure the NHIS functions optimally.