Says Only international benchmarks will stop brain drain
as 220 PHCs need major refurbishment
By Chioma Obinna
RECENTLY, the Lagos State Commissioner for Health, Professor. Akin Abayomi unveiled his plans to move the State health sector forward. During the chat, Abayomi who spoke on his two-prong approach to address the health needs of Lagosians said Nigeria is losing huge resources to medical tourism, hence the need to recreate Lagos as a centre of medical excellence. He disclosed that currently, 66 percent of Lagosians cannot afford healthcare and are a step away from extreme poverty. Excerpts:
Plans and programmes
For our strategies, we have two major issues in Lagos. First is the health of underprivileged Lagosians which according to the Lagos State Bureau of statistics suggest that about 66 per cent of Lagosians are under that threshold, in other words, we feel that they are one sickness away from extreme poverty.
If something happens to them or their family, they don’t have enough reserve, they don’t have enough capacity to respond and they may be driven from poverty to extreme poverty.
The government is very focused on defining a way of reaching this population with some social safety nets; of course, top of that list will be health. The way to do that is to ensure that we have a primary health care system because that is the bottom of the Pyramid where most people will go first when they are ill.
Ideally, we should have one Primary Health Centre, PHC, per ward and one flagship centre per local government in the 57 LGAs.
We are losing a lot of resources to medical tourism and it is an outflow of the country’s resources and that is one of the things we want to reverse.
We are coming with a two-prong approach. We are going for the base which is the primary care; we are also trying to make sure that we recreate Lagos as a centre of medical excellence that can be the drainage for the rest of Nigeria and for the rest of West Africa. So we will become the new India or new South Africa or Dubai.
Shortage of doctors
Nigeria is suffering a huge amount of brain drain. We are training doctors, nurses and health care professionals but greener pastures are attracting them.
First of all they migrate down to Lagos, there is an influx of doctors and nurses into Lagos but that is temporarily, Lagos is just a stepping stone for them to migrate out of the country.
It is very expensive to train health care professionals; we spend millions of Naira in our various tertiary institutions of health care. Training these different cadres of professionals only for them to be pouched free -of- charge by other communities of other countries that means we’ve got to reverse that because we are suffering from a very high ratio of health care professionals to population.
For example, if you look at any medical speciality, generally speaking, you would expect one specialist for 10,000 people within community whereas in Nigeria and the rest of Africa we are dealing with one specialist for millions of people.
To reverse that, we need to provide means for them to practice their profession in the country and for them to be able to stretch themselves and attain the international benchmark status of expertise. There is no point saying we have surgeons in Nigeria when they don’t have access to theatre etc.
Why Lagos Health Insurance Scheme is yet to take off
The challenges of health insurance is not unique to Lagos; the whole of Nigeria is struggling with the concept of universal health coverage. Generally speaking, the insurance scheme as I said earlier always rides on the platform of primary health care. And primary health care is at the moment disorganized and not running according to the policies and principles.
The issue that is facing most of the states is the issue around catering for the poor. There are two hard issues we face, compulsion and resources. For an insurance scheme to be functional it needs to have a mandatory compulsion. We need to make it mandatory for all persons to be part of this scheme. The other aspect is resources, if more than 60 per cent of your populations are not able to afford the premium, how are you going to enrol them? If 33 percent of Lagosians are the only people that can afford insurance then who is going to pay for the 66 percent? That is a major issue. What it means essentially is that the three tiers of government have to carry 66 percent of Lagosians. When we did the mathematics that figure is close to N100 billion. It requires an out of the box solution.
I am not surprised that the scheme is struggling to take off. It is struggling to take off for two reasons, one there is lack of confidence in the sense that people are being weary to go to primary healthcare facilities because a lot of them are not in a desirable state. There is a shortage of manpower in the PHCS. If you take your family for treatment and getting there and there is no doctor in the facility, where is the confidence?
Out of the 330 primary health care facilities, only 57 have doctors. Most people will go to such a facility and say there is no doctor around I am not coming back here because when I go to a hospital or a centre I expect a doctor to be there not that we are undermining the role of other professionals. If the majority of your primary health care facilities does not have doctors then there is going to be a confidence issue.
So I cannot force you even though it is mandatory. People will rather go to facilities that there are personnel. We are working very hard now to define a model for our primary health care facilities. We have to address supply sides like infrastructure, human resources for health, electricity, water and supply of consumables etc.
Right now, 220 primary health care facilities need major refurbishment. On the demand side, I have just told you that only 33 percent can access the supplies. Then, when you do the mathematics, 66 percent of people living in Lagos cannot afford healthcare which is why a lot of people are talking about having a private sector come in to play a role. If you look at the premium in Lagos state which is N40, 000 for a family of six, if we use the equity funds which is one per cent of the internally generated fund for underprivileged. If we use the whole of equity fund which is about N6 billion, it is only going to cater for about 5 per cent of that 66 per cent, leaving about 55 per cent un-cared for. We actually need N50 to N60 billion to cater for the less privileged in Lagos, so that they can enter the scheme. We also need huge money to revamp the infrastructure. This is why we are talking about Public-Private partnership, PPP. There are some out of box ideas and solutions that we are thinking about to actually get this train moving, it is not moving because we have a number of obstacles on our way and it’s about economics because the political will is there.
Bed space problem
We have a serious shortage of beds for 24 million people; we need a certain number of bed space capacities, in public and private sector. I think that it is impossible to calculate how many beds we have precisely. Most of the bed spaces provided are by the private sector. One of the strategies we are going to apply to address the bed space problem is to change the way in which we construct medical facilities, from primary to secondary and tertiary.
So the first thing we are going to do is to develop a blueprint for primary and secondary facilities. The structures must be designed according to the disciplines that you are dealing with. We also need to inculcate our climate. Our climate is getting hotter so what are we going to do? Are we going to be constantly dependent on diesel and generators to cool down our patients? Why can’t we cool them down naturally? So we are setting a standard and we’ve already started engaging with people who know how to design. We are going to set a certain blueprint in place.
As far as the government is concerned we want to have at least one General hospital in one local government across the 57 LGAs/LCDAs. At the moment, we have 28 general hospitals, so we’ve got a deficit.
If the primary health care structures were doing what they are supposed to be doing, there wouldn’t be a need for so many beds. Why should you go from your house to a General hospital for malaria? It should be treated at primary health care. Typhoid, malaria, pregnancy, delivery, simple cesarean section, minor surgery operations, dentistry anything that can be managed at the primary structure should be managed there. Then the General Hospitals are there to do their discipline. But the primary health care is the foundation, and if we get the primary health care right then it takes the pressure off everything. So because the secondary are under pressure, the secondary is putting pressure on the tertiary. We need to bring everything back to the primary health care platform. We can build more General Hospitals, even though it is expensive but the government is committed.